case_images: PMC5392388_01
case_images: Panoramic radiograph showing periapical lesions related to the right mandibular second molar and canine and the left mandibular canine.
case_images: CRID2017-9525893.001.jpg
case_images: PMC5392388_01_CRID2017-9525893.001.jpg
case_images: fig1
case_images: The patient's past dental history revealed extractions of mandibular right first molar and both mandibular canines due to periapical lesions, with curettage of granulation tissue (Figure 1).
case_images: (a) Preoperative CBCT (cross-sectional and axial images) evaluation of the mandibular symphyses after dental extractions. Left mandibular position of the implant. (b) Preoperative CBCT (cross-sectional and axial images) evaluation of the mandibular symphyses after dental extractions. Right mandibular position of the implant.
case_images: CRID2017-9525893.002.jpg
case_images: PMC5392388_01_CRID2017-9525893.002.jpg
case_images: fig2
case_images: Five months after the tooth extractions, an implant-based therapeutic project was proposed, and preoperative cone-beam computed tomography (CBCT) was performed prior to dental implant therapy to analyze the left (Figure 2(a)) and right Figure 2(b) mandibular symphyses.
case_images: PMC5392388_02
case_images: (a) Panoramic radiograph showing bone osteolytic lesions without defined borders after the second-stage surgery. (b) CBCT urgently performed showing osteolysis, with lingual and buccal cortical interruption.
case_images: CRID2017-9525893.003.jpg
case_images: PMC5392388_02_CRID2017-9525893.003.jpg
case_images: fig3
case_images: A panoramic radiograph revealed a radiolucent, diffuse osteolytic lesion with poorly defined borders in the symphysis area of the mandible (Figure 3(a)). Alveolar and basal bones are affected (Figure 3(b)).
case_images: PMC5392388_03
case_images: (a) Microscopic view of the bone biopsy. Hematoxylin-eosin staining (HES), low-magnification view (x10). Diffuse neutrophil infiltrate and osteoclastic bone resorption through neutrophil-osteoclast interactions. (b) HES, higher magnification (x40). Intense acute inflammation with numerous neutrophils and images of bone resorption.
case_images: CRID2017-9525893.004.jpg
case_images: PMC5392388_03_CRID2017-9525893.004.jpg
case_images: fig4
case_images: A bone biopsy was sent for histopathology analyses, which confirmed the diagnosis of chronic osteomyelitis with diffuse neutrophil infiltration (Figures 4(a) and 4(b)).
case_images: PMC5392388_04
case_images: (a) Follow-up after surgery. CBCT images 12 months after osteomyelitis. (b) Intraoral photography showing the two dental implants without inflammation 12 months after osteomyelitis.
case_images: CRID2017-9525893.005.jpg
case_images: PMC5392388_04_CRID2017-9525893.005.jpg
case_images: fig5
case_images: There was no evidence of local recurrence at 12 months (Figures 5(a) and 5(b)) after treatment, and placement of prosthetic abutments was performed.