A patient receiving INTRAVENOUS bisphosphonate therapy wants treatment for gingival recession on the mandibular anterior teeth. What is the MOST appropriate management?

Correct answer: C. Place a class V restoration to cover the exposed root surface

• A. A connective tissue graft requires a palatal donor site and surgical flap elevation over the recipient bone — an elective surgical exposure that should be avoided in this patient.
• B. A free gingival graft likewise involves surgical wounds at both donor and recipient sites over bone.
• C. Correct. IV bisphosphonates carry a substantially higher MRONJ risk than the oral formulations, so ELECTIVE procedures involving bone exposure or manipulation should be avoided. A class V restoration is a non-surgical alternative that covers the exposed root, reduces sensitivity, improves esthetics and protects against root caries — with no risk of osteonecrosis.
• D. A coronally advanced flap requires periosteal reflection and elective bone exposure — the very thing to avoid in a patient on IV bisphosphonates.