Imaging Sci Dent.  2015 Sep;45(3):199-203. 10.5624/isd.2015.45.3.199.

Bisphosphonate-related osteonecrosis of the jaw in a multiple myeloma patient: A case report with characteristic radiographic features

• Lee BD
• Park MR
• Kwon KH

• KMID: 2045029
• DOI: http://doi.org/10.5624/isd.2015.45.3.199

Abstract

A 59-year-old male who had suffered from multiple myeloma for nine years and had been administered bisphosphonates for seven years visited a dental hospital for pain relief due to extensive caries in his left maxillary molars. The molars were extracted, leaving an exposed wound for three months. The radiograph showed sequestra formation and irregular bone destruction in the left maxilla. Sudden pain and gingival swelling in the right mandibular molar area occurred six months later. The interseptum of the right lower second molar was observed to be necrotic during surgery. These findings coincided with the features of bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, the long intravenous administration of bisphosphonates and tooth extraction were likely the etiologic factors of BRONJ in a patient with multiple myeloma; moreover, the bilateral occurrence of BRONJ is a characteristic feature.

Keyword

Multiple Myeloma; Bisphosphonate-Associated Osteonecrosis of the Jaw; Tooth Extraction

MeSH Terms

Administration, Intravenous
Bisphosphonate-Associated Osteonecrosis of the Jaw*
Diphosphonates
Humans
Male
Maxilla
Middle Aged
Molar
Multiple Myeloma*
Tooth Extraction
Wounds and Injuries
Diphosphonates

Figure

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  Fig. 1 A panoramic radiograph (A) and periapical radiograph (B) show a carious lesion on the maxillary first, second, and third molars extending into the subgingival area, with a suspected mucosal antral cyst in the left maxillary sinus.

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  Fig. 2 Compression fracture of T12 and diffuse osteopenia of the pelvic bone.

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  Fig. 3 Skull radiographs show a punched-out appearance.

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  Fig. 4 At 50 days after extraction, pus discharge from the wound and sequestra formation are observed.

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  Fig. 5 A panoramic radiograph (A) and a computed tomograph (B) reveal the separation of the alveolar ridge from the surrounding maxillary bone, sequestra, and irregular bone destruction. Chronic sinusitis is seen in the left maxillary sinus.

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  Fig. 6 A photograph shows the extracted premolars, the first molar, and a necrotized bone fragment.

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  Fig. 7 A. An intraoral photograph shows gingival swelling around the lower second and third molars. B. A periapical radiograph shows moderate periodontitis and proximal caries on the distal surface of the first molar.

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  Fig. 8 A photograph shows the necrotic interseptum of the right lower second molar.

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