4
Staging
➤ A well-established staging system should be used to quantify the
severity and extent of MRONJ and to guide management decisions.
Options include the 2014 AAOMS staging system, the Common
Terminology Criteria for Adverse Events (CTCAE) 5.0 and the 2017
International Task Force on ONJ (osteonecrosis of the jaw) staging
system for MRONJ. The same system should be used throughout the
patient's MRONJ course of care. Diagnostic imaging may be used as
an adjunct to these staging systems. (Weak Recommendation; FC-Ins)
➤ Optimally, staging should be performed by a clinician experienced
with the management of MRONJ. (Weak Recommendation; FC-Ins)
Initial Treatment of MRONJ
➤ Conservative measures comprise the initial approach to treatment
of MRONJ. Conservative measures may include antimicrobial mouth
rinses, antibiotics if clinically indicated, effective oral hygiene, and
conservative surgical interventions (e.g., removal of a superficial
bone spicule). (Moderate Recommendation; FC-Ins)
Treatment of Refractory MRONJ
➤ Aggressive surgical interventions (e.g., mucosal flap elevation,
block resection of necrotic bone, soft tissue closure) may be used if
MRONJ results in persistent symptoms or impacts function despite
initial conservative treatment. Aggressive surgical intervention is not
recommended for asymptomatic bone exposure. In advance of the
aggressive surgical intervention, the multidisciplinary care team and
the patient should thoroughly discuss the risks and benefits of the
proposed intervention. (Weak Recommendation; FC-Ins)
Temporary Discontinuation of BMAs
➤ For patients diagnosed with MRONJ while being treated with BMAs,
there is insufficient evidence to support or refute the discontinuation
of the BMAs. Administration of the BMA may be deferred at the
discretion of the treating physician, in conjunction with discussion
with the patient and the oral health provider. (Weak Recommendation;
FC-Ins)
Treatment
