Abstract
BackgroundMedication-related osteonecrosis of the jaw (MRONJ) is characterized by the development of bone necrosis in the jaws of patients receiving antiresorptive and/or antiangiogenic medications. No scientific reports have been published yet on bevacizumab-related osteonecrosis of the jaw (BeRONJ) when associated with dental implant placement and adjuvant ozone therapy.Case presentationA 54-year-old female patient with a history of metastatic breast cancer and bevacizumab use presented with a dental infection. Dental extraction followed immediately by dental implant placement was planned after suspension of the bevacizumab treatment. The patient presented with pain, drainage of purulent secretion, and bone exposure 5 weeks post-surgery. Complete healing was achieved at postoperative 7 months.ConclusionsThe combination of adjuvant ozone therapy and surgical debridement was effective for the treatment of MRONJ; however, the risk of MRONJ may persist after the suspension of bevacizumab for 28 days.
Highlights
Medication-related osteonecrosis of the jaw (MRONJ) is characterized by the development of bone necrosis in the jaws of patients receiving antiresorptive and/or antiangiogenic medications
Antiangiogenic agents may increase the risk of medication-related osteonecrosis of the jaw (MRONJ), either as monotherapy or in combination with bisphosphonates [3]
Many clinicians are aware of the associated risk of MRONJ around dental implants in patients exposed to bisphosphonates; a consensus regarding the use of bevacizumab is still lacking in the literature
Summary
The treatment of malignancies often involves the use of targeted therapies to control the growth and survival of malignant cells by interfering with specific molecular agents involved in carcinogenesis [1]. Antiangiogenic agents may increase the risk of medication-related osteonecrosis of the jaw (MRONJ), either as monotherapy or in combination with bisphosphonates [3]. Many clinicians are aware of the associated risk of MRONJ around dental implants in patients exposed to bisphosphonates; a consensus regarding the use of bevacizumab is still lacking in the literature. The purpose of this manuscript was to report a rare case of osteonecrosis of the jaw related to the use of bevacizumab in a patient who received dental implants. At 54 days after the last dose of bevacizumab, and on completion of 3 months of docetaxel and carboplatin infusions, debridement and dental extractions of teeth 16, 25, 27, 44, and 47 were performed in combination with immediate insertion of Straumann® Bone Level Tapered-BLT® implants (SLActive) in regions of teeth 44, 45, 46, and 47 (Fig. 3). No signs of bone lysis or sequestration were seen on the panoramic radiograph (Fig. 7)
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