10
Treatment
Table 5. Treatment Strategies by Stage of MRONJ
a
Staging of MRONJ
b
Treatment Strategies
c
Stage 2: Exposed and necrotic bone or
fistulas that probes to bone associated
with infection as evidenced by pain and
erythema in the region of exposed bone
with or without purulent drainage
• Symptomatic treatment with oral
antibiotics and topical antibacterial rinse
• Pain control
• Debridement to relieve soft tissue
irritation and infection control
• Clinical follow-up on a q8week basis by
dental specialist with communication of
lesion status to oncologist
• Patient education and reduction of
modifiable risk factors
Stage 3: Exposed and necrotic bone or
a fistula that probes to bone in patients
with pain, infection, and ≥1 of the
following : exposed and necrotic bone
extending beyond the region of alveolar
bone (i.e., inferior border and ramus in
mandible maxillary sinus, and zygoma in
maxilla) resulting in pathologic fracture,
extraoral fistula, oral antral or oral nasal
communication, or osteolysis extending
to inferior border of the mandible or sinus
floor
• Symptomatic treatment with oral
antibiotics and topical antibacterial rinse
• Pain control
• Surgical debridement or resection for
long-term palliation of infection and
pain
• Clinical follow-up on a q8week basis by
dental specialist with communication of
lesion status to oncologist
• Patient education and reduction of
modifiable risk factors
a
Adapted from Ruggiero et al. 2014.
b
Exposed or probable bone in the maxillofacial region without resolution for longer than 8 weeks
in patients treated with an anti-resorptive or an angiogenic inhibitor and who have not received
radiation therapy to the jaws.
c
Regardless of disease stage, mobile segments of bony sequestrum should be removed without
exposing uninvolved bone. Extraction of symptomatic teeth within exposed necrotic bone should
be considered because it is unlikely that extraction will exacerbate the established necrotic process.
(cont'd)
