New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

Table 2

Dimensional staging.

	Clinical and radiological findings	Treatment
Stage 0	No bone exposure with nonspecific radiographic findings, such as osteosclerosis and periosteal Hyperplasia, and nonspecific symptoms, such as pain	Medical therapy and clinical-radiological follow-up
Stage I	Bone exposure and/or radiographic evidences of necrotic bone*, or persisting alveolar sockets <2 cm in the major diameter, with or without pain	Medical therapy, surgical debridement, and LLLT
Stage II	Bone exposure and/or radiographic evidences of necrotic bone* between 2 and 4 cm in the major diameter, with pain responsive to NSAIDs and possible abscesses	Medical therapy and small open-access surgery with piezosurgery of bone margins
Stage III	Bone exposure and/or radiographic evidences of necrotic bone* >4 cm in the major diameter, with strong pain responsive or not to NSAIDs, abscesses, orocutaneous fistula, and/or maxillary sinus and mandibular nerve involvement	Medical therapy and wide open-access surgery with extensive maxillary or mandibular resection, the Caldwell-Luc technique, and piezosurgery of bone margins

∗Radiographic evidences of necrotic bone: irregular hyper- and hypocalcified areas and/or bone sequestra.