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case_images: Initial radiograph (A) and after implant removal (B).
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case_images: Clinical and radiographic examination detected significant bone loss around the referred implant (Figure 1A). After approval from the institution to disclose data from this clinical case, the patient signed the institutional informed consent form, authorizing the treatment plan and use of images, the dental implant was removed with surgical instruments (Figure 1B).
case_images: CBCT Transversal section (A) and Longitudinal section (B) of the tomography image showing the characteristics of the bone tissue after 3 months of implant removal.
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case_images: A computed tomography (CBCT) examination revealed no bone repair at the socket (Figure 2).
case_images: Clinical diagnosis of osteonecrosis with evidence of bone exposure (A) and periapical radiograph showing extensive bone loss (B).
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case_images: Clinical evidence of bone exposure and suppuration was seen after 3 months (Figure 3A), periapical radiography showed that there was still significant bone loss (Figure 3B), and at this moment, the MRONJ diagnosis was made.
case_images: Thirty days of follow-up after surgical debridement (A) and topical application of blue m oral gel (B).
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case_images: The wound remained open after 30 days of clinical follow-up (Figure 4A), and the patient reported pain. At this time, a curettage was done, followed by application of blue m oral gel to fill the socket (Figure 4B).
case_images: Clinical appearance after 15 days of treatment (A) and 2-year follow-up (B).
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case_images: When the patient returned after 15 days, it was observed that the wound was in a healing process, with the presence of epithelialized tissue and no bone exposure (Figure 5A). On the 2-year clinical follow-up, the lesion had healed entirely (Figure 5B).   
case_images: CBCT examination (A) and virtual planning for implant installation (B).
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case_images: The installation of a new implant was performed. (Figure 6).
case_images: Initial drilling showing vital bone (A), periapical radiograph after implant installation (B) and application of the blue m oral gel in the immediate post-operative (C).
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case_images: During the implant surgical procedure, it was possible to observe the quality and vitality of the existing bone (Figure 7A). Following the implant placement (Straumann Tissue Level WN 4.8 x 6mm) (Figure 7A and B), the blue m oral gel was applied to the wound (Figure 7C).
case_images: Clinical appearance after healing of the implant (A) and final prosthesis (B).
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case_images: It was possible to see a healthy soft tissue (Figure 8A) and a ceramic crown was installed (Figure 8B).