Bisphosphonate-Induced Osteonecrosis in Jaw: Case Report
DOI:
https://doi.org/10.21270/archi.v11i1.5523Keywords:
Jaw, Diphosphonates, MandibleAbstract
The use of bisphosphonate is associated with bone necrosis of the jaws, a condition secondary to the drug's mechanisms of action, resulting in anti-osteoclastic and anti-angiogenic activities, altering bone metabolism, inhibiting resorption and decreasing tissue renewal. This article aims to report a case of bisphosphonate-induced osteonecrosis in the mandibular retromolar area of a 76 years old female patient, user a removable prosthesis who has been using Alendronate sodium for over 20 years for the treatment of osteoporosis. The intraoral examination revealed a sessile nodular lesion, painless, soft consistency, irregular shape and surface, erythematous color in the central area, measuring 1.5 x 0.6 x 0.5 cm, located in the lower left alveolar ridge, with four months of evolution. The tomography showed an area of cup resorption. An excisional biopsy of the superficial lesion was performed, showing a clinical appearance of parulide and the material was submitted to histopathological examination, which revealed epithelium with hyperplastic and atrophic areas, with foci of disorganization due to polymorphonuclear exocytosis and, in the connective tissue, fibrinopurulent exudate and necrosis coagulative with kyorrhex, in addition to microbial agglomerates. Based on the anamnesis, imaging and histopathological examinations, it was possible to associate the clinical diagnosis of the lesion with the underlying osteonecrosis, induced by the use of bisphosphonate. The treatment instituted was surgical removal of the superficial lesion, prosthetic wear for the relief of local trauma and local low-intensity red and infrared 3 J/cm² laser therapy. The patient had no recurrence of the lesion after 1 year and 11 months of treatment.
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