Antiresorptives (MRONJ)
Dental Considerations for Patients Taking Denosumab (oncology dose)
High MRONJ risk — IV/oncology antiresorptive + bony procedure
High-dose IV bisphosphonate/denosumab for oncology plus a bony procedure carries high MRONJ risk. Avoid extractions/implants where possible; refer to a specialist / oral surgery.
Emergency vs routine management
If EMERGENCY — what to do
- • Prefer non-surgical options: root canal treatment or decoronation (retain roots) instead of extraction.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 extraction is unavoidable: atraumatic technique, smooth bone edges, primary closure, chlorhexidine 0.2% rinse; consider antibiotic cover and refer to oral & maxillofacial 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
If ROUTINE — what to do
- • Avoid elective invasive bone procedures; implants are contraindicated with oncology-dose antiresorptives.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
- • 3-monthly recall, intensive prevention, review any extraction socket at 8 weeks.Ref: SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
Clinical precautions
- • Avoid extraction where possible; consider alternatives (e.g. decoronation/root retention)
- • Refer to oral & maxillofacial specialist
- • Informed consent regarding MRONJ
- • Atraumatic technique, primary closure if surgery unavoidable
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) | EMERGENCY / DEFER High MRONJ risk — IV/oncology antiresorptive + bony procedure |
| Surgical / bony extraction | EMERGENCY / DEFER High MRONJ risk — IV/oncology antiresorptive + bony procedure |
| Implant placement | EMERGENCY / DEFER High MRONJ risk — IV/oncology antiresorptive + bony procedure |
References
- AAOMS 2022 — MRONJ Position Paper
- SDCEP — Oral health & antiresorptive drugs
- Ruggiero SL et al. AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaws — 2022 Update. J Oral Maxillofac Surg 2022;80:920–943
- SDCEP. Oral Health Management of Patients at Risk of MRONJ, 2017
Related guides
This guide supports — and does not replace — professional clinical judgment. Always consider the individual patient and consult the treating physician when indicated.