Grün Pascal, Pfaffeneder-Mantai Florian, Schneider Benedikt, Meier Marius, Bytyqi Ditjon, Bandura Patrick, Turhani Dritan
Center for Oral and Maxillofacial Surgery, Department of Dentistry.
Division for Chemistry and Physics of Materials, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University, Krems, Austria.
Ann Med Surg (Lond). 2024 Feb 15;86(4):2266-2276. doi: 10.1097/MS9.0000000000001826. eCollection 2024 Apr.
Extraction of mandibular third molars can lead to complications such as chronic sclerosing osteomyelitis (CSO), an inflammatory bone marrow disease that tends to progress. CSO involves the cortical plates and often the periosteal tissues and is caused by a variety of microorganisms, including spp. The treatment of chronic osteomyelitis (CO) and CSO remains challenging, as there is no universal treatment protocol. This case report investigated whether jaw bone that has healed from chronic sclerosing osteomyelitis can be considered healthy bone when planning dental implants.
A 21-year-old Caucasian woman developed CO and CSO after third molar surgery.
A combination of alveolar ridge bone resection, extraction of teeth 47-32, and long-term specific antibiotic therapy against spp. was administered. An attempt at preprosthetic alveolar ridge reconstruction with an anterior superior iliac crest bone graft resulted in graft failure and the patient refused further harvesting procedures. Implantation in the intraforaminal zone also resulted in the loss of two implants after loading. Finally, inferior alveolar nerve transposition resulted in the successful reimplantation of two implants, which were fully functional almost 11 years later.
This case report presents the treatment history of this patient. With a longitudinal observation period of greater than 20 years, the results of this case demonstrate the successful treatment of bone with CO, CSO, and spp. infection. Following the removal of infected bone, radical debridement, and long-term antibiotic therapy, bone health was restored.
下颌第三磨牙拔除可能导致慢性硬化性骨髓炎（CSO）等并发症，这是一种有进展倾向的炎症性骨髓疾病。CSO累及皮质板，常累及骨膜组织，由多种微生物引起，包括 菌属。慢性骨髓炎（CO）和CSO的治疗仍然具有挑战性，因为没有通用的治疗方案。本病例报告调查了在计划植入牙种植体时，已从慢性硬化性骨髓炎愈合的颌骨是否可被视为健康骨。
一名21岁的白种女性在第三磨牙手术后发生了CO和CSO。
采用牙槽嵴骨切除术、拔除47 - 32牙以及针对 菌属的长期特异性抗生素治疗相结合的方法。尝试用髂前上棘骨移植进行修复前牙槽嵴重建，结果移植失败，患者拒绝进一步的取骨手术。在孔内区植入种植体在加载后也导致两颗种植体丢失。最后，下牙槽神经移位使两颗种植体成功重新植入，近11年后功能完全正常。
本病例报告展示了该患者的治疗历程。经过超过20年的纵向观察期，该病例结果表明成功治疗了患有CO、CSO和 菌属感染的骨。在去除感染骨、彻底清创和长期抗生素治疗后，骨健康得以恢复。
