Late‐onset medication‐related osteonecrosis of the jaw 11 years after IV bisphosphonates following implant placement

This report describes a patient who developed a rare complication of long-term bisphosphonate therapy, a medication commonly used to treat bone diseases such as multiple myeloma. Eleven years after receiving high-dose intravenous bisphosphonates, the patient underwent tooth extraction and dental implant placement, initially healing without problems. Several months later, a small area of exposed, infected bone appeared near the implant, which was diagnosed as medication-related osteonecrosis of the jaw (MRONJ). The condition was successfully treated with careful surgical cleaning, local antiseptic rinses, short-term antibiotics, and close monitoring, without the need to remove the implant. This case is important because it shows that MRONJ can occur more than a decade after stopping bisphosphonate therapy, even when routine blood tests suggest low risk. It also demonstrates that the disease can appear near, rather than exactly at, the surgical site. The report emphasizes the need for thorough risk assessment, careful surgical planning, prompt recognition of complications, and collaboration among dental and medical specialists. Overall, it highlights that patients with a remote history of high-dose bisphosphonates require long-term vigilance and individualized care when undergoing dental procedures.