title: Non-exposed bisphosphonate-related osteonecrosis of the jaw: a critical assessment of current definition, staging, and treatment guidelines.
abstract: 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.
authors.affiliation: Orofacial Pain and Oral Medicine Center, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: S
authors.initials: S
authors.lastname: Patel
authors.forename: S
authors.initials: S
authors.lastname: Choyee
authors.forename: J
authors.initials: J
authors.lastname: Uyanne
authors.forename: A L
authors.initials: AL
authors.lastname: Nguyen
authors.forename: P
authors.initials: P
authors.lastname: Lee
authors.forename: P P
authors.initials: PP
authors.lastname: Sedghizadeh
authors.forename: S K S
authors.initials: SK
authors.lastname: Kumar
authors.forename: J
authors.initials: J
authors.lastname: Lytle
authors.forename: S
authors.initials: S
authors.lastname: Shi
authors.forename: A D
authors.initials: AD
authors.lastname: Le
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000473:pathology* / Q000628:therapy*; D000069448:Denosumab; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000628:therapy; D010020:Osteonecrosis / Q000139:chemically induced / Q000628:therapy; D017410:Practice Guidelines as Topic; D009626:Terminology as Topic
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D000069448:Denosumab