Endodontics · patient case question
What treatment would you perform to SAVE the appliance?
Patient case: Denosumab, Kennedy Class I RPD with a precision attachment on #21
Scenario: Patient with OSTEOPOROSIS taking DENOSUMAB. Kennedy Class I with a PRECISION ATTACHMENT on tooth #21. The chief complaint involves MOBILITY TYPE 3; the COLD TEST WAS NEGATIVE but the tooth was SENSITIVE TO PERCUSSION. A periapical shows one crown carrying the attachment system, bone resorption to the MIDDLE THIRD of the root, and an inflamed (not infected) periodontal ligament.
Show answer and explanation
Correct answer: B. Root canal treatment through the existing restoration
- A. Implant placement in a patient on DENOSUMAB (an antiresorptive with MRONJ risk comparable to bisphosphonates) is a further reason to avoid surgery here.
- B. Correct. The abutment carries the precision attachment for a Kennedy Class I RPD. Extracting it would convert the case and force a remake of the prosthesis. Endodontic treatment through an access in the existing crown preserves the abutment and the attachment, and is the conservative choice when the tooth is otherwise retainable.
- C. Extraction sacrifices the abutment and the attachment system, which is precisely what the question asks you to avoid.
- D. Periodontal surgery does not address a necrotic pulp.
Note: Denosumab is a RANK-ligand inhibitor — not a bisphosphonate, but it carries a comparable MRONJ risk. Unlike bisphosphonates it does not incorporate into bone, so its effect wanes roughly 6 months after the last dose, which affects the timing of any elective surgery.