Antiresorptives (MRONJ)
Dental Considerations for Patients Taking Denosumab
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 with atraumatic technique and primary closure where possible.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
If ROUTINE — what to do
- • Plan invasive treatment ~3–4 months after the last injection, before the next dose.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
- • Do not delay the denosumab dose beyond 7 months — rebound vertebral fracture risk.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
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.