Restor Dent Endod.  2024 May;49(2):e13. 10.5395/rde.2024.49.e13.

Garre’s osteomyelitis of the mandible managed by nonsurgical reendodontic treatment

• Kim H
• Kwon J
• Kim HJ
• Oh S
• Kim DS
• Jang JH

• KMID: 2556542
• DOI: http://doi.org/10.5395/rde.2024.49.e13

Abstract

Chronic osteomyelitis with proliferative periostitis, known as Garre’s osteomyelitis, is a type of osteomyelitis characterized by a distinctive gross thickening of the periosteum of bones. Peripheral reactive bone formation can be caused by mild irritation or infection. Garre’s osteomyelitis is usually diagnosed in children and young adults, and the mandible is more affected than the maxilla. The following is a case report of a 12-year-old female patient with Garre’s osteomyelitis of the mandible due to an infection of a root canal-treated tooth. Without surgical intervention, the patient’s symptoms were relieved through nonsurgical root canal re-treatment with long-term calcium hydroxide placement. A cone-beam computed tomography image obtained 6 months after treatment completion displayed complete healing of the periapical lesion and resolution of the peripheral reactive buccal bone. Due to the clinical features of Garre's osteomyelitis, which is characterized by thickening of the periosteum, it can be mistaken for other diseases such as fibrous dysplasia. It is important to correctly diagnose Garre's osteomyelitis based on its distinctive clinical features to avoid unnecessary surgical intervention, and it can lead to minimally invasive treatment options.

Keyword

Calcium hydroxide; Garre’s osteomyelitis; Proliferative periostitis

Figure

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  Figure 1 Preoperative examination. (A) A clinical photograph displaying the normal coral-pink color of the buccal vestibule of tooth #36 and the absence of a sinus tract. (B) A periapical radiograph displaying apical radiolucency associated with #36.

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  Figure 2 Cone beam computed tomography images of tooth #36. (A) A sagittal image displaying periapical radiolucency of tooth #36. (B, C) The coronal view exhibits unique proliferative buccal cortical bone formation (arrow). (D, E) The axial view displays a typical “onion skin-like appearance over the cortical bone (arrow). (F) Three-dimensional reconstruction image presenting buccal bone changes which indicate the neo-hard tissue formation (arrow).

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  Figure 3 Intraoperative photograph and follow-up periapical radiograph. (A) After removal of composite resin core, contaminated gutta-percha cones were observed. (B) Six-month follow-up after nonsurgical root canal retreatment revealed the resolution of periapical radiolucency. Tooth #36 is asymptomatic and functional.

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  Figure 4 Cone beam computed tomography images of tooth #36 after 6-month follow-up. (A) A sagittal image displaying the complete resolution of periapical radiolucency of tooth #36. (B, C) Coronal and axial views display the absence of buccal cortical bone formation. (D) Three-dimensional reconstruction image presents normal buccal bone anatomy of the mandible.

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