Surgical Management of Stage-3 Osteonecrosis of the Jaw in a Patient with Rheumatoid Arthritis: A Case Report

Abstract

Background: Medication-related osteonecrosis of the jaw (MRONJ) is an adverse reaction, characterized by the progressive destruction and necrosis of the jaw bone of patients treated with antiresorptive and antiangiogenic drugs, increasingly common in recent years. The propose of this study is to report surgical procedures in the treatment of third stage MRONJ. Case Description: A 68 years-old woman presented to the Oral and Maxillo-facial department at the University of Rome Tor Vergata in march 2021, complaining of pain and infection signs in the left side of the lower jow. The Patient refers to be affected by rheumatoid arthritis treated for 18 months with Denosumab fl 60 mg every 6 months subcutaneously. In July 2020 undergoes tooth extraction in the third quadrant with no healing and persistence of pain refractory to medical therapy. After diagnosis of stage 3 MRONJ was performed a sequestrectomy, osteoplasty and suture by first intention. Clinical signs of pain, inflammation and oral infection have completely healed after the surgery intervention. Conclusion: The primary intent of surgical therapy of ONJ should not be palliative, but curative. Curative intent is the complete removal of the tissue macroscopically involved by the disease and the achievement of a healthy tissue that allows stable healing over time. Surgery will certainly be less invasive and will have a greater margin of success if the disease to be treated has a limited extent.