none 10.31254/dentistry.2025.10209 BioMed Research Publishers BioMed Research Publishers 16195 194914239 314763 20260515021110050 10.31254 2026-05-15T02:11:33Z 2026-05-15T02:11:17Z 0 International Journal of Dentistry Research Int J Dentistry Res 25813218 10.31254/dentistry https://dentistryscience.com/ 8 31 2025 10 2 Marisa Roncati Senior Lecturer, Department of Translational Medicine, School of Dentistry, University of Ferrara, Ferrara, Italy https://orcid.org/0000-0002-3610-9951 Lucrezia Parma-Benfenati Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI., USA https://orcid.org/0009-0008-3158-6477 Aldo Carnevale Diagnostic Imaging and Radiotherapy Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy https://orcid.org/0000-0001-8191-6042 Carlo Contini Infectious and Diseases, Department of Medical Sciences, St. Anna Hospital, University of Ferrara, Ferrara, Italy https://orcid.org/0000-0001-8809-6470 Paolo Vescovi Department of Otolaryngological/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma, Parma, Italy https://orcid.org/0000-0002-2223-3716 Background: This case report presents an instance of osteonecrosis of the jaw (ONJ) triggered by tooth extraction in a patient with metastatic renal cell carcinoma (RCC) undergoing multidrug treatment therapy. This was a 68-year-old man who presented in September 2023 to a private dental office complaining of severe pain that he had exposed bone in the alveolus of his left maxillary third molar 11 months following the extraction of the tooth root. Methods: The patient was treated for 4 months with various antibiotics and curettage to remove exposed bone with no improvement. The patient had received several courses of tyrosine kinase (TK) inhibitors, the Sunitinib® and Cabometix®, which were discontinued due to drug-related toxic effects and then Everolimus®, which was also discontinued due to pulmonary complications. A year earlier he had undergone antiresorptive therapy with the bisphosphonate Zolendronic® acid and then the human monoclonal antibody Denosumab®. A chronic non-healing extraction cavity's clinical and radiological picture was consistent with ONJ. Results: The CT scan showed a picture suggesting a focus on osteonecrosis. In contrast, the magnetic resonance imaging (MRI) scan showed evidence of ethmoidal-maxillary sinusopathy with the left maxillary sinus almost completely occupied by material fluid with fibrotic sprouts. The patient was treated for 4 months with various antibiotics and curettage to remove the exposed bone without improvement. After several oncology consultations, re- treatment with Sunitinib® was started. A few months later, the patient was referred to another dentist who suggested photobiostimulation therapy with a 980-nanometer diode laser and an ozone-based gel, which resulted in total healing. Conclusions: Mucosal lesions resolved with complete reconstitution of the oral tissue, accompanied by a progressive spontaneous expulsion of a bone sequestrum after topical ozone gel applications and photobiostimulation laser therapy. No toxicity was reported. 8 31 2025 71 80 1 10.31254/biomed-crossmark-policy www.biomedresearch.org false 10.31254/dentistry.2025.10209 https://www.dentistryscience.com/IJDR_2025102_09.pdf