A patient on bisphosphonates presents for evaluation. Their treatment plan requires multiple extractions. What is the BEST management?

Correct answer: A. Coronectomy and root canal treatment on the tooth requiring extraction (to avoid exposing bone to osteonecrosis risk)

• A. Correct. For patients on bisphosphonates (especially IV bisphosphonates like zoledronic acid), TOOTH EXTRACTION carries significant risk of MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ). For a tooth that would normally require extraction, CORONECTOMY (removing the crown and leaving the roots) combined with RCT of the retained roots avoids exposing the alveolar bone to extraction socket healing complications, reducing MRONJ risk.
• B. Partial extractions without a plan for retained roots is not a complete approach.
• C. Antibiotics alone do not resolve the need for tooth removal; the risk remains.
• D. Extracting all teeth in a bisphosphonate patient carries high MRONJ risk — should be avoided unless absolutely necessary.