Periodontal disease-like bone loss after adjuvant radiotherapy in the head and neck region: A case report and review of the literature

Objective: The purpose of this study was to present a rare case of periodontal disease-like bone loss and possible treatment options. This paper discusses the pros and cons of conservative treatment and radical surgical intervention and summarizes possible complications. It focuses also on the individual situation of the patient and provides a review of literature. Method and Materials: A 32-year-old patient presented with widening of the periodontal spaces and apical translucencies at every tooth after adjuvant radiotherapy of an oral squamous cell carcinoma (OSCC) of the tongue. In addition, the patient suffers from slight mental retardation. The following periodontal parameters were examined: Bleeding Index, Plaque Index, tooth mobility, and clinical attachment loss. Panoramic radiography and computed tomography were used for diagnosis and follow-up purposes. The literature review was carried out systematically combined with individual searching. Results: This study presents a distinct case of rarely mentioned periodontal-disease-like bone loss, most likely radiation-induced. This resulted in complete devitalization of the entire dentition and will eventually lead to a loss of all teeth. The review of the literature summarizes the incidence of post-radiogenic periodontitis, bone loss, and possible risk-factors of unwanted events after radiotherapy in the oral cavity and dentoalveolar structures. Conclusion: The combination of the patient's history and individual situation makes this a special case with regard to decision making and further therapy. After carefully considering the possible options, a conservative treatment with minimal surgical interventions and close surveillance was followed. The intention was the preservation of the patient's natural dentition as long as possible as well as the prevention of an osteonecrosis of the jaw. Taking the literature review into account this article presents a patient with an unusually distinct extent of periodontal disease-like bone loss, which is not to be compared to periodontal disease. Keywords: apical translucency, bone loss, oral squamous cell carcinoma, periodontal, radiotherapy