The treatment plan calls for maxillary and mandibular complete dentures, but the patient has been on INTRAVENOUS bisphosphonates for more than 10 years. Best approach?

Correct answer: B. Extract only the hopeless, non-restorable teeth, keeping surgical trauma to a minimum

• A. Endodontic treatment and coronectomy of every tooth is over-treatment and is not a recognized protocol. Selective root retention under an overdenture is the reasonable version of this idea.
• B. CORRECT. More than four years of intravenous bisphosphonate therapy places this patient in the highest MRONJ risk tier. The governing principle is minimizing surgical insult: extract only what genuinely cannot be retained, work in small segments, use atraumatic technique with alveoloplasty and primary closure, and consider retaining sound roots as overdenture abutments rather than extracting them.
• C. 'Routine' is exactly what this patient cannot have.
• D. Full-mouth extraction in one visit maximizes exposed bone in the highest-risk patient possible. This is the worst option listed.

Note: MRONJ risk stratification: oral bisphosphonates under 4 years and no steroids = low risk, proceed with routine care. Over 4 years, or any duration with corticosteroids or antiangiogenics, or any IV therapy for malignancy = high risk, minimize surgery and consult the prescribing physician. Note that dentures themselves can traumatize the mucosa — meticulous relief and follow-up matter here.