Bilateral ONJ in a patient affected by metastatic prostate adenocarcinoma.

We present the diagnosis and management of a case of bilateral ONJ of the mandible in a patient that had been taking zoledronic acid treatment for 7 years following a diagnosis of metastatic prostate adenocarcinoma.  The patient was referred to our Division by his dental practitioner, that had performed the extraction of the left lower first molar six months before. In the first months after the extraction the patient did not reported any symptom and he started to use a mandibular removable prosthesis.  About 5 months following the extraction, the patient started to complain of pain in correspondence of the left body region. He had performed a panoramic radiograph and a CT scan showing a possible initial stage of mandibular ONJ bilaterally, with a predominance in the left mandibular body in the post-extraction socket. Therefore, a curettage of the left mandibular body was decided. Postoperative course was uneventful. Twelve months later, the patient complained of pain in the right mandibular region and in correspondence of the residual right lower third molar. A panoramic radiograph confirmed the extension of mandibular right ONJ. A curettage of the right mandibular body, together with the removal of the right lower third molar, was performed, with a following uneventful postoperative course.  Two years later, the patient complained of pain in the left mandibular region in correspondence of the residual left lower second premolar. A panoramic radiograph confirmed the extension of mandibular left ONJ with involvement of the root of the aforementioned premolar. A curettage of the right mandibular body, together with the removal of the left lower second premolar, was performed, with a following uneventful postoperative course. Three years later, a complete healing was obtained.