A Case of Medication-related Osteonecrosis of the Jaw Caused by Peri-implantitis in a Patient with Dementia

Abstract

In recent years, Japan has become a super-aging society, and the number of people with dementia who require nursing care is increasing. Due to the spread of dental implant treatment and long-term prognosis, the maintenance and management of dental implants in patients requiring nursing care has become a problem. We report a case of medication-related osteonecrosis of the jaw (MRONJ) caused by peri-implantitis in a patient with dementia. The patient was an 87-year-old woman. She had a history of Alzheimer's dementia, thoracolumbar compression fractures, and osteoporosis. She presented to our department with chief complaints of swelling in her right cheek and pain in her right submandibular region. She had right cheek swelling, submandibular fistula, and purulent drainage. Redness, swelling, and purulent drainage were noted in the peri-implant gingiva of her right lower jaw. CT images showed segregation and bone sclerosis around the implant body. She was diagnosed with peri-implantitis and MRONJ stage 3, and implant removal and isolation was performed under local anesthesia. Since the number of patients with dementia and osteoporosis undergoing implant treatment is expected to increase in the future, prevention of the development of peri-implantitis and MRONJ is important, as well as appropriate measures after the onset of these diseases.