An 84-year-old woman was referred to the oral and maxillofacial surgery service by her dentist when she presented mandibular crestal bone exposure and periimplant suppuration 3 weeks after the placement of 6 dental implants with immediate loading.
As a personal history of the patient only highlights the presence of hypertension and osteoporosis.
She did not take any medication regularly and she was never treated with bisphosphonates.
Five months before the implant placement surgery, the patient began antiresorptive treatment with denosumab 60 mg subcutaneously to treat osteoporosis.
Only one dose of 60 mg denosumab was administered.
Physical examination revealed pain due to palpation of the mandibular alveolar ridge at the level of the areas of bone exposure corresponding to extra dental caries prior to surgery of teeth 48 and 47.
An orthopantomography showed the presence of several osteolytic zones at the level of the right mandibular body and around the implants.
A mandibular CT scan to determine the extent of the lesions showed a destruction of the buccal cortical length cm of the mandibular body, trabecular spaces delating it with areas hypothesized implantable teeth and irregular osteonecrosis at the right level.
A bone scintigraphy showed severe infection at the mandibular level.
Conservative treatment with antibiotics was initiated according to the protocol of our service (amoxicillin-clavulanic orally 875/125 mg, 3 times/day for 15 days associated with rinses of chlorhexidine at 0.12%.
Two weeks after starting treatment, the patient presented improvement of pain, with disappearance of suppuration and improvement of peri-implantitis.
Low-dose teriparatide 20 μg subcutaneously injected daily for 6 months was then started.
After this time, teriparatide treatment was then discontinued, since the foci of bone exposure were covered by a healthy oral mucosa with a certain CT scan and a recovery of the osteolytic degree to dementia.
Currently, 8 months after the end of treatment with teriparide, the patient is asymptomatic, and prosthetic rehabilitation has been performed on viable implants 6 months after complete remission of lesions.
