PMC5392388_01
Panoramic radiograph showing periapical lesions related to the right mandibular second molar and canine and the left mandibular canine.
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The patient's past dental history revealed extractions of mandibular right first molar and both mandibular canines due to periapical lesions, with curettage of granulation tissue (Figure 1).
(a) Preoperative CBCT (cross-sectional and axial images) evaluation of the mandibular symphyses after dental extractions. Left mandibular position of the implant. (b) Preoperative CBCT (cross-sectional and axial images) evaluation of the mandibular symphyses after dental extractions. Right mandibular position of the implant.
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Five months after the tooth extractions, an implant-based therapeutic project was proposed, and preoperative cone-beam computed tomography (CBCT) was performed prior to dental implant therapy to analyze the left (Figure 2(a)) and right Figure 2(b) mandibular symphyses.
PMC5392388_02
(a) Panoramic radiograph showing bone osteolytic lesions without defined borders after the second-stage surgery. (b) CBCT urgently performed showing osteolysis, with lingual and buccal cortical interruption.
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A panoramic radiograph revealed a radiolucent, diffuse osteolytic lesion with poorly defined borders in the symphysis area of the mandible (Figure 3(a)). Alveolar and basal bones are affected (Figure 3(b)).
PMC5392388_03
(a) Microscopic view of the bone biopsy. Hematoxylin-eosin staining (HES), low-magnification view (x10). Diffuse neutrophil infiltrate and osteoclastic bone resorption through neutrophil-osteoclast interactions. (b) HES, higher magnification (x40). Intense acute inflammation with numerous neutrophils and images of bone resorption.
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A bone biopsy was sent for histopathology analyses, which confirmed the diagnosis of chronic osteomyelitis with diffuse neutrophil infiltration (Figures 4(a) and 4(b)).
PMC5392388_04
(a) Follow-up after surgery. CBCT images 12 months after osteomyelitis. (b) Intraoral photography showing the two dental implants without inflammation 12 months after osteomyelitis.
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There was no evidence of local recurrence at 12 months (Figures 5(a) and 5(b)) after treatment, and placement of prosthetic abutments was performed.