Long-term administration of antiangiogenic agents does not directly indicate a high risk of MRONJ [16], though some authors have established 7-, 14-, and 28-day intervals of bevacizumab suspension for oral surgery [17,18,19]. In this case, the antiangiogenic medication was suspended for 28 days before implant placement; however, this was not enough to prevent MRONJ. The surfaces of Straumann® SLactive implants have been shown to present rapid osseointegration occurring between 21 and 28 days before implantation [20]. In order to avoid interference with the bevacizumab regimen and to accelerate osseointegration, Straumann® Bone Level Tapered-BLT® implants (SLactive) were used in this case. Of the four inserted implants, three were osseointegrated by the time that osteonecrosis manifested. Kwon et al., in 2014 [7], also reported bone sequestration involving histologically osseointegrated implants. On the other hand, the formation of sequestra may still continue in the deep regions of cancellous bone.

August et al. [21] reported in 2002 that the survival rate of dental implants is not significantly impacted by chemotherapy, regardless of whether administered before or after implant insertion. In contrast, Dantas et al. [22] reported that a 30-day period of chemotherapy suspension for implant placement would negatively affect osseointegration. Therefore, a consensus could not be established regarding the exact safe period for dental implant placement in patients undergoing chemotherapy. In this case, docetaxel and carboplatin infusions had been already suspended for 3 months preoperatively and resumed 3 months postoperatively. Additionally, these infusions do not represent a risk factor for MRONJ, according to Ruggiero et al. [9].

In addition to the risk of MRONJ for oral surgery, oral function and quality of life also play important roles in deciding the indications for a dental surgical procedure on a patient receiving antiresorptive agents [23]. To the best of our knowledge, no contraindication for dental implant installation in patients exposed to bevacizumab has been reported in scientific literature, when a period of 28 days without medication is observed pre-and post-procedure [17,18,19]. Nonetheless, specialists should be aware of the complexity of managing such patients.