Jawbone Cavitations (FDOJ/NICO): What They Are and How They Are Treated
Updated: Jul 22
The short answer: A jawbone cavitation is an area inside the jawbone — usually at an old tooth-extraction site — where the bone did not heal completely and instead left a hollow or soft, poorly mineralised zone. In biological dentistry these lesions are known as FDOJ (Fatty Degenerative Osteonecrosis of the Jaw) or, in older literature, NICO (Neuralgia-Inducing Cavitational Osteonecrosis). They are often painless and hard to see on ordinary X-rays, which is why they are frequently missed. It is important to be clear from the outset: this is a genuinely debated topic in dentistry — some of the systemic claims made about cavitations are not established by high-quality evidence, and I will say so honestly below. What is not in doubt is that incomplete bone healing after extraction is real, detectable on 3D imaging, and worth evaluating when the clinical picture calls for it.
What is a jawbone cavitation?
When a tooth is removed, the socket is expected to fill in with healthy, solid bone over the following months. Sometimes that process is incomplete. Instead of dense bone, the site develops a pocket of fatty, non-mineralised, poorly vascularised tissue — sometimes a partial hollow within the bone. This is what biological dentists mean by a cavitation.
The lesions are most common at sites of past extractions — particularly wisdom teeth — and are also described around root canal-treated teeth. Because they sit inside the bone and often cause no local pain, they can remain unnoticed for years.
The names: FDOJ, NICO, BMDJ — same idea, different eras
The terminology is confusing because it has evolved over a century:
• NICO (Neuralgia-Inducing Cavitational Osteonecrosis) — an older term, introduced when the lesions were linked mainly to facial nerve pain.
• FDOJ (Fatty Degenerative Osteonecrosis of the Jaw) — the term coined by Dr. Johann Lechner in Munich, now the most widely used in biological dentistry.
• BMDJ (Bone Marrow Defects of the Jaw) — a more recent, descriptive variant.
They refer to the same clinical picture: a chronic, low-grade problem area in the jawbone that does not behave like a classic “hot” infection.
Why biological dentistry takes them seriously
Conventional dentistry tends to view the mouth as a local, mechanical system. Biological dentistry looks at the jawbone as part of the whole body — which is the same principle behind the biological approach to root-treated teeth.
The specific concern with cavitations is that the tissue inside them has been shown, in some research, to over-express an inflammatory signalling molecule called RANTES/CCL5. The hypothesis — associated primarily with Dr. Lechner’s work — is that this creates a “silent inflammation” that adds to the body’s overall inflammatory load. Unlike an acute abscess, these lesions often show low levels of the usual acute-inflammation markers, which is part of why standard dentistry can overlook them.
An honest word about the controversy
I would not be doing my job as a doctor if I presented only one side.
The existence of incomplete bone healing after extraction is not controversial — it is visible on imaging and in surgery. What is debated is (1) how common truly pathological cavitations are versus normal variations in socket healing, and (2) whether they cause the wide range of distant, whole-body symptoms sometimes attributed to them.
Major conventional bodies, including the American Association of Endodontists, consider NICO poorly defined and its treatment not yet supported by high-quality evidence. Recent radiological research has also proposed that some non-mineralised areas at old extraction sites may simply be a benign consequence of the socket healing incompletely — not a disease at all. And the ultrasound devices used to detect cavitations, while promising, have not yet been fully standardised or validated.
My position is a clinician’s, not an ideologue’s: cavitations are real as a healing phenomenon, worth investigating in the right patient, and over-claimed by some in this field. I do not promise that treating a cavitation will cure a systemic illness — anyone who guarantees that is ahead of the evidence. What I offer is careful diagnosis and, where genuinely indicated, careful treatment.
