Treatment of bisphosphonate related osteonecrosis following root canal therapy at the 1-year follow-up: report of two cases
A 62-year-old female patient presented to the Yeditepe University, Faculty of Dentistry with prosthetic needs (). Her medical history revealed a diagnosis of breast cancer and oral bisphosphonate administration (Fasamax, Merck, Whitehouse Station, NJ, USA) 5 mg per day along with anastrozole (Arimidex®, AstraZeneca) 1 mg per day for 4 years. Root canal treatments were performed as described above for teeth #35, #45, and #47 due to prosthetic reasons and two implants were placed to replace missing teeth #36 and #37 ( and ). The tooth #47 did not have C canal configuration. Extreme care was taken to provide oral hygiene during that period and prophylactic antibiotics (2 g of amoxicillin 1 hour before treatment) was also administered for each session. One month later, the patient complained of a mild pain in the dentoalveolar bone of the right mandible. None of the teeth were tender to percussion and palpation. Antibiotics were prescribed (500 mg amoxicillin three times a day for 3 weeks) and topical ozone treatment was initiated, as described above. The patient was trained to detect symptoms of BRONJ as described above and scheduled for regular dental monitoring on a 6 month basis.\nThe intravenous administration of zoledronic acid (4 mg Zometa®, Novartis) every 6 months was initiated upon a diagnosis of progression of breast cancer approximately 1 month after the endodontic therapy. At the 1-year recall, no symptoms related to BRONJ were present.