A patient has been receiving intravenous zoledronic acid (Zometa) for 2 years for metastatic bone disease and is now partially edentulous. Which restorative approach is most appropriate?

Correct answer: A. Avoid implant surgery and provide a well-designed removable partial denture with careful relief

• A. Correct. Two years of INTRAVENOUS nitrogen-containing bisphosphonate for an oncology indication places this patient in the HIGH-RISK category for MRONJ. Elective bone surgery, including implant placement, is contraindicated. The appropriate plan is a non-surgical, tissue-borne prosthesis — a carefully designed and adjusted removable partial denture with generous relief over bony prominences, plus meticulous review to prevent denture sore spots, which are themselves a trigger for MRONJ.
• B. Incorrect. Same objection: it still requires surgical implant placement.
• C. Incorrect. Any option requiring implant placement means osteotomy preparation in bone with profoundly suppressed remodelling — precisely the trigger for MRONJ in a high-risk oncology patient.
• D. Incorrect. Same objection, with the added biomechanical liability of a cantilever loading compromised bone.

Note: Risk tiers matter: oral bisphosphonates for osteoporosis carry a low MRONJ risk (roughly 0.01–0.1%) and implants are usually acceptable after discussion. IV oncology dosing raises the risk to roughly 1–15% and is a genuine contraindication to elective bone surgery.