Natural Sciences, Stomotology, 2026
ISSN: 1829-006X
A RARE CASE OF METHOTREXATE-RELATED OSTEONECROSIS OF MANDIBLE WITH AGGRESSIVE COURSE (CASE REPORT)
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Submitted: 2026-04-08
© 2026 by author(s) and The Gufo Inc.
This work is licensed under Creative Commons Attribution–NonCommercial International License
(CC BY-NC 4.0).
Abstract
Methotrexate-related osteonecrosis of the jaws is a rare disease. It is usually diagnosed in patients with rheumatoid
arthritis treated with methotrexate. The most common trigger of MTX-ONJ is odontogenic infection. Common clinical
findings in these patients are exposed alveolar ridges and fistulas with purulent discharge, redness, and edema of
surrounding soft tissues. Stage-1 and -2 cases are usually found. Stage-3 cases are too rare. On CBCT scans,
sequestrums and bone destruction are common.
The period of sequestrum formation is not prolonged as in BRONJ patients. After sequestrum formation, surgical
treatment is effective, with low recurrence rates. Usually, sequestrum removal and bone debridement are proper.
This study presents a rare case of stage 3 MTX-related ON of the mandible with a pathological fracture. Mandible
segmental resection under general anesthesia was proper for the treatment.