Proceedings 2019, 35, 78; doi:10.3390/proceedings2019035078 www.mdpi.com/journal/proceedings Extended Abstract MRONJ Treatment with Ultrasonic Navigation: A Case Report † Salvatore Emanuele Teresi *, Gerardo Pellegrino, Roberto Parrulli, Agnese Ferri, Francesca Pavanelli, Riccardo Pirrotta and Claudio Marchetti Unit of Oral and Maxillofacial Surgery, Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, 40125 Bologna, Italy; gerardo.pellegrino2@unibo.it (G.P.); roberto.parrulli@studio.unibo.it (R.P.); agnese.ferri@studio.unibo.it (A.F.); francesca.pavanelli2@unibo.it (F.P.); riccardo.pirrotta@studio.unibo.it (R.P.); claudio.marchetti@unibo.it (C.M.) * Correspondence: salvatore.teresi@studio.unibo.it; Tel.: +39-3209118860 † Presented at the XV National and III International Congress of the Italian Society of Oral Pathology and Medicine (SIPMO), Bari, Italy, 17–19 October 2019. Published: 12 December 2019 Nowadays dynamic computer-based image navigation has become ordinary for hospital-based surgical specialties such as neurosurgery, otolaryngology and maxillofacial-surgery, its use for osteonecrosis curettage is considered “off-label” and isn’t reported in literature. The surgical navigator is a technological-tool which relate the real anatomy of a patient to his radiological images, showing the exact three-dimensional intraoperative position of surgical-instruments. In particular, ImplaNav (BresMedical, Sydney, Australia) is composed of an infrared-camera and reference systems that are placed on the patient and on surgical-handpiece, whose position is detected in real- time by camera. In this report we expose the innovative use of navigated ultrasonic surgery in the treatment of a bilateral medication-related osteonecrosis of the jaw (MRONJ) stage 2b [1] involving the right mandibular canal’s roof in molar region, which is why the patient reported paresthesia to lower right lip, and incurred following the lower first molars’ extraction in a 75-year-old male patient, subjected to 43 previous administrations of Zoledronate (from January 2014 to June 2017) for the treatment of bone metastases from stage IV follicular-thyroid carcinoma. In order to operate with navigator’s aid, the patient’s pre-operative cone-beam computed- tomography (CBCT) was performed by positioning a reference system on dental arches, fixed with an impression material, according to ImplaNav protocol [2]. The surgery was conducted as in-office procedure (Figures 1 and 2) under local anesthesia, after antibiotic-prophylaxis with Amoxicillin + Clavulanic-Acid 1 g/8 h and Metronidazole 250 mg/8 h, both from 3 days before the operation. The preparation of the buccal and lingual flaps and their subsequent suturing have been performed in order to ensure an optimal vision and primary wound closure. Compared to the traditional multi-blade burr mounted on a straight-handpiece, the well-known atraumaticity of ultrasonic-surgery allowed the respect of nerve-vascular bundle and a reduced trauma on the bone. The navigation added, to the simultaneously clinical finding of bleeding bone, the possibility of a constant comparison between clinical vision and CBCT monitor vision, allowing a rapid and complete removal of the radiographically detected altered bone.