Abstract
Prevention of bisphosphonate related osteonecrosis of the jaws (BRONJ) represents an important challenge for clinicians. Dent alveolar surgery is usually performed to reduce the risk local and systemic complications, In fact, removing the tooth that is the source of the infectious outbreak, brings to the removal of the infected tissue and determines a correct healing of the disease. However, in patients are undergoing bisphosphonate this procedure expose patients to an increased risk of BRONJ. However, in patients who are in treatment with systemic bisphosphonates, this procedure exposes them to an increased risk of BRONJ. When possible, avoid the surgical interventions in favors of endodontic treatment could be an important clinical options in reducing the possibility of BRONJ occurrence. In this paper, we report a case of endodontic re-treatment in a tooth with a floor perforation in a patient was assuming oral alendronate. Limits and advantages of performing endodontic retreatment for the prevention of BRONJ development have still not well elucidated. Due to the very low power of this study, no conclusions should be made to perform an endodontic retreatment instead of performing a tooth extraction. However, this case report support the execution of future studies related to the calculation of BRONJ incidence after surgical extraction vs endodontic retreatment.
Highlights
The osteonecrosis of the jaws associated with bisphosphonate therapy (BRONJ) is a drug-related adverse event that may reduce the patient related quality of life [1]
We report a case of endodontic re-treatment in a tooth with a floor perforation in a patient was assuming oral alendronate
Cases of bisphosphonate related osteonecrosis of the jaws (BRONJ) following endodontic treatment are described in literature, in the majority of cases is associated with incorrect treatments
Summary
The osteonecrosis of the jaws associated with bisphosphonate therapy (BRONJ) is a drug-related adverse event that may reduce the patient related quality of life [1]. Due to the persistence of infections of the jaws, avoid the surgical treatment, in some cases, increase the possibility of spontaneous BRONJ and, simultaneously, exposes the patient to the onset of infectious complications [9] In such cases, the endodontic treatment of very compromised teeth, if predictable, is recommended in patients treated with bisphosphonates to avoid teeth extractions and get the healing of the intraosseous infections [10]. At 2 year follow-up the absence of clinical disorders (absence of pain and inflammation), and healing of the furcation lesion was revealed both with periodontal surgery and X-rays (Figures 3 and 4). Both mesial and distal channels were not appropriately shaped and sealed. A composite restoration was performed after two weeks isolating the tooth with rubber dam, after that the absence of clinical disorders was noticed (Figure 2)
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