Same case — a patient taking bisphosphonate has gum recession on ONE tooth. What is the best management for this condition?

Correct answer: A. Class V restoration

• A. For LOCALIZED GINGIVAL RECESSION on ONE TOOTH in a patient taking bisphosphonates, a CLASS V RESTORATION is the recommended management. Soft tissue grafting (free gingival graft, connective tissue graft) involves surgical incisions that RISK triggering MRONJ in patients on bisphosphonates. A class V composite or glass ionomer restoration covers the exposed root surface, reduces sensitivity, and prevents further root caries without the surgical risk of MRONJ.
• B. Free gingival graft involves surgical incisions in the oral cavity — this carries a risk of MRONJ in bisphosphonate patients. The non-surgical option (Class V restoration) is preferred.
• C. Referral to an oral surgeon is appropriate if MRONJ is suspected — but for simple recession management in a bisphosphonate patient WITHOUT MRONJ, a Class V restoration is the conservative first approach.
• D. Connective tissue graft is also surgical and carries MRONJ risk in bisphosphonate patients.