The “CROMa” Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure

Table 1

2013 SIPMO/SIMCF clinical-radiological staging of BRONJ [28].

Stage 1	Focal BRONJ: in the presence of at least 1 minor clinical sign or of bone thickening on CT limited to mandibular or maxillary dentoalveolar process*, with or without other early radiological signs.
	Minor clinical signs and symptoms: halitosis, odontogenic abscess, mandibular asymmetry, pain of dental and/or boned origin, bone exposure, mucosal fistula, postextractive mucosal healing failure, rapid onset tooth mobility, paresthesia/dysesthesia of the lips, purulent leakage, spontaneous seizure of bone fragments, trismus, and soft tissues swelling.
	Signs on CT: trabecular thickening, bone marrow focal osteosclerosis, with or without thickening of the alveolar crest, postextractive socket persistence, and periodontal space flare.
	(A) Asymptomatic.
	(B) Symptomatic (presence of pain and/or suppuration).
Stage 2	Widespread  BRONJ: in the presence of at least 1 minor clinical sign or of bone thickening on CT, also extended to the mandibular or maxillary basal process, with or without late radiological signs.
	Minor clinical signs and symptoms: as for Stage 1.
	CT signs: widespread osteosclerosis, with or without oroantral and oronasal fistula, thickening of the inferior alveolar nerve canal, periosteal reaction, bone seizure, and sinusitis.
	(A) Asymptomatic.
	(B) Symptomatic (presence of pain and/or suppuration).
Stage 3	Complicated BRONJ: as in Stage 2, in the presence of 1 or more of the following signs:
	Minor clinical signs: extraoral fistula, leakage of fluid from the nose, and preternatural mobility of the jaw with or without occlusion preservation.
	CT signs: mucocutaneous fistula, pathologic fracture, osteolysis extended to maxillary sinus, and cheekbone and/or hard palate osteosclerosis.

Dentoalveolar bone anatomical structure that constitutes the skeletal support for the teeth. By definition, the dentoalveolar process ends in craniocaudal direction immediately below the root of the teeth.