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In a patient treated with denosumab for osteoporosis, a case of stage II MRONJ occurred after 3 months from implant placement and subsequent implant loss. The first surgical approach led to a worsening at Stage III. A second surgery with a conservative approach was performed more than 6 months after the last denosumab injection obtaining therefore the definitive healing. Pharmacokinetics and surgical approach should be considered in MRONJ treatment scheduling.doi:10.32388/r75cty fatcat:cols6sgfijfmrivn2yv23bk75u