Fig. 7. Panoramic radiograph at 7-month follow-up
Fig. 6. Image obtained 7 months postoperatively showing no lesions
Fig. 5. a, b Histological image of the lesion
Fig. 4. Bone exposure surrounding the implants with drainage of purulent secretion
Fig. 3. Panoramic radiograph after dental extractions with subsequent dental implants
Fig. 2. a, b Tomographic findings: lesions, measurements, and bone quality
Fig. 1. Initial clinical image showing oral infection foci
Maluf, G., Caldas, R.J., Fregnani, E.R. et al. A rare case of bevacizumab-related osteonecrosis of the jaw associated with dental implants.
Int J Implant Dent 5, 34 (2019). https://doi.org/10.1186/s40729-019-0188-0
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Received: 01 July 2019
Accepted: 30 August 2019
Published: 01 October 2019
DOI: https://doi.org/10.1186/s40729-019-0188-0
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The requirements of the Helsinki Declaration were observed, and the patient gave informed consent for all surgical procedures.
Written informed consent was obtained from the patient for the publication of this report and all accompanying images.
Gustavo Maluf, Rogério Jardim Caldas, Eduardo Rodrigues Fregnani, and Paulo Sérgio da Silva Santos declare that they have no competing interests.
Private Clinic, Brasília, DF, Brazil
Gustavo Maluf
Brasília, Brasil
Gustavo Maluf
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Bauru, SP, Brazil
Rogério Jardim Caldas
Department of Oral Medicine, Hospital Sírio-Libanês, São Paulo, SP, Brazil
Eduardo Rodrigues Fregnani
Department of Stomatology, Bauru Dental School, USP–University of São Paulo, Ba...
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Bevacizumab-related osteonecrosis of the jaw
Bone level tapered
Computed tomography
Medication-related osteonecrosis of the jaw
Vascular endothelial growth factor A
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
The findings of the present case indicate that insertion of dental implants is a risk factor for osteonecrosis of the jaw in patients exposed to bevacizumab. Therefore, prospective randomized studies should be encouraged to determine a safer bevacizumab regimen that considers both oral surgeries and the risk of dental implants for the management of osteonecrosis in clinical settings.
MRONJ is a side effect of drugs with a predilection for the mandible [24], which can be attributed to the relatively low vascularization of the mandible as compared to the maxilla [13]. Dental infections, surgical interventions, corticosteroid treatment, and chemotherapy have been described as risk factors for osteonecrosis [25]. In this case, the patient presented with stage 2 osteonecrosis with ...
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® S...
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 c...
Five weeks postoperatively, pain, drainage of purulent secretion, and bone exposure around the implants were observed (Fig. 4), although none of the implants showed mobility. Ten ozone therapy sessions associated with levofloxacin were performed. After 4 weeks of therapy with ozone oil (Philozon®, Balneário Camboriú, SC, Brazil), no pain or drainage of purulent secretion were present. Bone s...
A 54-year-old Caucasian woman complained of an unpleasant taste and pain in the mouth. Her medical history included breast cancer with metastasis, which was diagnosed in 2007. The patient had no comorbidities and no history of smoking. A radical mastectomy with axillary dissection was performed. The patient had no previous history of radiotherapy of the head and neck or use of bisphosphonates. The...
The treatment of malignancies often involves the use of targeted therapies to control the growth and survival of malignant cells by interfering with specific molecular agents involved in carcinogenesis [1]. Bevacizumab is a recombinant humanized monoclonal antibody designed to selectively bind and inhibit the biological activity of all human vascular endothelial growth factor (VEGF-A) isoforms. It...