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case_images: Clinical and radiographic images of the patient. (A) clinical findings at the time of diagnosis - fistula with purulent exudation in the vestibule of the lower jaw in area of missing tooth 46. (B) CBCT 3D reconstruction - osteolysis and sequestration of the mandibular bone in area of teeth 45, 46. (C) CBCT 3D reconstruction - osteolysis and sequestration of the mandibular bone in area of teeth 45, 46. (D) CBCT sagittal section - osteolysis and sequestration of mandibular bone in area of teeth 45, 46, teeth 44 and 45 are endodontically treated. (E) sequestrectomy and osteonecrectomy of the mandible under local anesthesia with atraumatic preservation of the mental nerve and extraction of teeth 44 and 45 - elevation of the mucoperiosteal flap with marked bone sequestration. (F) sequestrectomy and osteonecrectomy of the mandible under local anesthesia with atraumatic preservation of the mental nerve and extraction of teeth 44 and 45 - bone sequestration removed. (G) sequestrectomy and osteonecrectomy of the mandible under local anesthesia with atraumatic preservation of the mental nerve and extraction of teeth 44 and 45 - state after smoothening sharp bone edges and wound debridement, before primary wound closure. (H) sequestrectomy and osteonecrectomy of the mandible under local anesthesia with atraumatic preservation of the mental nerve and extraction of teeth 44 and 45 - primary wound closure with monofilament absorbable suture. (I) condition 7 months after the procedure, healed soft tissue, without signs of MRONJ. (J) CBCT 3D reconstruction - mandibular defect with signs of bone healing. (K) CBCT 3D reconstruction - mandibular defect with signs of bone healing. (L) CBCT sagittal section - mandibular defect with signs of bone healing.
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case_images: The patient was diagnosed with MRONJ stage II (characterized by symptoms of infection) (Figure 1A), according to the staging system developed by American Association of Oral and Maxillofacial Surgeons (AAOMS). Radiographic findings revealed significant osteolytic bone destruction and localized sequestration in the areas of teeth 45 and 46 of size 20x15x10 mm (Figure 1B-D). This procedure included a mucoperiosteal flap elevating in the range of teeth 44-47 (Figure 1E), smoothening of sharp bony edges and carefully dissecting and preserving of mental nerve (Figure 1G). The specimen of necrotic bone (Figure 1F) was sent for the histopathological examination (Figure 2A and B), and after local antisepsis the wound was closed primarily, with absorbable sutures (Figure 1H). Similarly, imaging studies have revealed evidence of bone healing 7 months after surgery (Figure 1I-L).
case_images: Histopathological images of osteonecrosis of the jaw. (A) Bone fragments, fibrinous-purulent exudate and the presence of actinomycotic drusen, stained with Hematoxylin and eosin, and magnified by 10-100x. (B) Bone fragments, fibrinous-purulent exudate and the presence of actinomycotic drusen, with Periodic Acid-Schiff staining, and magnified by 10-84x.
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case_images: The specimen of necrotic bone (Figure 1F) was sent for the histopathological examination (Figure 2A and B), and after local antisepsis the wound was closed primarily, with absorbable sutures (Figure 1H).