Endodontics · single question

To save tooth #21 (with the RPD precision attachment) in the denosumab patient, which treatment is indicated?

Apicoectomy as first-line treatment
Extraction of #21 and redesign of the RPD
Antibiotics only for 2 weeks, then reassess
Root canal treatment (RCT) of tooth #21 to eliminate the infection and save the abutment tooth

Show answer and explanation

Correct answer: D. Root canal treatment (RCT) of tooth #21 to eliminate the infection and save the abutment tooth

A. Apicoectomy (periapical surgery) is a secondary/adjunct option when conventional RCT fails or is inaccessible. It is not first-line when a root canal can be performed.
B. Extraction eliminates the abutment and necessitates complete prosthetic redesign. In a denosumab patient, extraction also carries MRONJ risk. RCT is preferred when the tooth is restorable.
C. Antibiotics manage infection temporarily but do not address the source (necrotic pulp). Without definitive endodontic treatment, the infection recurs.
D. CORRECT. Root canal treatment eliminates the necrotic infected pulp, allows periapical healing, and saves tooth #21 as the abutment for the precision attachment. Saving the abutment is critical to maintaining the current prosthetic design. Extraction would require complete RPD redesign and, in a denosumab patient, surgical intervention risks osteonecrosis.

More Endodontics practice questions