A patient taking bisphosphonates wears a maxillary complete denture and a mandibular RPD. She now asks about an implant-supported prosthesis. What is the primary concern?

Correct answer: C. Medication-related osteonecrosis of the jaw following implant surgery

• A. Titanium allergy is exceedingly rare and is not the issue here.
• B. Candidiasis is a denture hygiene problem, not the primary surgical risk in an antiresorptive patient.
• C. CORRECT. Implant placement is a surgical procedure involving BONE, and in a patient on antiresorptive therapy it carries the risk of MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ). Risk stratification matters: oral bisphosphonates for less than 4 years without steroids carry low risk; more than 4 years, concurrent corticosteroids or antiangiogenics, or IV/high-potency agents (zoledronate, denosumab) for oncologic indications carry substantially higher risk. Informed consent, medical consultation, atraumatic technique, and consideration of non-surgical alternatives are all required.
• D. Denture bases attach to implants through well-established mechanical attachment systems; bonding is not the concern.

Note: MRONJ definition: exposed bone or bone probed through a fistula, persisting more than 8 weeks, in a patient on antiresorptive or antiangiogenic therapy with no history of radiation to the jaws.