The same terminal abutment tests non-responsive to cold, has had no root canal treatment, shows Miller Class III mobility, a 7 mm distal probing depth and radiolucency extending along the distal root surface to the apex. The patient needs a new partial denture that will last. What is the most appropriate treatment for this tooth?

Correct answer: C. Extraction and redesign of the prosthesis

• A. Root canal treatment resolves only the pulpal half of the problem. A tooth with Class III mobility and attachment loss to the apex cannot serve as an abutment for anything, endodontically treated or not.
• B. Splinting can help a tooth with SECONDARY occlusal trauma and reduced but stable support. It is futile when attachment loss reaches the apex — splinting a hopeless tooth simply recruits its neighbour into the problem.
• C. CORRECT. This tooth has a HOPELESS prognosis, and each finding independently supports that: Class III mobility means it is depressible in the socket, the pocket communicates with a necrotic pulp in a combined endodontic-periodontal lesion, and the attachment loss extends to the apex. Endodontic treatment addresses the pulp but does nothing for the lost attachment that is causing the mobility. Retaining a hopeless abutment guarantees the new prosthesis fails when the tooth is eventually lost. Extract, allow healing, and design the denture around a sound abutment.
• D. A post and crown adds restorative cost and complexity to a tooth whose periodontal support is already gone. The post does not reinforce the root, and no coronal restoration compensates for absent attachment.

Note: ⚑ Group discussion point. The recall notes this patient takes DENOSUMAB, and the writer hesitated between extraction and root canal treatment for that reason. The hesitation is reasonable but the answer does not change. For a patient on denosumab at OSTEOPOROSIS dosing (Prolia, 60 mg every 6 months), MRONJ risk after extraction is low — roughly comparable to oral bisphosphonates — and a hopeless tooth left in place is itself a source of infection and a well-recognised MRONJ trigger. Coordinate with the prescribing physician, time the extraction in the drug interval where feasible, use atraumatic technique with primary closure, and follow up. Oncologic dosing (Xgeva, 120 mg monthly) carries substantially higher risk and warrants a more cautious conversation. Note also that denosumab, unlike bisphosphonates, is not incorporated into bone and its effect reverses within months of discontinuation.