A case of aimed at healing by the open wound after sequestectomy to bisphosphonate-related osteonecrosis of the jaw

A 74-year-old woman was referred to our department by her dentist because of bone exposure and pus discharge of the right mandibular region. An oral examination revealed exposed devitalized bone, and pus discharge at a tooth-extraction socket of the right lower canine and lateral incisor, and a radiographic examination showed radiolucency of the right mandibular region. She had osteoporosis, and had received an oral bisphosphonate therapy. Bisphosphonate-induced osteonecrosis of the mandible was diagnosed. Bisphosphonate administration was terminated, and conservative therapy with oral administration of antibiotics and wound irrigation was carried out, but were not effective. After 4 months of conservative therapy, primary surgical therapy was carried out, because of radiographic examination suggested that a remove sequestrum had formed. Three months after primary surgery, An oral examination revealed exposed devitalized bone and teeth mobility of the left maxillary region. Eight months after primary surgery, secondary surgical therapy was carried out because of the same reason of primary surgery. Both of lesions were kept open wound after surgery. The postoperative course was uneventful.