Acta Scientific Dental Sciences

Case ReportVolume 1 Issue 5

Medication-Related Osteonecrosis of the Jaw – A Case Report

Gurkan Unsal1, Arda Ozgon2, Aysegul Senemtasi2, Ilknur Ozcan1 and Meltem Koray2*

1Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul University, İstanbul, Turkey
2Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, İstanbul, Turkey

*Corresponding Author: Meltem Koray, Associate Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey.

Received: October 12, 2017; Published: October 30, 2017

Citation: Meltem Koray., et al. “Medication-Related Osteonecrosis of the Jaw – A Case Report”. Acta Scientific Dental Sciences 1.5 (2018).


Aim: Bisphosphonates are synthetic analogs of pyrophosphates, which are used for malignancy-related hypercalcemia, multiple myeloma, bone metastases and osteoporosis. After the realization of the similarities between the effects of some chemotherapeutic agents and bisphosphonates, a new term emerged in 2014: Medication-Related Osteonecrosis of the Jaw (MRONJ). In this case, we present a MRONJ in the mandible.

Method: 65 years old female patient referred to Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery with a pain at the both retromandibular areas and halitosis. After getting anamnesis, It was understood that the patient had a pancreas cancer and due to the metastases on her liver, she was taking sunitinib malate (Sutent® 37.5 mg capsule, Pfizer, Istanbul, Turkey) for 3 years. 0.7 x 0.7 x 2,5 cm3 necrotic regions were seen on the right, 0.5 x 0.5 x 0.3 cm3 necrotic areas were seen on the left side of the mandibular alveolar process. For the detection of the necrotic borders of MRONJ, Cone Beam Computed Tomography (CBCT) images were interpreted

Results: Amoxicillin/clavulanic acid tablet and chlorhexidine mouthwash were prescribed and necrotic areas were cleansed with the physiological saline solution once a week. On our recommendation, sunitinib malate was reduced to 25 mg per day by oncologists. Sunitinib malate taking was not quit since It may increase the occurrence chance of a metastasis. Pain and halitosis were removed however borders of necrotic tissue hasn’t changed. The patient is under control for 1 year in our clinic.

Conclusion: Osteonecrosis is characterized by irregularity at the cortical bony margins and the destruction of cortical bone in CBCT images. Sunitinib malate is an antiangiogenic agent which was first used in 2006 hence the long-term effects are yet to know. Although the most common reason of MRONJ is tooth extraction, It can be seen in regions/patients which/who have no surgical procedure history. In order to avoid complications dentists need to take a thorough anamnesis and should be aware of the side effects of intaking drugs. Patients who had anti-resorptive medication treatments should have a regular follow up even no surgical operation was performed.

Keywords: MRONJ; Sunitinib Malate; Cone Beam Computed Tomography; Bisphosphonate; Osteonecrosis; Jaws

Copyright: © 2018 Idiberto José Zotarelli Filho., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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