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OBJECTIVES The aim of this study was to compare the panoramic radiographs of patients with early-stage and advanced-stage medication-related osteonecrosis of the jaw (MRONJ) for differences in radiographic findings and fractal dimension (FD). STUDY DESIGN Data were collected from the medical records of 66 patients confirmed as having MRONJ. Panoramic radiographs of 66 patients (group I; without bone exposure; and group II; with bone exposure) were evaluated for the following signs; osteolysis, cortical erosion, focal and diffuse sclerosis, sequestrum, lamina dura thickening, enhancement of the inferior alveolar canal (IAC), persistent alveolar socket, pathologic fractures, and enhancement of the external oblique ridge. FD values were also compared between groups. RESULTS The signs of focal and diffuse sclerosis, sequestrum, and enhancement of the IAC were observed significantly more often in group II than group I (P < .05). The mean FD values were 1.42 ± 0.11 in group I and 1.44 ± 0.18 in group II and were significantly different only in 1 region but not significantly different overall. CONCLUSIONS Radiographic alterations of bone structures appeared more frequently in patients with advanced stages of MRONJ. No significant difference was detected in the FD values among the tested regions except the cancellous bone above the mandibular canal on the distal side of the mental foramen.