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

Correct answer: C. Coronectomy + root canal + new removable denture

• A. Incorrect. Crown lengthening requires osseous surgery — high MRONJ risk with denosumab (anti-RANKL).
• B. Incorrect. Full extraction in a patient on denosumab carries high MRONJ risk since denosumab inhibits osteoclast activity and bone remodeling needed for socket healing.
• C. Correct. Coronectomy (intentional root retention) + endodontic treatment avoids full extraction, preserving roots while treating infection. This minimizes MRONJ risk in anti-resorptive therapy patients.
• D. Incorrect. Caries extends to alveolar crest, making the tooth non-restorable with composite alone.