PMC10243946_01
Pre-operative CBCT images of the patient depicting ill-defined patchy lytic radiolucent areas in the mandible surrounded by sclerotic bone in the posterior region on the (a) right and (b) left sides.
CRID2023-2449298.001.jpg
PMC10243946_01_CRID2023-2449298.001.jpg
fig1
Sequesters were seen in the lesion, in addition to cortical bone resorption and a fistula to the right lingual cortical border (Figure 1).
Hematoxylin and eosin staining of the incised sample indicating areas of bone necrosis (arrows).
CRID2023-2449298.002.jpg
PMC10243946_01_CRID2023-2449298.002.jpg
fig2
Based on the radiological and histopathological findings as well as the history of radiation therapy of the mandibular region, a diagnosis of ORN was made (Figure 2).
Post-surgical photograph of the inserted mandibular fixtures in the anterior region.
CRID2023-2449298.003.jpg
PMC10243946_01_CRID2023-2449298.003.jpg
fig3
Four implants (two with 4 mm x 13 mm and two with 4 mm x 10 mm dimensions) were then inserted (35 rpm, 35 Nm), and the cover screws were fastened after checking the primary stability (Figure 3).
Prepared injectable PRF, recombinant human BMP 2 (RhBMP2), and sticky bone (combination of leukocyte PRF, xenograft, and autogenous bone particles obtained by drilling).
CRID2023-2449298.004.jpg
PMC10243946_01_CRID2023-2449298.004.jpg
fig4
RHBMP2 and I-PRF were injected from the buccal side into the wound area (Figure 4).
Intra-oral photograph depicting the final results of full-mouth reconstruction.
CRID2023-2449298.005.jpg
PMC10243946_01_CRID2023-2449298.005.jpg
fig5
The patient was then referred to the prosthodontist for construction of the full-mouth prostheses using bar attachments and overdentures for both jaws (Figure 5).
Follow-up panoramic radiograph 10 months after loading.
CRID2023-2449298.006.jpg
PMC10243946_01_CRID2023-2449298.006.jpg
fig6
In addition to favorable clinical and self-reported findings, no evidence of implant failure, considerable peri-implant bone loss, or deterioration of the osteonecrosis regions was observed in any of the radiographic examinations (Figure 6).  Figure 7 illustrates a timeline of the case.
Timeline of the case.
CRID2023-2449298.007.jpg
PMC10243946_01_CRID2023-2449298.007.jpg
fig7
In addition to favorable clinical and self-reported findings, no evidence of implant failure, considerable peri-implant bone loss, or deterioration of the osteonecrosis regions was observed in any of the radiographic examinations (Figure 6).  Figure 7 illustrates a timeline of the case.