Table 1.
Dimensional staging of MRONJ and corresponding treatment options, as proposed by Franco et al. [14].
| Clinical and radiological findings of MRONJ | Treatment | |
|---|---|---|
| Stage 0 | No bone exposure with nonspecific radiographic findings, such as osteosclerosis and periosteal hyperplasia, and nonspecific symptoms, such as pain | Medical therapy and clinical-radiological follow-up |
| Stage I | Bone exposure and/or radiographic evidence of necrotic bone, or persisting alveolar sockets < 2 cm in the major diameter, with or without pain | Medical therapy, surgical debridement, and low-level laser therapy (LLLT) |
| Stage II | Bone exposure and/or radiographic evidence of necrotic bone between 2 and 4 cm in maximum diameter, with pain responsive to NSAIDs and possible abscesses | Medical therapy and small open-access surgery with piezosurgery of bone margins |
| Stage III | Bone exposure and/or radiographic evidence of necrotic bone > 4 cm in the maximum diameter, with strong pain, responsive or not to NSAIDs, abscesses, orocutaneous fistulas, and/or maxillary sinus and mandibular nerve involvement | Medical therapy and wide open-access surgery, with extensive maxillary (Caldwell-Luc technique) or mandibular resection, and piezosurgery of bone margins |