Osteonecrosis of the jaws (ONJ) is a painful non-specific necrotic bone lesion characterized by a slow progression and incapability of spontaneous healing with incapability to heal spontaneously. The most commonly described etiologic factor is radiotherapy of the head and neck region, osteoradionecrosis.
In recent years a progressive increase of osteonecrosis lesions in patients undergoing chronic therapy with intravenous BPs has been thoroughly manifested. BP-related osteonecrosis of the jaws (BRONJ) has been clearly defined as a clinical scenario characterized by 3 diagnostic features: 1) current or previous treatment with a BP; 2) the presence, for longer than 8 weeks, of exposed bone in the maxillofacial region; and 3) no history of radiation therapy to the jaws.
We present a case report of osteonecrosis unrelated to bisphosphonate therapy linked to corticosteroids therapy.
Clinical data
A 50-year-old male patient was referred to our clinic for a post-extractive non-healing lesion characterized by exposed bone. The subject underwent a single extraction of mandibular left second premolar, 3 months before attending our clinic.
Systemically the subject was positive for hypertension, hypothyroidism and psoriatic arthropathy. The patient denied any history of smoking. The patient reported also a previous therapy with prednisone 7,5 mg/day for two years finishing two months before extraction. He denied any usage of BPs or radiotherapy.
Clinically, the patient exhibited an area of exposing bone involving the premolar region of the left mandible. A panoramic radiograph taken at the time of initial consultation showed an area of sclerosis, localized in the left mandible, involving the mental foramen. Treatment consisted of surgical debridement of the mandible, under local anaesthesia. After 30 days the area showed almost a complete recovery of the mucosa. The patient showed no symptoms or complain.
References
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