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Table 1 Clinical and imaging findings of MRONJ in each stage

From: Clinical considerations for medication-related osteonecrosis of the jaw: a comprehensive literature review

Staging Clinical symptoms Imaging findings
Stage 0 no bone exposure/necrosis, deep periodontal pocket, loose tooth, oral mucosal ulcer, swelling, abscess formation, trismus, hypoesthesia/numbness of the lower lip (Vincent’s symptom), non-odontogenic pain sclerotic alveolar bone, remaining tooth extraction socket, alveolar bone loss or resorption not attributable to chronic periodontal disease, changes to trabecular pattern—dense bone and no new bone in extraction sockets, regions of osteosclerosis involving the alveolar bone or surrounding basilar bone, thickening or obscuring of the periodontal ligament (thickening of the lamina dura, sclerosis, and decreased periodontal ligament space)
Stage 1 asymptomatic bone exposure/necrosis without signs of infection, or fistula in which the bone is palpable with a probe
Stage 2 bone exposure/necrosis associated with pain, infection, fistula in which bone is palpable with a probe or at least one of the following symptoms including bone exposure/necrosis over the alveolar bone, which result in pathologic fracture, extraoral fistula, nasal/maxillary sinus fistula formation, or advanced osteolysis extending to the mandibular inferior edge or maxillary sinus
Stage 3 bone exposure/necrosis associated with pain, infection, or at least one of the following symptoms, or fistula in which bone is palpable with a probe. Bone exposure/necrosis over the alveolar bone. As a result, pathologic fracture or extraoral fistula, nasal/maxillary sinus fistula formation, or advanced osteolysis extending to the mandibular inferior edge or maxillary sinus osteosclerosis/osteolysis of the surrounding bone (cheek bone, palatine bone), pathologic mandibular fracture, and osteolysis extending to the maxillary sinus floor