Symptoms sometimes associated with cavitations
These are not diagnostic — they are reasons a biological dentist might look more closely, especially when other causes have been excluded:
• Non-specific or atypical facial pain, or a dull ache with no obvious dental cause
• A past traumatic or complicated extraction (often wisdom teeth) that “never felt quite right”
• Persistent local tenderness at an old extraction site
I want to be careful here: many general symptoms (fatigue, joint aches, and so on) have countless possible causes. A cavitation is, at most, one item on a long list — and never a diagnosis made from symptoms alone.
How cavitations are diagnosed
Proper evaluation is imaging-led, not guesswork:
CBCT (3D cone-beam scan) — the foundation. A flat 2D X-ray frequently misses these lesions; a high-resolution 3D scan can reveal non-mineralised zones and the classic “phantom” appearance at an old socket.
Ultrasound bone-density assessment (e.g. CaviTAU®) — a radiation-free method that some clinics abroad use as an adjunct to CBCT. It is worth knowing about, but it is not currently available in our region, and the technology is still being validated. In my Dubai practice, diagnosis is therefore led by high-resolution CBCT, which remains the practical and reliable foundation for assessing these lesions.
Clinical history — previous extractions, healing course, and exclusion of other causes.
The order matters: diagnosis first, on real imaging. No responsible clinician operates on a jawbone based on a symptom questionnaire.
How cavitations are treated
When treatment is genuinely indicated, the biological approach is minimally invasive and focused on giving the bone a chance to heal properly this time:
• Careful surgical cleaning of the affected area, typically with piezosurgery — a precise, tissue-sparing technique that protects surrounding structures.
• Disinfection, often with ozone.
• PRF (platelet-rich fibrin) — a concentrate from the patient’s own blood placed in the cleaned site to support genuine bone regeneration. This is the same healing biology I use in ceramic implant surgery.
The goal is straightforward: remove the poorly healed tissue as atraumatically as possible and create the conditions for solid bone to form.
Cavitations and implant planning
There is a very practical, non-controversial reason to care about non-mineralised areas in the jaw: they matter when planning an implant. An unrecognised soft zone at a former extraction site can compromise the primary stability of an implant. Identifying and addressing it beforehand is simply good surgical planning — one more argument for thorough 3D diagnostics before any implant.
Frequently asked questions
Are jawbone cavitations a proven medical condition?
Incomplete bone healing after extraction is well documented. The broader concept of cavitations as a cause of whole-body illness is scientifically debated and not established by high-quality evidence. An honest clinician treats the local bone problem where indicated, without over-promising systemic cures.
Can a cavitation be seen on a normal X-ray?
Often not. These lesions are frequently invisible on standard 2D X-rays, which is why a CBCT 3D scan is the appropriate imaging when a cavitation is suspected.
Do cavitations always need surgery?
No. Not every non-mineralised area is a lesion that requires treatment — some are benign healing variations. Surgery is considered only when imaging and clinical findings genuinely support it. Over-treatment is a real risk in this field, and I treat it as one.
Should I get checked “just in case”?
If you have no symptoms and no relevant history, routine screening for cavitations is not something I would push. If you have an old extraction site that has never felt right, unexplained atypical facial pain with dental causes excluded, or you are planning an implant near a former extraction, a CBCT evaluation is reasonable.
Do you treat cavitations in Dubai?
Yes — with the same principles described here: 3D-led diagnosis, honest assessment of whether treatment is warranted, and minimally invasive, PRF-supported surgery when it is. And an honest conversation when it is not.
Dr. Tomasz Zaranski is a ceramic implant specialist and biological dentist practising at Dr. Joy Dental Clinic in Dubai. He is SMART certified (IAOMT), trained in the Swiss BioHealth concept, and has completed the Biodentistry 3.0 certification programme including the Bone Healing Protocol. He holds Diplomate status with the ICOI and DGOI and has over 21 years of clinical experience.
This article is for general information and reflects an area of ongoing scientific debate. It does not replace an individual diagnosis. To have an old extraction site or unexplained symptom properly evaluated, book a consultation.
