Juodzbalys G. J Oral Maxillofac Res 2022;13(3):e5
http://www.ejomr.org/JOMR/archives/2022/3/e5/v13n3e5.pdf
doi: 10.5037/jomr.2022.13305

This case report provides insights into the management of a rare clinical condition mostly affecting the alveolar process of adult women and suggests a treatment protocol to achieve a successful implant-supported rehabilitation.

CASE DESCRIPTION

Panoramic x-ray of an edentulous site in the posterior lower jaw of a 54-year old woman revealed a large radiolucency with irregular borders, which was diagnosed a cortical focal osteoporotic bone marrow defect (FOBMD). These type of lesions are characterized by osteolytic hyperplasia of the hematopoietic bone marrow. As no clinical symptoms were present, an implant surgery was planned to bring back the missing dentition.

TREATMENT

After flap elevation the bone bed for the insertion of a tissue level implant was prepared. The intra-operative evaluation of the site after preparation of the osteotomy showed no pathological signs like cyst or hematomas and the previous radiological diagnosis of could be confirmed. Furthermore, involvement of the inferior alveolar nerve could be excluded. Before implant insertion, the osteoporotic focus was filled with small cerabone® granules, gently compacted. Then, a gauge was inserted to create a bed for the implant and a Straumann® Tissue Level Implant (4.1 x 10 mm) was inserted with its shoulder resting on the margins of the osteotomy.

RESULTS & CONCLUSION

The healing course was uneventful. Four months after implant placement a second surgery for soft tissue correction was performed and the final crown was delivered. Annual follow ups and the six-year re-evaluation demonstrated a stable clinical situation without signs of peri-implantitis, marginal bone loss, failed implant osseointegration or other complications. In conclusion, a thorough diagnosis of FOBMD together with appropriate planning and execution of the implant surgery, which is proposed in a six-step treatment protocol, is prerequisite for a successful outcome.