PREVENTION PROTOCOL OF OSTEORADIONECROSIS AFTER RADIOTHERAPY OF THE HEAD AND NECK: BIMODAL TREATMENT

Abstract

Although osteoradionecrosis is considered a late sequela of radiotherapy in the head and neck region, it is the most severe. Dental examination should be performed in advance to eliminate all odontogenic foci, decreasing the chance of developing osteoradionecrosis. A white female patient, 50 years of age, was treated with adjuvant radiotherapy for undetected primary tumor with cervical metastasis. After 6 months, extensive caries in the lower left second molar were noticed, which were removed and a glass ionomer restoration and indirect pulp-capping with calcium hydroxide were performed. Dental pulp vitality test along with periapical radiography to follow the treatment's progress were also done. After 10 months, a periapical radiolucent lesion was observed. Pulp vitality testing turned out negative. As a sequela of radiotherapy, the patient presented with severe trismus, making endodontic treatment impossible. Exodontic procedure with antibiotic and laser therapy for the prevention of osteoradionecrosis was recommended, and the patient remains without any complications.