Staging of Medication Related Osteonecrosis of the Jaws

A quick little refresher on MRONJ staging! Have you seen my instagram post on medications related to MRONJ?

A position paper of the American Association of Oral and Maxillofacial Surgeons describes a clinical staging process.

Clinical Staging of MRONJ (adapted from Ruggeiro et al. 2014)

At risk—no apparent necrotic bone in patients who have been treated with oral or intravenous bisphosphonates

Stage 0—no clinical evidence of necrotic bone but nonspecific clinical findings, radiographic changes, and symptoms

Stage 1—exposed and necrotic bone or fistulas that probes to bone in patients who are asymptomatic and have no evidence of infection

Stage 2—exposed and necrotic bone or fistulas that probes to bone associated with infection as evidenced by pain and erythema in the region of exposed bone with or without purulent drainage

Stage 3—exposed and necrotic bone or a fistula that probes to bone in patients with pain, infection, and 1 of the following: exposed and necrotic bone extending beyond the region of alveolar bone (i.e, inferior border and ramus in mandible, maxillary sinus, and zygoma in maxilla) resulting in pathologic fracture, extraoral fistula, oral antral or oral nasal communication, or osteolysis extending to inferior border of the mandible or sinus floor

An area of exposed bone involving the lower right mandible in a 72-year-old female who received denosumab (Prolia®) injections

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