Biphosphonate related osteonecrosis of the jaws: Atypical clinical appearance

The clinical signs of bisphosphonate related osteonecrosis of the jaws are exposed necrotic bone, pain, inflammation and pus drainage. the absence of exposed necrotic bone, a characteristic clinical sign, can lead to late diagnosis and refractory treatment. 56-year-old female patient, admitted to our clinic with a complaint of pain in the right lower jaw. clinical and radiographic examination showed stage 2 bisphosphonate related osteonecrosis and surgical debridement was performed; after surgery the mucosa healed completely, but it was determined that bone necrosis continued under the intact mucosa. a second surgery with sekestrectomy and curretage was performed. the stage 2 patients should be followed up long-term after conservative treatment, as well as the primary diagnosis of bisphosphonate related osteonecrosis of the jaws without exposed necrotic bone, after surgical debridement, mucosal healing can completed and the bone necrosis may continue under the intact mucosa.