IADR Abstract Archives
Accelerated Extensive Osteonecrosis of the Mandibular Body Under Denosumab Treatment
Objectives: Medication-related osteonecrosis of the jaws (MRONJ) is a rare complication induced by antiresorptive agents such as bisphosphonates and Denosumab, as well as anti-angiogenics. Invasive dental procedures or chronic apical infections are usually incriminated for the risk of MRONJ.
Methods: A 73-year-old woman consulted for chronic tooth ache. The patient’s history includes arterial hypertension, equilibrated diabetes, breast cancer with bone metastases treated with monthly Denosumab (for 2 years) associated with anti-angiogenics. She described the spontaneous loss of three mandibular incisors and belated healing.
The first oral exam showed a slightly inflamed but healed mucosa, absence of fistulization and loose, painful mandibular teeth. The intraoral and extraoral palpations of the jaw were painful. The panoramic dental X-ray seemed normal with some bone densification. It was suspected an MRONJ, with interruption of Denosumab treatment within the month.
After two months, oral mucosa thickened and mucosal fistulization appeared, followed by discomfort under the chin. Radiographic exams showed a bone densification in the chin area of the jaw with periosteal apposition zones. The MRONJ was confirmed and a switch to bisphosphonates was made. A close clinical surveillance was installed.
Results: The jaw bone complete sequestration happened after one year, with the mandibular body exposed in the mouth, a continuous extra-oral fistulized suppuration treated with antibiotics and the spontaneous loss of all the remaining teeth. The loose jaw bone was extracted under general anaesthesia. Despite the large bone loss, with the lysis of the inferior alveolar canal, especially in the parasymphyseal region, the nerve was not touched, having itself migrated under the dead bone.
Conclusions: We are the first to illustrate such an accelerated evolution of osteonecrosis of the mandibular body under Denosumab, particularly when no dental invasive treatment occurred. This case raises many new questions concerning the MRONJ process and etiologies.
Methods: A 73-year-old woman consulted for chronic tooth ache. The patient’s history includes arterial hypertension, equilibrated diabetes, breast cancer with bone metastases treated with monthly Denosumab (for 2 years) associated with anti-angiogenics. She described the spontaneous loss of three mandibular incisors and belated healing.
The first oral exam showed a slightly inflamed but healed mucosa, absence of fistulization and loose, painful mandibular teeth. The intraoral and extraoral palpations of the jaw were painful. The panoramic dental X-ray seemed normal with some bone densification. It was suspected an MRONJ, with interruption of Denosumab treatment within the month.
After two months, oral mucosa thickened and mucosal fistulization appeared, followed by discomfort under the chin. Radiographic exams showed a bone densification in the chin area of the jaw with periosteal apposition zones. The MRONJ was confirmed and a switch to bisphosphonates was made. A close clinical surveillance was installed.
Results: The jaw bone complete sequestration happened after one year, with the mandibular body exposed in the mouth, a continuous extra-oral fistulized suppuration treated with antibiotics and the spontaneous loss of all the remaining teeth. The loose jaw bone was extracted under general anaesthesia. Despite the large bone loss, with the lysis of the inferior alveolar canal, especially in the parasymphyseal region, the nerve was not touched, having itself migrated under the dead bone.
Conclusions: We are the first to illustrate such an accelerated evolution of osteonecrosis of the mandibular body under Denosumab, particularly when no dental invasive treatment occurred. This case raises many new questions concerning the MRONJ process and etiologies.