Table 5:
RadORN – A Novel Classification system for ORN
| Description | Stage | Radiographic Findings | Clinical Findings | Intervention | Clinical trial grade proposalC |
|---|---|---|---|---|---|
| Distinct from ORN, occurs more often in patients with history of RT | Minor Bone Spicules | None, aside from superficial sequestra | Intact mucosa with superficial mobile sequestra within mucosa Mobile bone in soft tissue |
None indicated | Grade 0 |
| Radiographic evidence of bone necrosis confined to alveolar bone with no clinical signs of ORN | Stage 0 | Bone necrosis confined to alveolar bone includingA: • Bone lysis/sclerosis • Widening periodontal ligament (PDL) space • Absence of osseous filling of extraction sockets |
Intact Mucosa | None indicated | Grade 1 |
| Clinical signs of ORN with or without radiographic evidence of bone necrosis confined to alveolar bone | Stage 1 | None or as stage 0 | Exposed boneB | Minor surgical intervention may be indicated (Sequestrectomy) and or medical management maybe indicated (Pentodo, HBO) with or without adjunctive conservative management (chlorhexidine rinses, antibiotics) | Grade 2 |
| Radiographic evidence involving basilar bone with or without clinical signs of ORN | Stage 2 | Bone necrosis involving the basilar bone or maxillary sinus | Intact mucosa or Exposed boneB | Intermediate surgical intervention may be indicated, (transoral surgical intervention and debridement, alveolectomy, soft tissue closure) with or without adjunctive conservative and medical management | Grade 3 |
| Advanced ORN | Stage 3 | One or more of the following, ○ Pathological fracture ○ Orocutaneous fistula ○ Oral antral communication/Oral nasal communication |
One or more of the following, ○ Pathological fracture ○ Orocutaneous fistula ○ Oral antral communication/Oral nasal communication |
Reconstructive surgical intervention is indicated e.g. segmental maxillectomy/mandibulectomy with vascularized free tissue reconstruction with or without adjunctive conservative and medical management | Grade 4 |
A:
Depending on the imaging modality used, scatter from metallic restorations can impede detection of Stage 0 radiographic findings
B:
Including pin-point mucosal breach (intra-oral fistula) that probes to bone and/or probing to bone along periodontal tissues
C:
Clinical trial grading may correspond to clinical, radiographic and/or intervention