Medication-related Osteonecrosis of the Jaw and Dental Implant: A Case Report

The rising use of anti-resorptive agents, including denosumab, for bone metastases has led to an increased incidence of medication-related osteonecrosis of the jaw. This particular case represents an important, but also often overlooked, potential late sequelae that may be seen in cancer patients, which is the failure of a previously well-functioning dental implant years down the line, which may then become a causative factor for MRONJ.

A 70-year-old female patient, a chronic user of high-dose denosumab for metastatic breast carcinoma, presented with pain and infection of the mandibular implant, which was functionally osseointegrated for seven years before the onset of symptoms. The patient was evaluated and was found to have a bony sequestrum containing the implant, meaning the diagnosis was a Stage 2 MRONJ. Conservative management was ineffective; thus, surgical intervention involving sequestrectomy and removal of the implant en bloc was performed.

This case of treating the patient also shows us that patients undergoing any treatment with denosumab, who have dental implants, are continuously at risk of late-onset MRONJ and hence need long-term surveillance, and thereby, more emphasis needs to be placed on giving them informed consent for such a lifelong risk of acquiring the disease. Thus, great care must be taken before performing any such surgical procedure. This case also shows that the surgery has been successful in treating the patient, without the need to withdraw any ongoing antiresorptive drugs.