Staging & Tx strategies

Pt at Risk apparent necrotic bone Tx

Strategies
.
. no :

.
asymptomatic . inform of risk Of developing MRONJ

@ tx
+
sees of this dls process
. Wl IV / oral

antiresorphivelantiangiogenic
0
stage

Radio
clinical findings Tx
Strategies
:
.
@ evidence of nec . bone :

. alveolar bone loss ( @ nn chronic Peno )

/
.

. @ non .

specific sees clinical / radio findings .

symptomatic tx
changes To trabearlar pattern
radio alone Conservative Mx of local f.
DOI use signs ↳ dense
.
woven bone

↳ persistence unrcmodeled bone ↳ caries 'o

( overestimate 1 False + ve ) of @ extsroqfetfjm &
pen

aw .

bone and systemic Mx :

sclerosis /
* 50% of Stage 0 have Progress led to 1,2 ,
3 osteo
involving \ surround basilar bone ↳ meal for chronic pain
Sx : ↳ control infection wl ATB
thickening lamina aura
/
thickening obscuring
\f
1
ppl
.
odontalgia @ explained by odon Cause close monitoring
size of ppl
.

space

. dull aching bone pain @ body of Md .

(
may progress To higher stage )

(
may radiate To TMJ region )

sinus Pain : inflame thickening of mx .

sinus wall

. altered neuw sensory fn .

Clinical findings
:

.
loosening of teeth (@ nn .
chronic Peno )

* these non specific findings may occur in pt wl a prior hx of

/ periodontal
-

periapical fistula (@
.

puipnec )
.
m .
.

Stage 1,2 ,
Or 3 Who @ healed & @ Clinical evidence of exposed bone

Stage 1
Tx
strategies
:

asymptomatic . Med .
MX :
Oral antimicrobial rinses ( CHX 0.12-1 .

7 On or
P Walton budnimosuwarinowssirnw
Clinical findings
:
@ exposed & necrotic bone

@ fistula that probes To bone Qintatmosusway )

\ @ operative tx required
✓

@ evidence of infection

Radio findings which is

:
Oiauuaow stage 0

localized To alv .
bone region

Stage 2
Tx
strategies
:

Clinical findings
:
@ exposed & necrotic banc local bone & ST in tctioh is Not the i° enology
@ evidence of infection colonization of
.
exposed bone :
very common

- 1. med Mx : -
oral antimicrobial rise ANI

:
"

antM€r0LrFaD -

ATB therapy
:
.
penicillin ( ww penicillin ) .
clindamycin
= s

.
Quinolone
.
doxycyaine
EE
to± erythromycin
.
-
Metwnidazole .

of Colonized
-

volume bone
2. operative therapy : reduce the & necrotic

( nooturomduns →
mucosa widasieooiw )

Stage } :

Tx
Strategies
:

Clinical findings
:
@ exposed & necrotic bone

@ fistula that probes To bone

debridement
including
. :

@ evidence of infection
* *
.
exposed necrotic bone
extending beyond an .
bone resection & immediate reconstruction
@ zy of the followings :
* *
pathologic fracture
.
ATB therapy clang -

term )
extra fistula
final
oral pain
. .

. oral -

antral 1 oral -

nasal communication .
long -

term palliation wl resolution of acute

.
Osteolysis extending To inf .
border of Md .
/ sinus floor

Osteolysis of Md .
wlpatho fracture