Medication-Related Osteonecrosis of the Jaws: Considerations on a New Antiresorptive Therapy (Denosumab) and Treatment Outcome after a 13-Year Experience

Table 1

Dimensional staging of MRONJ and corresponding treatment options, as proposed by Franco et al. [14].

	Clinical and radiological findings of MRONJ	Treatment
Stage 0	No bone exposure with nonspecific radiographic findings, such as osteosclerosis and periosteal hyperplasia, and nonspecific symptoms, such as pain	Medical therapy and clinical-radiological follow-up
Stage I	Bone exposure and/or radiographic evidence of necrotic bone, or persisting alveolar sockets < 2 cm in the major diameter, with or without pain	Medical therapy, surgical debridement, and low-level laser therapy (LLLT)
Stage II	Bone exposure and/or radiographic evidence of necrotic bone between 2 and 4 cm in maximum diameter, with pain responsive to NSAIDs and possible abscesses	Medical therapy and small open-access surgery with piezosurgery of bone margins
Stage III	Bone exposure and/or radiographic evidence of necrotic bone > 4 cm in the maximum diameter, with strong pain, responsive or not to NSAIDs, abscesses, orocutaneous fistulas, and/or maxillary sinus and mandibular nerve involvement	Medical therapy and wide open-access surgery, with extensive maxillary (Caldwell-Luc technique) or mandibular resection, and piezosurgery of bone margins