Cases reported "Osteonecrosis"

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1/17. Localized alveolar bone necrosis following the use of an arsenical paste: a case report.

    AIM: To describe some toxic effects of arsenic trioxide in the mouth, to condemn its continued use, and present a case in which a tooth was preserved despite significant bony destruction. SUMMARY: A case is presented in which severe alveolar bone necrosis resulted from leak-age of an arsenical devitalization paste into the periodontium.The tooth was root canal treated before root amputation, and restored with a cuspal coverage restoration. The tooth was observed to be symptomless and functional at the one-year follow-up. KEY learning POINTS: * arsenic and its compounds have no place in contemporary endodontics. * dentists should protect their patients by avoiding the use of arsenic-containing materials and refusing to use products whose constituents are not known. * Localized bone necrosis may not require tooth extraction. Depending on the severity of the case, the tooth may be preserved by a combination of endodontic, periodontal,prosthodontic and maintenance therapies.
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2/17. tooth exfoliation, osteonecrosis and neuralgia following herpes zoster of trigeminal nerve.

    A case of herpes zoster of the trigeminal nerve with complications of osteonecrosis and neuralgia in the absence of local or systemic predisposing factors is presented. The literature is reviewed and the role of varicella zoster virus in the pathology of tooth exfoliation and osteonecrosis is discussed.
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3/17. tooth exfoliation and necrosis of the crestal bone caused by the use of formocresol.

    A 68-year-old woman received a formocresol pulpectomy of the right lower lateral incisor. The temporary restoration was lost within hours. The next day, the patient suffered continuous pain, the gingiva sloughed, and the alveolar bone was exposed. Four days after treatment, the patient complained of moderate pain. Six days after the pulpectomy, the tooth spontaneously exfoliated. At this time she was referred to our hospital. The clinical diagnosis was chronic alveolitis. Treatment consisted of irrigation of the area. Three weeks after the pulpectomy, the dull pain had subsided, but the alveolar bone of the area showed increased mobility. Five weeks after the pulpectomy, the mobility of the alveolar bone was more significant and a sequestrectomy was performed with the patient under local anesthesia. The sequestrum of necrotic bone was approximately 10 x 5 x 5 mm in size. The patient has been symptom-free for 2 years since the sequestrectomy.
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4/17. Maxillary osteomyelitis and spontaneous tooth exfoliation after herpes zoster.

    Reports of spontaneous tooth exfoliation and osteonecrosis trigeminal herpes zoster are extremely rare and have been sporadic. This article reports a pertinent case of a 50-year-old man who exhibited prodromal odontalgia before the appearance of vesicular mucocutaneous lesions, together with severe destruction of the maxillary bone and exfoliation of multiple teeth. This patient was successfully treated using a unique closed nasal-vestibular drainage system for the ultimate control of maxillary bone viability. A review and analysis of the clinical aspects and the pathogenesis of herpes zoster and bone necrosis are discussed.
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5/17. Avascular jaw osteonecrosis in association with cancer chemotherapy: series of 10 cases.

    BACKGROUND: We present a series of 10 patients with osteonecrosis of the jaws (ONJ) that appeared following cancer chemotherapy. MATERIAL AND methods: Of the 10 cases with ONJ, six had bone metastases from breast cancers and the other four had multiple myeloma. We analysed the location of bone metastases, as well as the characteristics of the ONJ, and the drugs with which they had been treated for their bone metastases. RESULTS: Of the 10 patients, all had ONJ in the mandible; 50% also had maxillary involvement. The average number of areas of painful exposed was 2.1 per patient (range 1-5). In seven patients a tooth extraction preceded the onset of ONJ. Two patients developed oroantral communications and another a cutaneous fistula to the neck with suppuration. In all the 10 patients the histopatholological diagnosis was of chronic osteomyelitis without evidence of metastatic disease to the jaws. All the patients had received treatment for their malignant bone disease with bisphosphonates. These were the only drugs that all patients had received. CONCLUSION: ONJ appears to have a relationship with the use of bisphosphonates.
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6/17. Alveolar bone necrosis and tooth exfoliation following herpes zoster infection: a review of the literature and case report.

