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Oral Surgery · single question

A patient receiving intravenous zoledronic acid (Zometa) has a molar with grade 3 mobility, advanced periodontal breakdown and a deep carious lesion. Which approach BEST reduces the risk of medication-related osteonecrosis of the jaw?

  1. Endodontic treatment with coronectomy, leaving the roots in situ
  2. No treatment and observation alone
  3. Routine extraction with primary closure
  4. Extraction with immediate implant placement
Show answer and explanation

Correct answer: A. Endodontic treatment with coronectomy, leaving the roots in situ

  • A. Correct. In a patient on IV zoledronic acid the priority is to AVOID BONE EXPOSURE. Endodontic treatment followed by CORONECTOMY — decoronating the tooth at or below the gingival margin and allowing the mucosa to heal over the retained, endodontically treated roots — eliminates the coronal pathology while leaving the alveolar bone undisturbed. This is the recommended alternative to extraction in high-risk patients.
  • B. Leaving frank infection untreated risks a spreading infection, which itself precipitates osteonecrosis.
  • C. Extraction is precisely the trigger most strongly associated with MRONJ in patients on high-potency IV bisphosphonates for oncological indications.
  • D. Implant placement is contraindicated in patients on IV bisphosphonates for malignancy.

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