Garrote Marcel da Silva, Barbosa Alexandre Augustus Costa, Teixeira Maria de Fátima Batista Medeiros Alves, Mendonça Elismauro Francisco, Fenelon Gilberto, Guedes Orlando Aguirre, Estrela Carlos
Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil.
Department Infectious Diseases, Tropical Disease Hospital, Goiânia, Goiás, Brazil.
Case Rep Dent. 2025 Feb 24;2025:6770915. doi: 10.1155/crid/6770915. eCollection 2025.
Osteomyelitis is an infection caused by bacterial contamination of the bone marrow, cortical surfaces, and the periosteum. The clinical examination of a patient with severe osteomyelitis secondary to dental implants revealed a large facial swelling, suppuration in the perimandibular region, limited mouth opening, and diffuse pain that started after the placement of five dental implants. Two failed implants were removed, a reconstructive titanium plate was placed, and the patient was treated with antibiotics, but the infection did not resolve. The patient's clinical condition became worse, and she sought hospital care. At presentation, she had a fever and was dehydrated. She was hospitalized for 16 days. Her treatment included surgery for the removal of the reconstructive plate, the implants with peri-implantitis, and bone and necrotic tissue, together with administration of systemic drugs. The diagnosis of osteomyelitis was based on clinical, imaging, and histopathological findings, and she was treated with administration of antibiotics (penicillin, amikacin) for 16 days, followed by cephalosporin for 15 days after hospital discharge. Sixteen days later, her clinical condition was normal. Twelve months later, she received new implants and underwent prosthetic rehabilitation. Imaging tests, surgical elimination of bone and necrotic tissue, and histopathological analyses are essential for an accurate diagnosis. In our case, infection control demanded a careful surgical intervention associated with the administration of systemic antibiotics.
骨髓炎是一种由骨髓、皮质表面和骨膜的细菌污染引起的感染。对一名因牙种植体继发严重骨髓炎的患者进行临床检查发现，面部有大面积肿胀，下颌周围区域有化脓，张口受限，且在植入五颗牙种植体后开始出现弥漫性疼痛。取出了两颗失败的种植体，放置了一块重建钛板，并给予患者抗生素治疗，但感染并未消除。患者的临床状况恶化，于是寻求住院治疗。就诊时，她发烧且脱水。她住院了16天。她的治疗包括手术取出重建板、患有种植体周围炎的种植体以及骨和坏死组织，同时给予全身用药。骨髓炎的诊断基于临床、影像学和组织病理学检查结果，她接受了16天的抗生素（青霉素、阿米卡星）治疗，出院后又接受了15天的头孢菌素治疗。16天后，她的临床状况恢复正常。12个月后，她接受了新的种植体并进行了修复康复。影像学检查、手术清除骨和坏死组织以及组织病理学分析对于准确诊断至关重要。在我们的病例中，控制感染需要进行仔细的手术干预并联合使用全身抗生素。
