Treatment of Apical Periodontitis Induced BRONJ with Endodontic Treatment

Abstract

Bisphosphonate-related osteonecrosis of the jaw (BRONJ), which is one of the serious side effects of bisphosphonates, has an increasing clinical importance due to the widespread use of bisphosphonates in the treatment of many diseases such as osteoporosis, osteopenia, Paget's disease, osteogenesis imperfecta, and multiple myeloma. BRONJ can spontaneously develop in the jawbones. In addition, many factors such as tooth extraction, periodontal diseases, and local trauma can trigger BRONJ. In our case, it was detected that the lesion appearing like BRONJ in the left lower jaw of the 67-year-old female patient with a history of oral bisphosphonate use developed due to apical periodontitis resulting from the tooth numbered 34. Root canal treatment was administered to the relevant tooth of the patient, the fistula tract was closed after this treatment, and as a result of the CBCT examination, it was observed that the enlargement in the necrotic bone area stopped. In addition, the patient's complaints about the relevant tooth disappeared. As a result, endodontic treatment is an effective treatment approach in the treatment of BRONJ developing due to apical periodontitis. In order to avoid the risk of BRONJ, a detailed oral examination should be performed before starting the bisphosphonate treatment, and necessary endodontic, restorative and periodontal treatments should be followed.