PMC5329666_01
Panoramic radiographic images. (a) Image taken in October 2002 (before starting the oral bisphosphonate [BP]). (b) Image taken in February 2005 (before starting the oral BP). (c) Image taken in September 2008 (1 year and 4 months after starting the oral BP). (d) Image taken in September 2011 (5 years and 4 months after starting the oral BP). These images show chronological changes in the subpontic bone formation.
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Serial radiographic images taken by the former dentist revealed subpontic bone formation (Figure 1).
Intraoral photographic image taken in the first examination. The bone is exposed from the alveolar crest of the lower left teeth 6 and 7, with swelling and redness in the surrounding gingiva.
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Panoramic radiographic image taken in the first examination. Radiopaque area in the alveolar crest of lower left teeth 6 and 7, showing osteosclerosis and formation of bone resembling cortical bone.
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Sagittal computed tomographic image. Arrows: (A) the root of the lower left tooth #4 and (B) the root of the lower left tooth #8. Arrowhead: bone formation.
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Intraoral photographic image after detachment of the sequestrum. Epithelialization was underway with no exposed bone.
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Examination revealed that the area from which the tissue had detached was almost completely covered by the gum and had no discharge of pus (Figure 5).
Intraoral photographic image taken 2 months after exfoliation. Epithelialization was observed, with no signs of inflammation in the surrounding mucosa.
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Panoramic radiographic image taken 2 months after exfoliation. No recurrence of bone formation was observed.
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Spontaneously detached sequestrum.
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Histopathological findings (hematoxylin and eosin stain, slight magnification). Bone tissue, consisting of compact laminated structures, is void of cellular components but contains bacterial masses (arrow).
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