PMC5513807_01
Images of the areas affected by BRONJ.. Notes: (A) The initial appearance surrounding the extraction socket of lower left third molar, showing red and swollen gingiva with pus draining through gingival fistulas. (B) Initial cross-sectional CBCT images showed rarefaction of trabecular bone with a large area of osteonecrotic lesion around the extraction socket (as indicated by the white arrow). (C) After 2 years of SR treatment, the gingiva over the extraction socket is healthy with no sign of gingival inflammation. (D) After 2 years of SR treatment, CBCT images demonstrated that the bone density increased and new spongy bone had begun to fill into the area previously occupied by dead bone.. Abbreviations: BRONJ, bisphosphonate-related osteonecrosis of the jaw; CBCT, cone beam computed tomography; SR, strontium ranelate.
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Clinical examination identified an 8x6 mm gingival swelling with pus draining through gingival fistulas (Figure 1A). The cone beam computed tomography (CBCT) confirmed apparent osteolysis and osteosclerosis around the left edentulous area corresponding to the extraction socket (Figure 1B). The gingiva surrounding the extraction socket displayed no sign of inflammation or fistula (Figure 1C). The CBCT images showed increased bone density with no sign of osteolysis, and newly formed spongy bone was detected occupying the sites of previously necrotic area (Figure 1D).