Mandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature

Gabrić, Dragana and Seiwerth, Sven and Baraba, Anja and Vučićević Boras, Vanja (2017) Mandibular osteonecrosis due to the pulpal-periodontal syndrome: a case report and review of the literature. Acta Stomatologica Croatica, 51 (1). pp. 65-71. ISSN 0001-7019

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Abstract

OBJECTIVE: Ishemic bone disease has multifactorial etiologies. Cronic dental infections should be eliminated to prevent osteonecrosis of the jaw. ----- CASE REPORT: We report an unusual case of osteonecrosis due to the pulpal-peridontal syndrome and subsequent pulp necrosis. A case of 38 year old woman who presented with exposed bone, 8 mm in diameter, in the lingual area of the right lower third molar. The patient was otherwise healthy and was not taking any medications. A detailed medical history showed no previous diseases. Patient denied any type of local trauma. A complete blood count showed no abnormalities. The panoramic radiograph revealed a deep periodontal pocket between teeth 47 and 48. The CBCT revealed a deep periodontal pocket between molars and bone sequestrum of the lingual plate. Topical treatment consisted of adhesive periodontal dressing based on the cellulose and bethamethasone oitnment together with orabase, without improvement. Therefore, peroral amoxycillin was prescribed for a week. Since there was no improvement, the third molar was removed as well as necrotic bone; the alveolar bone was remodelled and sutures were placed. After suturing, the whole area was covered using intraoral resorbable bandage. Microbial swab of the wound aspirate did not reveal polymorphonuclears or the presence of microorganisms. Microbial swab of the biopsy specimen of the necrotic bone particle and sequestrum showed a large amount of gram-positive coccae, however, polymorphonuclears were not found. Histopathological analysis revealed acute chronic inflammation. One week after the surgery, the area healed completely. ----- CONCLUSION: This case highlights the fact that in some patients bone exposure might develop due to the pulpal-periodontal syndrome i.e. pulp necrosis.

Abstract in Croatian

Dosadašnje spoznaje: Ishemične koštane bolesti multifaktorijalne su etiologije. Potrebno je eliminirati kronične upale odontogene etiologije u svrhu prevencije osteonekroze čeljusti. ----- Prikaz slučaja: Opisan je neobičan slučaj osteonekroze nastale zbog pulpo-parodontnog sindroma i posljedične nekroze pulpe. Riječ je o 38-godišnjoj ženi kojoj je nađena eksponirana kost u promjeru od osam milimetara u lingvalnoj regiji u području donjega desnog trećeg molara. Pacijentica je inače anamnestički bila zdrava i nije uzimala nikakve lijekove. Nakon iscrpne anamneze nisu nađene nikakve ranije bolesti. Opovrgnula je bilo kakav oblik lokalne traume. Kompletna krvna slika bila je uredna. Na ortopantomogramu uočen je dubok parodontni džep između zuba 47 i 48, a na CBCT-u dubok parodontni džep između molara i koštani sekvestar u području lingvalnog kortikalisa. Primijenjena je topikalna terapija u obliku adhezivnog parodontnog zavoja te betametazon mast u orabazi, ali bezuspješno. Zbog toga je određena jednotjedna terapija amoksicilinom. S obzirom na to da i dalje nije bilo rezultata, ekstrahiran je treći molar te uklonjena nekrotična kost, modeliran je alveolarni greben i rana sašivena primarno. Nakon šivanja ponovno je postavljen intraoralni resorptivni zavoj. Uzet je bris iz rane za mikrobiološku obradu, no nije bilo polimorfonukleara ili mikroorganizama. Mikrobiološki uzorak nekrotične kosti pokazao je mnoštvo gram-pozitivnih koka, ali polimorfonukleari također nisu nađeni. Nakon histopatološke analize postavljena je dijagnoza akutne kronične upale. Rana je potpuno zacijelila sedam dana nakon kirurškoga zahvata. Zaključak: Prikazani slučaj opisuje mogućnost nastanka osteonekroze čeljusti kao posljedice pulpoparodontnog sindroma, odnosno nekroze pulpe.

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