Bisphosphonate-related osteonecrosis of the jaws: Study of the staging system in a series of clinical cases

Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity

“…It was also observed that the degree of sclerosis increased with the clinical stage of BRONJ, disagreeing with Hamada et al 38 Bone sclerosis, which is visualized as the loss of contrast definition between cortical bone and bone marrow space, 27,36 has been reported as the most significant early imaging sign of BRONJ. 16,19,27,29,30,36 It has been used as a criterion for non-exposed BRONJ because of its high prevalence at sites indicated by patients as symptomatic. 27,29,30,36 The explanation for this finding is the fact that bone sclerosis can be triggered by chronic infection such as periodontal and periapical abscesses, which in turn are risk factors for BRONJ.…”

“…[12][13][14][15][16][17][18][19][20] Since then, two updates have been performed by the AAOMS 21,22 and several authors have discussed the possibility of BRONJ occurrence despite the absence of bone exposure. 16,18,20,23,24 According to them, this condition should be called nonexposed BRONJ. 18,20,24 BRONJ is a relatively recent entity and many doubts regarding its aetiopathogenesis and approach still persist.…”

“…16,19,20,27,28 Meanwhile, some authors have been screening patients without bone exposure looking for signs and symptoms capable of providing early diagnosis of BRONJ. 16,19,24,27,29,30 Hutchinson et al 29 reported a cohort study in which maxillofacial imaging of 30 patients using oral bisphosphonate and presenting with non-specific symptoms suggesting BRONJ were evaluated. Radiographic changes were detected in 10 (33.33%) patients and consisted of bone sclerosis, persistent alveolar socket after tooth extraction, periradicular radiolucencies, increased thickness of the lamina dura and narrowing of the mandibular canal.…”

“…In a retrospective study of 126 cases, Bagan et al 16 classified patients according to the updated staging system of 2009. 21 Six patients did not fulfil the criteria, because even though they had some clinical signs of Stage 3 (extraoral fistula, mandible pathological fracture and/or osteolysis extending to the sinus floor/cortical bone), there was no necrotic bone exposure.…”

Osteochemonecrosis: An Overview

“…For radiographic aspects, due to the long time periods necessary for bone to demonstrate evidence of significant sclerotic or osteolytic change, it is assumed that the duration is of at least 8 weeks. Some other staging systems have been proposed but at this point in time the AAOMS paper is the most widely utilized [11,50].…”