Spontaneous Osteonecrosis of the Jaw in the Presence of Periodontal Disease in an Adolescent with Cyclic Neutropenia.

Abstract

The purpose of this report is to present the case of a 17-year-old girl diagnosed with cyclic neutropenia (CN), who had undergone six months of treatment with zoledronate three years before. She sought treatment for extreme mobility of the mandibular left lateral incisor, canine and first premolar that had been present for one month. Clinical features included calculus, severe gingival recession and mandibular bone exposure. Panoramic radiographs and cone beam computed tomography confirmed bone sequestration. Conservative treatment comprising antibiotic therapy, use of perio- dontal instrumentation and a hyperbaric chamber proved unsatisfactory. An unfavor- able evolution was confirmed by the presence of bone sequestration that required bone removal, together with the teeth located in the block of the detached bone. The diagnosis was osteonecrosis of the jaw. The patient presented moderate periodontal involvement associated with CN; therefore, periodontitis was unlikely to have been the main factor triggering the local and systemic complications.>.