Conservative Surgical Management of Stage I Bisphosphonate-Related Osteonecrosis of the Jaw

Table 1

Clinical classification of BRONJ by Ruggiero et al. [3] (2009).

BRONJ stage	Description	Treatment strategies
At risk category	No apparent necrotic bone in patients who have been treated with either oral or IV bisphosphonates	No treatment; Patients education
Stage 0	No clinical evidence of necrotic bone, but nonspecific clinical findings and symptoms	Systemic therapies including pain medications and antibiotics
Stage I	No symptomatic lesions with bone exposure in absence of signs of infection	Topical antiseptic therapy; Follow-up
Stage II	Bone exposure with pain, infection, and swelling in the area of lesion	Oral antibiotics—antibacterial mouth rinse-pain control; Superficial debridement to relieve soft tissues irritation
Stage III	Bone exposure, pain, inflammation, maxillary sinus involvement, cutaneous fistulas, and pathological fractures	Antibacterial mouth rinse; Antibiotic therapy and pain control; Surgical debridement and resection for longer term palliation of infection and pain

Modified from [3].