Antiresorptives (MRONJ)
Dental Considerations for Patients Taking Oral bisphosphonate
MRONJ precautions for bony procedure
Antiresorptive therapy with a planned bony procedure. Minimise trauma, obtain informed consent, and follow up healing.
Emergency vs routine management
If EMERGENCY — what to do
- • Treat pain/infection; extraction may proceed when needed using an atraumatic technique with primary closure where possible.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- • Do not request a drug holiday for an emergency.Ref: Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
If ROUTINE — what to do
- • Low-risk (< 4–5 years, no steroids): routine care including extractions with conservative technique.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- • ≥ 4 years or with steroids: prefer endodontics over extraction; a 2-month drug holiday may be discussed with the prescriber for elective surgery.Ref: Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
- • Review the socket 8 weeks after extraction.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
Clinical precautions
- • Atraumatic technique; minimise bone exposure
- • Informed consent regarding MRONJ risk
- • Chlorhexidine, review healing at 8 weeks
- • Consider drug-holiday discussion with the prescriber for higher-risk cases
At a glance by procedure
Initial assessment before lab results or timing details are entered.
| Procedure | Initial assessment |
|---|---|
| Examination / radiographs | ROUTINE Low MRONJ risk — no bony procedure |
| Supragingival scaling / polish | ROUTINE Low MRONJ risk — no bony procedure |
| Deep scaling / subgingival RSD (subgingival calculus) | ROUTINE Low MRONJ risk — no bony procedure |
| Root canal treatment | ROUTINE Low MRONJ risk — no bony procedure |
| Simple extraction (1–3 teeth) | MODIFY / CAUTION MRONJ precautions for bony procedure |
| Surgical / bony extraction | MODIFY / CAUTION MRONJ precautions for bony procedure |
| Implant placement | MODIFY / CAUTION MRONJ precautions for bony procedure |
References
- AAOMS 2022 — MRONJ Position Paper
- SDCEP — Oral health & antiresorptive drugs
- SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
- Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.