Osteoradionecrosis of the jaw caused by periapical periodontitis: A case report

Osteoradionecrosis of the jaws (ORNJ) is a well-known complication of head and neck radiotherapy that may severely impair patient quality of life. Not only dentoalveolar surgery but also root canal treatment may also damage the alveolar bone. This report describes a case of ORNJ in the maxilla following treatment for periapical periodontitis. The patient was treated with chemotherapy and radiotherapy consisting of the course of cisplatin and etoposide, and a total dose of 60 Gy/30Fr for small cell carcinoma of the right-maxillary gingiva. In April 2015, after irradiation therapy, he received root canal treatment in the right-maxillary first premolar because of periapical periodontitis. Six months after root canal treatment, he had developed ORNJ in the right maxilla with acute inflammation, and was thus treated with antibiotics. In April 2016, after treatment of ORNJ, T1- and T2-weighted magnetic resonance images showed a hypointense area surrounding the right-maxillary first premolar. These findings suggest that root canal treatment for dental pulp necrosis may be triggered to cause the ORNJ.