Exostosis after tooth extraction associated with bisphosphonate use

Abstract

Objective: To describe a clinical case of mandibular exostosis associated with tooth extraction in a patient under prolonged use of bisphosphonates, highlighting the clinical and radiographic aspects related to the mechanism of action involved in the formation of exostoses induced by these drugs in a postmenopausal patient with osteopenia. Case details: A 70-year-old female patient, under continuous use of sodium alendronate for more than four years for the treatment of osteoporosis, presented painful bone growth in the posterior region of the right mandible following a tooth extraction performed approximately two years earlier. Clinical examination revealed a hardened, bilobulated bone lesion, without bone exposure or inflammatory signs in the mucosa. Panoramic radiography showed areas of osteosclerosis associated with altered bone remodeling at the extraction site. Considering the medication history and the clinical and radiographic findings, it was concluded that the patient presented exostosis associated with prolonged bisphosphonate use, related to altered bone metabolism and compromised remodeling resulting from antiresorptive therapy. Treatment was conservative, including pain control, removal of local traumatic factors, and periodic clinical follow-up. Final consideration: This case highlights the importance of early diagnosis of bone alterations associated with long-term bisphosphonate use, as well as the adoption of conservative management and appropriate clinical-radiographic follow-up.