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MRONJ Prevention Oral Bisphosphonates — NDEB AFK MCQ

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ModerateOral SurgeryMRONJ Prevention Oral BisphosphonatesNDEB AFK

A 70-year-old patient on alendronate (oral bisphosphonate) for osteoporosis for 5 years requires extraction of a non-restorable tooth. Which of the following is the most appropriate pre-extraction measure?

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Correct answer: B — Perform the extraction atraumatically with primary closure and inform the patient of the small MRONJ risk

For patients on oral bisphosphonates, the MRONJ risk from dental extractions is low (approximately 0.01-0.04%). Current guidelines recommend informing the patient of the small risk, performing the extraction as atraumatically as possible, achieving primary soft tissue closure, and ensuring follow-up. Drug holidays are controversial and not uniformly recommended for dental procedures. Serum CTX is no longer considered a reliable predictor of MRONJ risk. The risk is higher with IV bisphosphonates (zoledronic acid) used for oncological indications.

Reference: CDA – MRONJ Position Statement, 2020; AAOMS – MRONJ Position Paper, 2022