2020 Volume 33 Issue 2 Pages 184-190
Object : We report a case of medication-related osteonecrosis of the jaw (MRONJ) accompanied by peri-implantitis suspected to involve Sunitinib, with good results obtained by surgical treatment.
Summary : Three years after implant treatment, the patient developed a kidney cancer, and Sunitinib, a molecular targeted drug, was used. Six years later, MRONJ with peri-implantitis developed in the bilateral mandibular jaw.
History : In September 2010, the patient visited our hospital for the purpose of implant treatment and implant placement was performed in November. Sunitinib administration was started in March 2016 due to bone metastasis of kidney cancer. There was swelling of peri-implant mucosa in the bilateral mandibular molar sites and continuous discharge of pus was observed in May 2016. Therefore, the implant was removed under local anesthesia in July 2017. Since the sequestration was confirmed by X-ray, bilateral mandibular humus removal was performed in December 2017 under general anesthesia. Eighteen months after surgery, there is no recurrence of inflammation and a good result has been obtained.
Discussion and conclusions : Regarding the course of this case, hospital visits to our department were discontinued, and during the period of perioperative oral management at another hospital, appropriate maintenance was not performed, oral hygiene was reduced, and peri-implantitis developed. It is presumed that administration of Sunitinib overlapped with osteonecrosis of the jaw. At the time of implant placement, it is difficult to predict the possibility of future use of molecular targeted drugs. It is suggested that the number of elderly and cancer-bearing patients will increase in the future, and implant treatment should be provided while taking such cases into consideration.