A 51-year-old male on denosumab (Prolia, anti-resorptive for osteoporosis) has deep caries on tooth #30 extending to the alveolar crest. What is the MOST appropriate treatment?

Correct answer: B. Coronectomy and root canal therapy, followed by new removable denture

• A. Incorrect. Simply excavating caries and doing a composite buildup is inadequate for deep caries to the alveolar crest with likely pulpal involvement.
• B. Correct. For a patient on denosumab (anti-resorptive) with a non-restorable tooth, CORONECTOMY (intentional partial tooth removal — removing the crown while leaving the roots) plus RCT of the retained roots MINIMIZES bone exposure and osteonecrosis risk. This is the evidence-based approach to reduce MRONJ while addressing the dental problem.
• C. Incorrect. Crown lengthening is a surgical procedure on the bone that increases MRONJ risk — contraindicated in anti-resorptive patients.
• D. Incorrect. Full extraction in an anti-resorptive patient with risk factors for MRONJ should be avoided when alternatives exist — coronectomy is preferred.