The most common clinical aspect of the lesions was mucosal ulceration with a non-vital bone exposure (Figs. 1, 2 and 3). In 1 case, we observed a mucosal fistula with a mild serosan- guineous exudation. The exposed bone was yellowish/whitish whereas the surrounding mucosa was often irritated and painful if touched (Fig. 4). On the other hand, the exposed bone did not cause any pain and did not bleed. The clinical situation showed all the features of avascular bone necrosis. Bone lesions showed a quite regular surface that in the following became irregular as a consequence of bone micro- traumatisms during chewing. In 1 case, the above mentioned irregularity produced ulcerations of the tongue edge touching the bone surface (Fig. 5). In 4 cases, bone exposed areas involved the upper maxillary at the crest and on the palate and in 5 cases the mandible on the postero-lingual and crest areas. When bone necrosis was close to the teeth, a deterioration of the local hygiene conditions was observed, with initial damage to the soft tissue with subsequent increased tooth mobility and loss. Case history revealed a previous intervention of the oral cavity, in particular tooth avulsions, insertion or removal of implants with subsequent incomplete healing of the surgical site and osteonecrosis of the post-avulsion fault.
Figure 1 – Exposed necrotic alveolar bone after tooth 31 extraction.
Figure 3 – Nonhealing alveolus with bone necrosis after the extraction of tooth 15.
Figure 4 – Bone necrosis and secondary infection near palatal root of tooth 26.
Depending of the clinical situation of osteonecrosis, radiographic evaluation and computerized tomography did not show any radiographic signs of the disease (Figs. 6, 7). The absence of the radiographic signs of the disease was probably due to the early development of the lesions contrarily to osteomyelitis where an active bone resorption or sequestration were observed.
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Figure 5 – Exposed necrotic bone on the posterior left lingual side of the
Figure 6 – Radiographic view of the area of tooth 31 without sequestra-
Figure 7 – Panoramic radiograph of the mandible following extraction of tooth 46. The image shows the mottled bone in the not healing extraction sites.