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Staging and treatment strategies for bisphosphonate-related osteonecrosis of the jaws (BRONJ, also referred to as antiresorptive agent-induced osteonecrosis of the jaw (ARONJ)

Patients may be considered to have BRONJ/ARONJ  if all of the following three characteristics are present:

  1. Current or previous treatment with a bisphosphonate or an antiresorptive agent;
  2. Exposed bone in the maxillofacial region that has persisted for more than eight weeks; and
  3. No history of radiation therapy to the jaws.
At Risk
Clinical Presentation
No apparent exposed or necrotic bone in a patient who have been treated with oral or IV antiresorptive agents.
Suggested Treatment
No treatment needed.
Provide patient education.

 

Stage 0
Clinical Presentation
No clinical evidence of necrotic bone, but presence of non-specific signs and symptoms.
Suggested Treatment
Symptomatic treatment.

 

Stage 1
Clinical Presentation
Exposed or necrotic bone in a patient without symptoms and no signs of infection.
Suggested Treatment
Antibacterial oral rinse.
3 months follow-ups.
Provide patient education.

 

Stage 2
Clinical Presentation
Exposed or necrotic bone associated with an infection accompanied by pain and erythema, and possible purulent drainage in the area of the lesion.
Suggested Treatment
Broad-spectrum antibiotic.
Antibacterial oral rinse.
Pain control.
Superficial debridement.

 

Stage 3
Clinical Presentation
Exposed or necrotic bone in a patient with pain, infection and one or more of the following: pathologic fracture, extraoral fistula, or osteolysis extending to the cortical border.
Suggested Treatment
Antibiotics.
Antibacterial oral rinse.
Analgestics.
Surgical debridement or resection.

Adapted from : American Association of Oral and Maxillofacial Surgeons Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaw—2009 Update

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