ABSTRACT Osteonecrosis of the jaws is a severe condition associated with the use of anti‐resorptive therapies, such as bisphosphonates, which inhibit osteoclast activity and diminish bone repair capacity. Although the risk of osteonecrosis is generally low in patients undergoing oral administration of these medications, the potential for complications remains. A lack of awareness among dental surgeons about this condition often leads to the performance of surgical procedures without adequate pre‐ and post‐operative care, potentially resulting in significant complications and serious long‐term consequences. Aim This work aims to report a case of a patient undergoing treatment with bisphosphonates who faced post‐surgical complications after surgical procedures performed without the appropriate care. Methods The patient, a 73‐year‐old woman, underwent tooth extractions and dental implant removal while being on sodium alendronate therapy for 2 years. She developed maxillary sinusitis associated with an oroantral fistula and suffered severe loss of a significant portion of her left maxilla. Results and Conclusion For case management, surgical and conservative approaches were employed, including surgical debridement, flap creation for oroantral fistula closure, laser therapy, antibiotic treatment and the combination of a medication protocol with pentoxifylline and tocopherol. This underscores the importance of dental surgeons having comprehensive knowledge of osteonecrosis of the jaws and being equipped to manage these cases effectively, considering both clinical treatment strategies and the potential prevention of complications.