New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

Table 1

Summary of different clinical BRONJ staging.

	Marx 2007 [28]	AAOMS 2009 [16]	SICMF and SIPMO 2012 [29]
At-risk; category		No apparent exposed/necrotic bone in patients who have been treated with either oral or IV bisphosphonates
Stage 0	Subclinical damage, microscopically represented by beginner hypocellularity osteoclast apoptosis and decrease of endosteal osteoblast	Nonspecific clinical findings and symptoms such as jaw pain or osteosclerosis but no clinical evidence of exposed bone
Stage 1	A: painless exposed bone <1 cm; B: painless exposed bone >1 cm	Exposed/necrotic bone in patients who are asymptomatic and who have no evidence of infection	Focal BRONJ; Clinical signs and symptoms: bone exposure; sudden dental mobility; nonhealing postextraction socket; mucosal fistula; swelling; abscess formation; trismus; gross mandibular deformity; and/or hypoesthesia/paraesthesia of the lips; CT finding: increased bone density limited to the alveolar bone region (trabecular thickening and/or focal osteosclerosis), with or without the following signs: markedly thickened and sclerotic lamina dura; persisting alveolar socket; and/or cortical disruption; 1a: asymptomatic; 1b: symptomatic (pain and purulent discharge)
Stage 2	A: painful and infected single exposed bone <2 cm; B: painful and infected single exposed bone >2 cm	Exposed/necrotic bone associated with infection as evidenced by pain and erythema in the region of the exposed bone with or without purulent drainage	Diffuse BRONJ; Clinical signs and symptoms: the same as Stage 1; CT findings: increased bone density extended to the basal bone (diffuse osteosclerosis), with or without the following signs: prominence of the inferior alveolar nerve canal; periosteal reaction; sinusitis; sequestra formation; and/or oroantral fistula; 1a: asymptomatic; 1b: symptomatic (pain and purulent discharge)
Stage 3	A: multiple exposed bone areas without clinical findings of osteolysis, orocutaneous fistula, or pathological fractures; B: exposed bone >3 cm or with clinical findings of osteolysis, or orocutaneous fistula, or pathological fractures	Exposed/necrotic bone in patients with pain, infection, and one or more of the following: pathologic fracture, extraoral fistula, or osteolysis extending to the inferior border or sinus floor	Complicated BRONJ; The same as Stage 2, with one or more of the following: clinical signs and symptoms: extraoral fistula; displaced mandibular stumps; nasal leakage of fluids; CT findings: osteosclerosis of adjacent bones (zygoma, hard palate); pathologic mandibular fracture; and/or osteolysis extending to the sinus floor