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Medication Related Osteonecrosis of the Jaw (MRONJ). Review and recent advances Cover

Medication Related Osteonecrosis of the Jaw (MRONJ). Review and recent advances

Forum of Clinical Oncology
Volume 13 (2022): Issue 1 (December 2022)
By:
Open Access
|Mar 2023

Figures & Tables

Figure 1

Osteonecrosis of the maxilla, presenting as exposed necrotic bone (compact arrow), after a dental extraction. Sockets without teeth (phantom sockets) (transparent arrow), are seen on the necrotic bone. Patient was asymptomatic at presentation.
Osteonecrosis of the maxilla, presenting as exposed necrotic bone (compact arrow), after a dental extraction. Sockets without teeth (phantom sockets) (transparent arrow), are seen on the necrotic bone. Patient was asymptomatic at presentation.

Figure 2

Osteonecrosis on the maxilla was diagnosed after probing necrotic bone through a fistula (arrow). A plastic material (gutaperka) was inserted into the fistula to better disclose the fistula. Patient presented with pain and swelling.
Osteonecrosis on the maxilla was diagnosed after probing necrotic bone through a fistula (arrow). A plastic material (gutaperka) was inserted into the fistula to better disclose the fistula. Patient presented with pain and swelling.

Figure 3

Panoramic radiograph of a cancer patient, who received antiresorptives and presented with a non-healing socket (phantom socket) two months after the dental extraction of the mandibular molar tooth. Patient was diagnosed with MRONJ stage 2.
Panoramic radiograph of a cancer patient, who received antiresorptives and presented with a non-healing socket (phantom socket) two months after the dental extraction of the mandibular molar tooth. Patient was diagnosed with MRONJ stage 2.

Figure 4

Cone Beam Computed Tomography of a cancer patient, who received antiresorptives. Osteolytic areas (arrows) and bone sequestrum (stars) are observed in the maxilla. Fullness of left sinus is also seen (asterisks). Patient was diagnosed with MRONJ stage 3.
Cone Beam Computed Tomography of a cancer patient, who received antiresorptives. Osteolytic areas (arrows) and bone sequestrum (stars) are observed in the maxilla. Fullness of left sinus is also seen (asterisks). Patient was diagnosed with MRONJ stage 3.

MRONJ Stages, American Association of Oral and Maxillofacial Surgeons 2014

Stage 0Stage 1Stage 2Stage 3
Clinical definitions
  • -

    Without clinical evidence of necrotic bone

  • -

    With nonspecific clinical findings

  • -

    With symptoms
  • -

    Exposed and necrotic bone or fistula probing the bone

  • -

    Asymptomatic patients

  • -

    No evidence of infection
  • -

    Exposed and necrotic bone or fistula probing the bone

  • -

    Infection evident by pain and erythema at the site of the exposed bone with or without purulent drainage
  • -

    Exposed and necrotic bone or fistula probing the bone

  • -

    Symptoms of pain and infection

  • -

    Extraoral fistula

  • -

    Oral antral or oral nasal communication

Radiographic features
  • -

    Alveolar bone loss, resorption not attributed to periodontal disease

  • -

    Trabecular pattern changes

  • -

    Dense bone

  • -

    Lamina dura thickening

  • -

    Decreased periodontal ligament space
  • -

    Radiological findings localized to the alveolar bone
  • -

    Radiological findings localized to the alveolar bone
  • -

    Findings extending beyond the region of alveolar bone

  • -

    Pathologic fracture

  • -

    Osteolysis extending to the inferior border of the mandible or sinus floor

DOI: https://doi.org/10.2478/fco-2022-0005 | Journal eISSN: 1792-362X | Journal ISSN: 1792-345X
Journal RSS Feed
Language: English
Page range: 38 - 47
Submitted on: Mar 22, 2018
Accepted on: Mar 17, 2019
Published on: Mar 27, 2023
Published by: Helenic Society of Medical Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 2 times per year
Keywords:
osteonecrosis of the jaw,
clinical presentation,
radiographical findings,
risk factors,
prevention,
dental extraction,
infection,
management
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology

© 2023 Dimitra Galiti, Aikaterini Karayianni, Kostas Tsiklakis, Amanda Psyrri, published by Helenic Society of Medical Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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