Severe chronic suppurative osteomyelitis following dental implant placement

Abstract

Osteomyelitis is an infection caused by bacterial contamination of the bone marrow, cortical surfaces, and the periosteum. The clinical examination of a patient with severe osteomyelitis secondary to dental implants revealed a large facial swelling, suppuration in the perimandibular region, limited mouth opening, and diffuse pain that started after the placement of five dental implants. Two failed implants were removed, a reconstructive titanium plate was placed, and the patient was treated with antibiotics, but the infection did not resolve. The patient’s clinical condition became worse, and she sought hospital care. At presentation, she had a fever and was dehydrated. She was hospitalized for 16 days. Her treatment included surgery for the removal of the reconstructive plate, the implants with peri-implantitis, and bone and necrotic tissue, together with administration of systemic drugs. The diagnosis of osteomyelitis was based on clinical, imaging, and histopathological findings, and she was treated with administration of antibiotics (penicillin, amikacin) for 16 days, followed by cephalosporin for 15 days after hospital discharge. Sixteen days later, her clinical condition was normal. Twelve months later, she received new implants and underwent prosthetic rehabilitation. Imaging tests, surgical elimination of bone and necrotic tissue, and histopathological analyses are essential for an accurate diagnosis. In our case, infection control demanded a careful surgical intervention associated with the administration of systemic antibiotics.