    BACKGROUND: herpes zoster (HZ) presents as a cutaneous vesicular eruption in the area innervated by the affected sensory nerve, usually associated with severe pain. oral manifestations of HZ appear when the mandibular or maxillary divisions of the trigeminal nerve are affected. methods: This is a case report of a 63-year-old woman with HZ infection with trigeminal nerve involvement that led to a rapid loss of alveolar bone and exfoliation of two teeth. RESULTS: The initial intraoral examination showed redness of the alveolar mucosa and gingiva of the lower right quadrant with multiple well-delimited and painful erosive lesions affecting the attached gingiva around the teeth. Two weeks later, teeth number 27 (lower right canine) and 28 (lower right first premolar) had class III mobility, flow of purulent exudate from the gingival sulcus, and deep pockets (>11 mm). The radiological examination showed advanced alveolar bone loss around both teeth. The prognosis for teeth number 27 and 28 was considered hopeless, and they were extracted. Due to extensive necrosis there was no interdental alveolar bone. The case is presented with a review of clinical data from patients with trigeminal HZ infection associated with osteonecrosis or exfoliation of teeth previously reported in the literature. The mechanisms by which the HZ infection leads to the alveolar bone necrosis are discussed. CONCLUSIONS: Extensive osteonecrosis and exfoliation of teeth in the area innervated by the nerve affected by HZ has been reported after HZ infection. Clinicians should be aware of this possible outcome after a trigeminal HZ infection.
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7/17. osteonecrosis of jaw in patient with hormone-refractory prostate cancer treated with zoledronic acid.

    Intravenous bisphosphonates are widely used in the management of metastatic bone disease, as well as osteoporosis. Recent published reports have documented a possible link between treatment with intravenous bisphosphonates and osteonecrosis of the jaw. We report a case of osteonecrosis of the jaw in 1 patient with prostate cancer receiving both chemotherapy and intravenous zoledronic acid (Zometa). Bisphosphonates have been demonstrated to alter the normal bone microenvironment and appear to have direct effects on tumors as well. These changes may contribute to the development of osteonecrosis of the jaw, particularly after tooth extractions or other invasive dental procedures.
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8/17. Bisphosphonate-associated mandibular osteonecrosis.

    A 66-year-old man with multiple myeloma treated with zoledronic acid, melphalan, and prednisone after a tooth extraction developed severe osteonecrosis of the mandible that was nonresponsive to antibiotic therapy. A CT scan showed innumerable fragmented sequestra in the mandible and some adjacent soft tissue fullness around the mandible. The association between the use of bisphosphonates and osteonecrosis of the jaw has been described only recently.
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9/17. jaw osteonecrosis associated with use of bisphosphonates and chemotherapy: paradoxical complication of treatment of bone lesions in multiple myeloma patients.

    It has been demonstrated that bisphosphonate-based supportive therapy (pamidronate or zoledronate) reduces skeletal events (onset or progression of osteolytic lesions) both in patients with multiple myeloma (MM) and in cancer patients with bone metastasis. Bisphosphonates (eg, alendronate) are also indicated in the treatment of osteoporosis. Nevertheless, osteonecrosis of the jaw (ONJ) has been reported in some patients being treated with bisphosphonates. We present a series of 9 MM patients who developed ONJ after treatment with bisphosphonates and chemotherapy. All the patients in this case series had undergone tooth extraction for recurrent dental abscesses while taking bisphosphonates. We also review the diagnostic and therapeutic implications of this paradoxical complication associated with treatment of bone lesions in MM.
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10/17. osteonecrosis of the jaw and oral bisphosphonate treatment.

    BACKGROUND: Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. CASE DESCRIPTION: A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic debridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. CLINICAL IMPLICATIONS: dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.
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