A Combined Treatment for a Case of Peri-Implant Bisphosphonate-Related Osteonecrosis of the Jaw.

OBJECTIVE

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is rarely reported as a complication after implants placement. In this article we report a combined treatment for a rare case of peri-implant BRONJ.

METHODS

A 71-year-old female patient presented for follow-up of a 4.3 x 13 mm implant placed on first upper-left premolar position 3 years prior. She was complaining of soreness of the area and bleeding when brushing. The patient had a history of breast cancer (removed 7 years prior) for which she was taking anastrozole 1 mg/day, causing a decrease in mineral bone density as side effect, for which she was prescribed a side-therapy of oral risedronate 35 mg/week taken for 4 years and stopped 2 years prior. A 9 mm deep pocket was detected on the mesial-buccal aspect of the implant. At the first visit local minocycline microspheres delivery was performed as antibacterial and anti-inflammatory agent. The patient was seen 10 weeks later with the presence of a bone sequestrum on the mesial-palatal aspect of the implant. A surgical minimally invasive single-flap approach was done to minimize periosteal elevation. Decontamination with EDTA-gel followed by delivery of rh-PDGF (recombinant platelet derived growth factor) with β-TCP (β-tricalcium phosphate) stabilized with a CaSO₄ barrier. A cycle of four consecutive 810 nm diode-laser-biostimulation visits was performed to promote fibroblasts growth. An 18-month post-surgical follow-up showed 3 mm residual probing depth (PD) and an absence of gingival inflammation with no symptoms reported by the patient.

RESULTS

Antimicrobial, regenerative and biostimulation therapies were implemented to successfully treat BRONJ around an osseointegrated implant. The results showed noticeable PD reduction and radiographic bone regeneration after 18 months.

CONCLUSIONS

A combined therapy aiming at regeneration of bone and soft tissues around osseointegrated implants was successful for treatment of implant-associated BRONJ.