Dental management prior to oncological treatment in a rare and extensive case of osteosarcoma in the mandible

Abstract

Surgical dental treatment for cancer patients requires more alertness in propaedeutics when in comparison to normoreactive subjects. Therapy must always be appropriate to the individual's clinical and systemic condition. Under those circumstances, we report a female patient, 51 years old, leucoderma, with a previous history of breast carcinoma. She underwent surgical excision, radiotherapy, and reconstruction of the right breast. The patient described experiencing pain around the 14 tooth area. Clinical and radiographical observations revealed the presence of a protuberance in the vestibule-distal region and in the alveolar ridge of the tooth. The protuberance is related to the local anatomy and previous exodontia, which occurred due to extensive coronary loss, deflection of the remaining cusps, presence of gingival hyperplasia covering the crown, endodontic treatment with the absence of gutta-percha in the region of the pulp chamber, and ankylosis. In her medication history, there was no use of anti-resorptive drugs, which would represent a surgical contraindication. The surgical planning for the region of the 14 tooth included flap making and vestibular and bone spike osteoplasty, with beveling of the osteotomy margins. An antibiotic was prescribed for 7 days and the patient should start taking it 2 days before the surgery. The subject had good post-surgical tissue repair and probable posterior prosthetic rehabilitation. Therefore, it is fair to conclude that careful anamnesis sets up an adequate surgical propaedeutics with a good prognosis, which may improve the quality of life of cancer patients.