## 2 Case Report
### Management  
According to AAOMS, the patient is classified as stage 2 (Table 1) [3]. This case was initially managed by a conservative surgical approach, bone debridement, and gentle removal of necrotic bony fragments (sequestrectomy) along with the prescription of an antibiotic (amoxicillin 500 mg twice/day for 7 days), analgesic, and an antibacterial (0.12% chlorhexidine) mouth rinse. The patient was also instructed to lightly irrigate the lesion with a 5 ML disposable syringe filled with normal Saline (Sodium Chloride 0.9%) and discontinue the use of her existing mandibular RPD. After the area was fully healed with no evidence of exposed necrotic bone radiographically (Figure 4) and clinically (Figure 5A,B), the patient was referred to a prosthodontist to fabricate a new well-fitting removable denture with careful evaluation of traumatic areas to reduce the risk of mucosal irritation, ulceration, and possible development of MRONJ again. During the initial prosthodontics consultation, the existing mandibular RPD was evaluated and the possible cause of trauma to the underlying tissue was indicated as exposed metal framework mesh and a lack of sufficient acrylic resin underneath it (Figure 6A). \begin{table}
\begin{tabular}{c c} \hline \hline
**Stages** & **Features** \\ \hline
**At risk** & No exposed necrotic bone clinically. patients have been treated with MRONJ-related medications. \\ \hline
**Stage 0** & Non-specific clinical findings, radiographic changes, and symptoms without clinical evidence of bony exposure. \\ \hline
**Stage 1** & Clinical evidence of asymptomatic exposed necrotic bone without signs of infection. \\ \hline
**Stage 2** & Clinical evidence of symptomatic exposed necrotic bone with signs of infection i.e., pain, erythema, or purulent discharge. \\ \hline
**Stage 3** & Clinical evidence of symptomatic exposed necrotic bone with signs of infection that extend beyond the region of alveolar bone. \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Stages of MRONJ based on the disease progression. Figure 4: OPG radiograph showing complete healing with no evidence of necrotic bone on the left posterior alveolar ridge of the mandible as marked by blue arrow. R: right and L: left. The patient was advised to discontinue the use of RPD to allow tissue healing. After 6 months, the new dentures were fabricated according to standard protocol in which the maxillary and mandibular primary impressions were made by alginate. Then, light-cured resin material was used to fabricate custom trays. Following that, the maxillary final impression for CD and Mandibular final impression for RPD were made with polyether impression material (ImpregumTM, 3M ESPE, Dental Products, St. Paul, MN, USA) after performing the border molding with the impression compound modeling plastic (Impression Compound Green Sticks; Kerr Corp) without any overextension. To fabricate the metal framework for mandibular, a relief space beneath the minor connectors and underlying tissue was established by placing a sheet of relief wax on the original master cast and duplicating it in the refractory cast. Following that--in a separate visit--metal framework of the mandibular RPD was tried in the mouth and the vertical dimension of occlusion  
Figure 5: Clinical photos showing complete healing with no evidence of necrotic bone on the left posterior alveolar ridge of the mandible. (**A**) Follow up after management and before dentures fabrication. (**B**) 3 months post dentures insertion. Figure 6: Mandibular RPD denture bases. (**A**) Old RPD with metal framework exposure. (**B**) Newly fabricated RPD with proper denture base extension and acrylic thickness. and centric occlusion were recorded. In another appointment, the wax maxillary CD and mandibular RPD dentures were tried on. The extension of denture bases was evaluated and the occlusion was checked. Before insertion, laboratory re-mounting was performed to reduce the processing errors. Following that, the intaglio surface of dentures was assessed and any rough objections were removed.