What is NICO in dentistry?
Neuralgia-Inducing Cavitational Osteonecrosis (NICO) refers to chronic jawbone lesions where bone healing is incomplete, often following dental extractions or infections, resulting in chronic pain and necrosis.
What causes Neuralgia-Inducing Cavitational Osteonecrosis?
NICO is caused by insufficient healing of bone tissue after dental trauma, infections, or surgical procedures.
The affected areas often show ischemic (low blood flow) conditions, leading to necrosis and chronic low-grade inflammation.
How do you know if you have NICO?
Typical symptoms include persistent jaw pain, TMJ discomfort, radiating facial pain, ear pain, chronic fatigue, and sometimes unexplained systemic issues.
Diagnosis requires advanced imaging (such as CBCT), as regular dental X-rays may miss these lesions.
What are the symptoms of NICO cavitations?
Symptoms can include:
- Ongoing jaw pain
- Ear discomfort
- TMJ symptoms
- Chronic sinus
- problems
- Headaches
- Fatigue
- Unexplained facial swelling or discomfort
Diagnosis and Differential Considerations
- Chronic localized osteitis / cavitation (NICO)
- Residual infection from incomplete tooth extraction
- Low-grade chronic osteomyelitis
Patients often seek support using search terms such as:
- Cavitational osteonecrosis treatment
- Osteonecrosis of the jaw
- Biological dentist for jawbone issues
NICO; A Case presentation
A 50-year old gentleman presented with chronic pain in the lower right jaw, including tenderness, discomfort radiating toward the ear, and pain in the temporomandibular joint (TMJ) area.
The symptoms had been ongoing since a tooth extraction, raising concerns about a jawbone infection after tooth extraction or a silent tooth infection not visible through routine dental examinations.
Patients with similar symptoms often search for:
- CBCT scan jaw pain
- Hidden dental infection symptoms
- Pain years after wisdom tooth removal
Advanced CBCT Imaging – Region Lower Right Six (LR6)
A Cone Beam CT (CBCT) scan was performed to explore the possibility of a dental infection that was not visible through traditional imaging. CBCT provides a 3D view of the jawbone and is highly effective in detecting subtle lesions, particularly cavitations in the jawbone.
CBCT Findings:
- A 3-dimensional radiolucent area around site LR6 (approx. 5mm × 12mm)
- A radiolucent channel extending toward the previous extraction site, suggesting incomplete healing
- Communication with the oral cavity, consistent with a residual infection or toxic bone lesion
Patients often associate these findings with terms such as:
- Dental cavitation symptoms
- Toxins in jaw bone
- Fatigue and jawbone infection link
Additional CBCT Findings – Tooth UR6
The CBCT scan also revealed a periapical infection affecting the mesiobuccal, distobuccal, and palatal roots of tooth UR6, with associated thickening of the sinus floor lining—suggestive of odontogenic sinusitis.
Diagnosis:
- Chronic apical periodontitis (Tooth UR6)
- Odontogenic maxillary sinusitis
Treatment Plan
LR6 – Suspected Cavitation Site
An explorative surgical procedure was recommended to treat the suspected jawbone cavitation.
Patients commonly use the following search terms when researching such treatments:
- Holistic treatment for dental cavitations
- Toxic jawbone infection symptoms
- CBCT scan for dental infection
Procedures:
- Explorative Surgical Access:
- Full-thickness flap raised
- Curettage of necrotic bone (using Lucas curettes)
- Irrigation and removal of infected tissues
- Biological Healing Support:
- Ozonated saline (45 γ) application
- Ozonated gauze placement for 30 minutes
- Photobiomodulation laser therapy (Laser, 660 nm, 25mW) before and after surgery
- Bony Defect Management:
- Guided bone regeneration (GBR) and adjunct antimicrobial treatment considered
- Postoperative Monitoring:
- Clinical follow-up visits
- Repeat CBCT imaging if necessary
UR6 (Upper Right Molar)
- Atraumatic Biological extraction of tooth UR6 was performed to eliminate the infection.
- Healing was supported using biological regenerative techniques.
Persistent jaw pain following dental procedures may be the result of hidden cavitations, chronic infections, or NICO lesions.
Using advanced diagnostics like CBCT combined with biological surgical therapies, we are able to offer patients a path to recovery that respects both oral and systemic health.
At London Specialist Dentists, our goal is to provide holistic, minimally invasive, and scientifically sound solutions for complex dental and jawbone conditions.
Dr. Nico Kamosi
Dr. Nico Kamosi
Specialist Periodontist, Implantologist, Prosthodontist, Holistic and Biological Dentist
TDL. DDS. (Swe.), MSc.Perio.(Eng.),
MClinDent.Perio.(Eng.), MSc.Imp.Dent.(Eng.),
Dip.Aesth.Med. (Eng.), MClinDent.Prosth.(Eng.),
Cert., Dip.DHSLM.(RCS.Eng.), Cert.Orth.(Eng.), Cert.Law (Eng.)
Member of: AACD - IAOMT - EFP - ESCI - SMART Certified
