Sir, we present a unique case of a foreign body reaction in a 52-year-old male patient presenting with pain in the lower right quadrant and a large destructive area of bone loss in the body of the mandible. This was subsequently attributed to an intra-osseous foreign body reaction as a result of amalgam displaced into the socket during an extraction several months ago.

Physical examination revealed slight facial swelling present at the right body of the mandible with no cervical lymphadenopathy or trismus. The patient had no neurological deficits including intact lip sensation.

Intraoral examination revealed a firm palpable swelling in the buccal sulcus around the lower right second premolar region, with no mobility or tenderness to percussion of the adjacent teeth.

Panoramic radiograph (Fig. 1) showed a diffused irregular radiolucent area in the right side of the body of the mandible with residual amalgam residue present within the affected bone leading to significant root resorption of the lower right canine, first premolar and first molar teeth. The pathological area was explored, debridement and curettage of the area was performed under local anaesthesia with extraction of the L44 and L46.

Figure 1
figure 1

Residual amalgam within socket

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The patient was followed up for six months and remains asymptomatic with radiological evidence for good bony infill (Fig. 2). This case clearly demonstrates iatrogenic cause for a large bony lesion of the mandible requiring surgical referral and treatment, which was potentially avoidable. The bony destruction resulted in the loss of two additional teeth and if allowed to progress could have resulted in further damage to bone and additional tooth loss.

Figure 2
figure 2

Six-month follow-up showing good bony infill

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We recommend dentists to be mindful of restorations of teeth to be extracted and adjacent soft tissues. Should there be any doubt of dislodged fragments of restoration, attempts should be made to recover them from the tissues and if unsuccessful then an appropriate referral to an oral maxillofacial unit is to be advised.