Endodontic Consequences of Early Stage of Medication-Related Osteonecrosis of the Jaw: A Case Report.

OBJECTIVES

Osteonecrosis of the jaws (MRONJ) is a frequent side effect of antiresorptive (AR) drugs used in oncology. MRONJ may have endodontic consequences, as reported in this clinical case.

MATERIAL AND METHODS

A 64-year-old woman being treated with antiresorptive (AR) drugs targeting bone metastasis of a primitive breast cancer consulted at the dental service of Pitié-Salpêtrière Hospital. She first experienced symptomatic apical periodontitis followed by symptomatic irreversible pulpitis, which were initially explained as resulting from occlusal trauma. Despite endodontic treatment, exacerbation of the symptomatology was noted. MRONJ was suspected, and the affected tooth was extracted.

RESULTS

The presence of necrotic bone during the surgery confirmed the diagnosis. Surgical treatment led to complete healing and total disappearance of clinical and radiological signs at 4 months.

CONCLUSIONS

MRONJ can induce alterations in adjacent tooth vascularization and secondary pulpal disease. Early diagnosis is difficult because early-stage MRONJ occurs without clear radiographic signs.