Focal mandibular osteonecrosis following intraosseous anesthesia: A case report

Introduction and importance: Intraosseous anesthesia (IOA), an important technique in dental anesthesia, delivers anesthetic directly into the bone, enhancing patient comfort and minimizing side effects. Despite advantages, several disadvantages are known such as injection discomfort, root damage, mechanical obstructions and needle fractures. This report highlights a rare yet significant complication of focal mandibular osteonecrosis following IOA. Case presentation: A 35-year-old male was referred with interdental septum necrosis between teeth 46 and 47, four months post-IOA. CBCT scan confirmed the septum sequestration and periapical osteolysis extending into the mandibular canal. The patient underwent sequestrectomy and tooth extraction under local anesthesia, successfully relieving him of pain. Clinical discussion: Focal osteonecrosis of the jawbone is possibly caused by factors such as frictional heat, improper pressure during perforation, absence of water cooling, and the use of vasoconstrictor-containing anesthetics, impairing blood flow in the low vascularized bone of the interdental septum. Most osteonecrosis cases so far reported are linked to medication, immunocompromised status or irradiation. Conclusion: Focal mandibular osteonecrosis is a rare complication of intraosseous anesthesia. To our knowledge, this is the first reported case of focal osteonecrosis in the mandible in a healthy patient. There are no previous reports in the literature to show this complication in an otherwise healthy individual.