Alendronate-Associated Osteonecrosis of the Hard Palate After Harvesting of a Connective Tissue Graft: A Case Report.

INTRODUCTION

Much attention has been given to the development of osteonecrosis of the jaws, concomitant with a history of bisphosphonate usage, particularly regarding inciting dental procedures. This report describes a case of bisphosphonate-related osteonecrosis of the hard palate after the harvesting of a subepithelial connective tissue (CT) graft for treatment of gingival recession (GR) in the mandible.

CASE PRESENTATION: A 60-year-old female sought periodontal therapy for GR. Her medical history revealed the use of alendronate for osteopenia, hypothyroidism, sulfa allergy, and >18 regimens of steroid formulations (oral, inhaled, and topical) for various upper respiratory and dermatologic disorders. The hard palate was selected as the donor site for the subepithelial CT graft. At a 4-month postoperative evaluation, osteonecrosis was evident in the palatal site. Successful clinical outcome was achieved after conservative debridement, antibiotics, and use of chlorhexidine gluconate.

CONCLUSIONS

It is advised that a patient's medical history include current and past intake of bisphosphonates and comorbidities that could predispose to the development of osteonecrosis of the jaws. Attempts should be instituted to achieve primary wound closure of the donor site in patients who have taken bisphosphonates. Postoperative follow-up of the donor site of CT grafts should continue for at least 6 months for surveillance of bisphosphonate-related osteonecrosis.