A meta-analysis showed that the placement of dental implants in patients exposed to bisphosphonates did not reduce the success rate of the dental implant [11], although these patients may experience complications. Based on this analysis, a risk assessment should be performed on a case-by-case basis, since MRONJ is rare but one among serious complication of bisphosphonate therapy [11]. However, a case-control study showed a significant negative influence of bisphosphonates on the success rate of dental implants [12]. In fact, the placement of dental implants is often considered a risk factor for the development of MRONJ [7, 10]. The cases of bevacizumab-related osteonecrosis of the jaw (BeRONJ) reported in the literature presented different triggering factors, such as dental extraction or denture trauma [4, 8, 13]. To the best of our knowledge, there is no data on osteonecrosis involving implant placement in patients who have received antiangiogenic drugs. Therefore, this report presents a rare case of BeRONJ related to the placement of dental implants.

The success rates of dental implants immediately inserted into the sockets of teeth with periodontal and periapical lesions are similar to those in cases without infection, provided that local debridement, meticulous cleaning of the tooth socket, mouth-washing with chlorhexidine, and pre- and postoperative systemic antibiotic use are performed [14, 15]. In our case report, the patient presented with infection involving both the superior and inferior teeth. Nonetheless, the insertion of dental implants was only planned for the mandible, as bone graft use was indicated before the placement of the superior dental implants. Considering that the patient would go back to receiving chemotherapy and the associated improvement in patient’s quality of life, a single-stage surgical procedure (dental extraction immediately followed by implant insertion) was considered a feasible approach for the mandible. In order to control local infection and decrease the risk of complications, an oral antibiotic was prescribed 5 days before the insertion of the dental implants, and the aforementioned measures were implemented.