インプラント体周囲に発症したビスフォスフォネート製剤関連顎骨壊死の1 例

抄録

Purpose: We report a case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) around implants placed in the mandible diagnosed by histopathological findings. The patient was a 58-year-old female who visited our department on 10th April 2010 due to gingival swelling and a feeling of discomfort around an implant placed in the left mandibular molar area. She had been treated by intravenous administration of bisphosphonate preparations (BPs) for vestibular bone metastasis due to breast cancer from October 2002 to March 2009. Based on the clinical findings, BRONJ was strongly suggested, so necrotic bone including the implant was resected under general anesthesia. Non-decalcified specimens of the resected bone were prepared and stained with toluidine blue. Results: She could start cancer chemotherapy because no recurrence of inflammation was noted postoperatively. However, she died from multiple metastasis one year postoperatively. Histopathological examination of marginally excised bone showed extensive contact without connective tissue between bone and the implant surface and also bone necrosis without osteocytes in lacunae of the bone. Discussion: At present, conservative medical treatment is recommended for BRONJ. However, we think it is acceptable to perform surgical treatment for BRONJ patients who need cancer chemotherapy as soon as possible.