Dados do Resumo

Título

Medication-related osteonecrosis of the jaw mimicking endodontic disease

Introdução

Several diseases and oral lesions can mimic endodontic diseases. Accurate diagnosis improves treatment outcomes and prevents complications. Medication-related osteonecrosis of the jaw (MRONJ) causes progressive bone destruction that can be probed through a fistula present for more than 8 weeks in patients on certain medications without prior radiation. Precise and accurate diagnosis is essential to prevent disease progression and significant bone loss in cancer patients.

Objetivo

This study aimed to report a case of a patient with medication-related osteonecrosis of the jaw mimicking endodontic pulp pathology.

Métodos

This case was reported following the recommendations of the Consensus-based Clinical Case Reporting Guideline Development (CARE).

Resultados

A 68-year-old man with hepatocellular carcinoma, treated with Atezolizumab, Bevacizumab, and Zoledronic acid, presented a spontaneous odontalgia on the lower right second premolar (#29). A pulp sensibility test was performed on the following lower right teeth: central incisor (#25), lateral incisor (#26), canine (#27), first premolar (#28) and the second premolar (#29) with an inconsistent response. Tooth #29 showed a negative response to the percussion and palpation test and posterior to that tooth two implants were observed which were installed 10 years ago. No extraoral changes were observed. Periapical radiography and cone beam computed tomography (CBCT) were performed for a preliminary examination and no lesions or abnormalities were observed. The implant crowns were removed, revealing bleeding on probing, suppuration, and a 5 mm peri-implant pocket depth. The main hypothesis was MRONJ stage 2 and the surgical treatment was performed. The implants were removed, and the necrotic bone was debrided. The pain ceased and signs of infection or inflammation were not observed within 6 months.

Conclusões

This case highlighted the challenges of distinguishing early MRONJ from other dental pathologies. MRONJ can mimic endodontic diseases, complicating diagnosis. Combining antiresorptive and antiangiogenic therapies increases MRONJ risk, as do dental implants. Precise Dentistry with accurate diagnosis requires thorough clinical and 3D imaging evaluation.

Palavras Chave

osteonecrosis; medication-related osteonecrosis of the jaw; endodontic diseases