Oral Surgery · single question
A patient taking bisphosphonates needs dental treatment. Which procedure carries the HIGHEST risk for medication-related osteonecrosis of the jaw (MRONJ)?
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Correct answer: A. Tooth extraction
Tooth extraction carries the highest risk for MRONJ in patients on bisphosphonates (or denosumab). Any procedure involving dentoalveolar surgery — extractions, implants, periapical surgery — can trigger MRONJ because they breach the oral mucosa and expose bone that cannot remodel normally due to impaired osteoclast function. Conservative treatments (RCT, SRP, crown prep) carry much lower risk and are preferred alternatives.
- A. ✅ CORRECT – Tooth extraction is the highest-risk procedure for MRONJ. Alternatives (RCT, coronectomy) should be considered first.
- B. ❌ Crown preparation is a non-invasive restorative procedure with minimal MRONJ risk.
- C. ❌ Root canal treatment is strongly preferred over extraction in bisphosphonate patients — much lower MRONJ risk.
- D. ❌ SRP (scaling and root planing) has a low MRONJ risk compared to surgical procedures.