title: Dramatic course of osteomyelitis in a patient treated with immediately placed dental implants suffering from uncontrolled diabetes: A case report.
abstract: OBJECTIVE
  To report a rare and dramatic complication following immediate dental implant placement in a heavy smoker, who had a delayed diagnosis of uncontrolled diabetes.
  
  
  METHODS
  In this case report we present the dramatic course of a 64-year old female patient treated with five immediate post-extractive dental implants in the mandible, who developed osteomyelitis, which manifested initially as local peri-implant inflammation and progressed into a spontaneous jaw fracture, despite repeated surgical interventions and antibiotic courses over a 3-year period, until diabetes was diagnosed.
  
  
  RESULTS
  A symptom-free status could be achieved only after partial mandibulectomy, treatment of diabetes and reconstruction with a microvascular fibula free flap.
  
  
  CONCLUSIONS
  In the presence of mandibular osteomyelitis refractory to therapy, yet undiagnosed underlying pathologies, such as diabetes, should be investigated and treated urgently.
authors.forename: Christian
authors.initials: C
authors.lastname: Doll
authors.forename: Stefan
authors.initials: S
authors.lastname: Hartwig
authors.forename: Claudia
authors.initials: C
authors.lastname: Nack
authors.forename: Susanne
authors.initials: S
authors.lastname: Nahles
authors.forename: Katja
authors.initials: K
authors.lastname: Nelson
authors.forename: Jan-Dirk
authors.initials: JD
authors.lastname: Raguse
mesh_terms: D000038:Abscess / Q000382:microbiology; D000540:Alveolar Ridge Augmentation / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D017577:Cutaneous Fistula / Q000175:diagnosis; D057210:Delayed Diagnosis; D015921:Dental Implants / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000009:adverse effects*; D008336:Mandibular Diseases / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D008337:Mandibular Fractures / Q000209:etiology; D063175:Mandibular Reconstruction / Q000379:methods; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D057873:Peri-Implantitis / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012907:Smoking; D013290:Streptococcal Infections / Q000175:diagnosis; D034367:Streptococcus intermedius / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D015921:Dental Implants