Case Conference
Medically Compromised Patients
Oncology
Oral Medicine
Oral Surgery
Supporting Your Practice
What’s your diagnosis of this case?
This case is presented by:
- Dr. Eric T. Stoopler, D.M.D., FDS RCSEd, FDS RCSEng
- Dr. Juan M. Bugueno, D.D.S.
- Dr. Kevin Sweeney, D.D.S.
- Dr. David C. Stanton, D.M.D., M.D., F.A.C.S
Click here to view the BRONJ Case Diagnosis and Treatment
Case Presentation
- A 64-year-old Caucasian female presented for evaluation of symptomatic exposed bone of a two-year duration post extraction of maxillary teeth with immediate placement of four dental implants.
- Medical history:
- Is at stage IV breast adenocarcinoma treated with surgery and trastuzumab.
- Received intravenous zoledronic acid (ZA) 4 mg monthly for approximately two years for metastatic bone disease.
- Underwent dental surgery approximately four months after initiation of ZA therapy.
- Onset of pain, suppuration, malodor and bony sequestration in the maxilla occurred after the dental procedure.
- Was treated with multiple courses of antibiotics and chlorhexidine rinses without improvement of symptoms or resolution of her condition.
Clinical Evaluation
- Significant exposure of necrotic maxillary alveolar bone with four dental implant abutments remaining, accompanied by mucosal erythema and oral malodour (Fig1).
- Panoramic imaging and cone beam computed tomography (CBCT) revealed extensive radiographic changes to the maxillary alveolus and maxillary sinuses, as well as sequestration of necrotic bone in the anterior maxilla (Figs 2 and 3).
What is your diagnosis of this case?
(You can remain anonymous, if you wish)
Do you have any questions about this case?
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I would diagnose this as Bisohosphonate induced osteonecrosis
Osteonecrosis of the maxilla after IV biphosphonates. Absolute contre-indication of implants.
We are in use to treat these patients (ONJ or Osteoradionecrosis) with schock-wave therapy and A-PRF. With high percentage of success.
Osteonecrosis of the maxilla after implantation, patient is under IV biphosphonates: absolute contra-indication of implants !
Patient could be treated with A-PRF and shock waves. After necrosis removal with piezo
What’s involved in A-PRF treatment. How is it applied?
Here is a link to Dr. Choukroun’s site all questions you have can be answered there:
http://www.processforprf.com/en/accueil.html
Below is a link to an EXCITING video, exciting to me anyways, from Blue Sky Bio showing the latest in A-PRF technology and its application:
https://www.youtube.com/watch?v=0ja0QJsHgfs
You can also go to my Facebook site. Dr. Leachman Inc for pics of mine
biphosphonic osteonecrosis from intravenus za without CTx telopeptidase exam