By: Victor M. Sternberg, D.M.D. 

August 14, 2024 

An otherwise healthy woman suddenly developed rapid recession on tooth #19. The dentist  was under the impression that it was a mucogingival defect. After careful evaluation, it was  noted that she had a large piece of a black material in the bifurcation of this tooth which had  rapidly developed recession. 

The patient had been on Prolia for four years and had no other dentistry done other than  prophylaxis during that time. 

The dark substance was removed. The photograph demonstrates the dark segment of bone  that had exfoliated from the bifurcation of this tooth. 

A radiograph taken on the other side shows pathology that might be related to dental issues but  could be secondary to osteonecrosis. The removal of these teeth poses a real problem in terms  of healing. 

I have noted, in my own patient population on Prolia, an increasing number of cases of  spontaneous bone exposure and necrosis without any dental intervention. 

Although the statistics on Prolia indicate a very low incidence of osteonecrosis, the fact that I  have seen now four cases of spontaneous necrosis with no dental intervention indicates that  this problem may be escalating. 

To date the only treatment we have is irrigation and perhaps the application of Chlorhexidine. 

There is some evidence that debridement might help, but at this point it is on a case-by-case  basis.

Just a heads up to be aware that as more and more of our patients are on Prolia, you may begin  to see an increasing number of individuals such as I present here. 

As always, I would appreciate your feedback 

Yours truly, 

Dr. Victor M. Sternberg 

By Westchester Center for Periodontal & Implant Excellence

December 31, 2023