Comprehensive Dental Rehabilitation in a 6-Year-Old Child with Juvenile Focal Osteoporosis Receiving IV Bisphosphonate Therapy - A Case Report

Sep 30, 2026

Pediatric patients receiving intravenous bisphosphonate therapy for juvenile focal osteoporosis face distinctive dental-management concerns due to medication-related osteonecrosis of the jaw (MRONJ), although documented risk in children is extremely low. This case report describes successful comprehensive dental rehabilitation in a 6-year-old child with juvenile focal osteoporosis receiving IV bisphosphonate therapy. After interdisciplinary consultation and evidence-based antibiotic prophylaxis protocols, multiple procedures were performed, including extractions, pulp therapy, restorations, and stainless-steel crown placement. No MRONJ or complications were observed over a 12-month follow-up, supporting safe, monitored treatment when guided by clinical evidence.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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Abstract

Introduction

Bisphosphonate

Case Report

Patient information and medical history

Case Report Comprehensive Dental Rehabilitation in a 6‑Year‑Old Child with Juvenile Focal Osteoporosis Receiving IV Bisphosphonate Therapy: A Case Report Rahaf Abdullah Alolayan Senior Registrar of Pediatric Dentistry at Private Practice, Unizah, Alqassim, Saudi Arabia Submitted: 14‑Aug‑2025 Revised: 19‑Aug‑2025 Accepted: 28‑Aug‑2025 Published: 17‑Dec‑2025. Abstract Pediatric patients receiving intravenous bisphosphonate therapy for juvenile focal osteoporosis present unique challenges for dental management due to concerns about medication‑related osteonecrosis of the jaw (MRONJ), despite extremely low documented risk in children. We report the successful comprehensive dental rehabilitation of a 6‑year‑old child with juvenile focal osteoporosis receiving IV bisphosphonate therapy. Following interdisciplinary consultation with the primary physician and implementation of antibiotic prophylaxis protocols, the patient underwent multiple dental procedures including extractions, pulp therapy, restorations, and stainless‑steel crown placement. No complications or signs of MRONJ developed during the 12‑month follow‑up period. This case demonstrates that comprehensive dental rehabilitation can be safely performed in pediatric patients receiving IV bisphosphonate therapy when evidence‑based protocols guide clinical decision‑making. Interdisciplinary consultation, antibiotic prophylaxis, and careful monitoring enable successful treatment outcomes while maintaining vigilance for potential complications. Keywords: Bisphosphonate, dental rehabilitation, juvenile focal osteoporosis, medication related osteonecrosis of the jaw, pediatric dentistry Introduction Bisphosphonate important in therapy has become increasingly pediatric medicine for treating various bone disorders, particularly juvenile focal osteoporosis and osteogenesis imperfecta.[1,2] Juvenile focal osteoporosis is a rare condition affecting children, characterized by localized bone loss that can affect the long bones, vertebrae, or other skeletal sites, requiring targeted bisphosphonate intervention to prevent further bone deterioration and fractures.[3] While medication‑related osteonecrosis of the jaw (MRONJ) represents a well‑documented complication in adult populations, the risk profile in children remains significantly different, with no documented cases reported in patients under 24 years of age treated for benign bone conditions.[4,5] Recent systematic reviews indicate MRONJ incidence in pediatric populations is extremely low at 0.25%, | Access this article online | | | --- | --- | | Quick Response Code:
| Website: [https://journals.lww.com/jpbs](https://journals.lww.com/jpbs) | | | DOI: 10.4103/jpbs.jpbs_1461_25 | compared to 1–10% in adult cancer patients receiving IV bisphosphonates.[6] The American Association of Oral and Maxillofacial Surgeons (AAOMS) 2022 position paper acknowledges this fundamental difference, stating that “no cases of MRONJ with sufficient evidence have been reported” in children under 24 years treated for benign bone diseases.[7] However, the rarity of pediatric cases has resulted in limited evidence‑based guidelines specifically addressing dental management in this population, with most recommendations extrapolated from adult protocols.[8,9] Emerging evidence reveals additional considerations beyond MRONJ risk, including potential effects on dental development and eruption patterns, particularly | Address for correspondence: Dr. Rahaf Abdullah Alolayan, Senior Registrar of Pediatric Dentistry at Private Practice, Unizah, Alqassim, Saudi Arabia.
E-mail: [rahaf.alolayan@qudent.org](rahaf.alolayan@qudent.org) | | --- | | This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used

FAQs

Why is dental management challenging in children receiving IV bisphosphonate therapy?

The main concern is medication-related osteonecrosis of the jaw (MRONJ). Although risk is extremely low in children, it still requires careful planning and precautions.

What dental procedures were performed in the reported case?

The patient underwent multiple procedures including extractions, pulp therapy, restorations, and stainless-steel crown placement.

What precautions and coordination were used to reduce risk?

Interdisciplinary consultation with the primary physician and implementation of evidence-based antibiotic prophylaxis protocols were used, along with careful monitoring throughout follow-up.

Sep 30, 2026

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