Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines

Authors

  • S Patel,

    1. Orofacial Pain and Oral Medicine Center, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
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  • S Choyee,

    1. Oral and Maxillofacial Surgery, LAC+USC Medical Center, Los Angeles, CA
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  • J Uyanne,

    1. Division of Endodontics, Oral and Maxillofacial Surgery, and Orthodontics, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
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  • AL Nguyen,

    1. Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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  • P Lee,

    1. Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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  • PP Sedghizadeh,

    1. Orofacial Pain and Oral Medicine Center, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
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  • SKS Kumar,

    1. Orofacial Pain and Oral Medicine Center, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
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  • J Lytle,

    1. Division of Endodontics, Oral and Maxillofacial Surgery, and Orthodontics, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
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  • S Shi,

    1. Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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  • AD Le

    1. Oral and Maxillofacial Surgery, LAC+USC Medical Center, Los Angeles, CA
    2. Division of Endodontics, Oral and Maxillofacial Surgery, and Orthodontics, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA
    3. Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
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Anh D. Le, DDS, PhD, Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry of University of Southern California, Health Sciences Campus, 2250 Alcazar Street, CSA107, Los Angeles, California 90033, USA. Tel: +323 442 2556, Fax: 323 442 2981, E-mail: anhle@usc.edu

Abstract

Oral Diseases (2012) 18, 625–632

Non-exposed bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a newly reported complication arising from bisphosphonate therapy that presents with atypical symptoms and no apparent mucosal fenestration or exposure of necrotic bone. The clinical observation of the presence of necrotic bone underneath normal epithelial coverage was not conclusive for the diagnosis of BRONJ based on current guidelines established by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the American Society for Bone and Mineral Research (ASBMR), which specify the presence of clinically exposed necrotic bone for more than 8 weeks. Hence, the purpose of this review is to critically assess the current guidelines for diagnosis and management of BRONJ and propose a modified staging system and treatment guidelines to properly address the non-exposed variant of BRONJ lesions.

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