Spontaneous Bisphosphonate Induced Osteonecrosis of a Mid-Palatal Torus: A Case Report

Dwight E. McLeod, D.D.S., M.S.^*, Medha Gautam, Ph. D.^†, Elio Reyes, D.D.S., M.S.D.^*, Cyril Pandarakalam, B.D.S., M.D.S^‡, Bradley A. Seyer, D.D.S.^‡

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Clinical Advances in Periodontics

Posted online on 12 Feb 2013

1-6

DOI: 10.1902/cap.2013.120106

ABSTRACT

Introduction: Bisphosphonates are commonly used in the United States primarily in post-menopausal women with a history of osteoporosis. Bisphosphonate therapy may result in bisphosphonate-related osteonecrosis of jaw (BRONJ). BRONJ is described as exposed bone in the maxillofacial region persisting for more than eight weeks in a patient who is taking, or has taken a bisphosphonate and has not had radiation therapy to the head and neck. The prevalence of BRONJ seems to vary depending on the mode and frequency of administration, drug potency, duration of treatment, and other factors.

Case Presentation: This paper reports on a case of bisphosphonate induced osteonecrosis of a mid-palatal torus in a 77 year-old patient of African-European heritage who was previously treated for osteoporosis. The lesion appeared as a pustulated erythematous soft tissue mass with partially exposed bone covered in plaque. The lesion was surgically debrided using a modified flap procedure and sent for histopathologic analysis. Systemic antibiotics, pain medication, and antimicrobial mouth rinse were prescribed. The mid-palatal area healed without complications, and the histopathology was consistent with bisphosphonate induced osteonecrosis with evidence of Actinomyces species.

Conclusions: With the widespread use of bisphosphonates and the prevalence of tori and/or exostoses, it is likely that clinicians may encounter a greater frequency of bisphosphonate induced osteonecrosis of these poorly vascularized bony growths that may initiate from daily traumatic oral activities. Clinicians should communicate to their patients the potential dangers that necrosis may cause. Consequently, treatment should be decisive, urgent, and incorporate aggressive management.

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