title: Bisphosphonate-related osteonecrosis of the jaw: from the sine qua non condition of bone exposure to a non-exposed BRONJ entity.
abstract: The present work aimed to review the literature focusing on the diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ) and its implications regarding the management of the disease. Since the report of the first cases, BRONJ concepts, diagnostic criteria and guidelines have been changed. The presence of bone exposure in the oral cavity was at first a sine qua non condition for diagnosis. However, it seems that the great concern now is the possibility of occurrence of BRONJ without this feature. Some authors warn that the bone exposure criterion leads to late diagnosis and poor response to treatment. Meanwhile, some radiographic features, such as bone sclerosis, have been postulated as early signs of the disease. Criticisms have also been raised about the clinical staging system of BRONJ. While there is no consensus on the subject, common sense recommends treating symptomatic patients taking bisphosphonate as having BRONJ despite the absence of bone exposure; and asymptomatic patients must be kept under dental follow-up, since all of them are at risk for BRONJ.
authors.affiliation: 1 Post-Graduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Valesca Sander
authors.initials: VS
authors.lastname: Koth
authors.affiliation: 1 Post-Graduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Figueiredo
authors.affiliation: 1 Post-Graduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Fernanda Gonçalves
authors.initials: FG
authors.lastname: Salum
authors.affiliation: 1 Post-Graduate Program, Dental College, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Karen
authors.initials: K
authors.lastname: Cherubini
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects; D042241:Early Diagnosis; D006801:Humans; D010026:Osteosclerosis / Q000000981:diagnostic imaging; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: MRI; bisphosphonate-related osteonecrosis of the jaw; osteonecrosis; radiography; tomography