[Maxillary osteonecrosis caused by toxic effect of zinc-oxide-eugenol paste]

Zinc-oxide powder mixed with eugenol or cariofillorum oil and sterilized cotton is frequently used in dental practice as surgical bandage for eliminating or dry socket. Osteonecrosis of alveolar bone caused by free eugenol is rare but possible complication. The aim of this paper is to present a patient with maxillary osteonecrosis complicated with maxillary sinusitis caused by a surgical paste of zinc-oxide. A 47-year-old female patient was admitted to our department after unsuccessful treatment of dry socket with a paste of zinc-oxide. Intense use of zinc-oxide paste as bandage over the extraction sockets caused two separately osteonecrosis of maxillary alveolar bone. Surgical resection of necrotic bone, extraction of adjacent teeth and revision surgery of maxillary sinus was treatment of choice. Postoperative course was uneventful and 6 months postoperatively there weren't present further signs of maxillary necrosis. In preparation of a paste of zinc-oxide as surgical bandage it is necessary that all the powder be filled up with intense mixing with liquid. In present case osteonecrosis was caused by free eugenol in surgical zinc-oxide bandage as well as due to the long term and frequently used of zinc-oxide. In resistant dry sockets we recommended combined method of treatment and not only the use of zinc-oxide paste especially if there was no analgesic and therapeutic effects.