Bisphosphonates and osteonecrosis: an open matter

Area of Science:

• Oral and Maxillofacial Surgery
• Biomaterials Science

Background:

• Osteonecrosis of the Jaw (ONJ) is a growing concern in patients undergoing long-term Bisphosphonate Therapy (BPT).
• Current treatment options for ONJ present therapeutic dilemmas with limited short-term benefits or proven efficacy.

Purpose of the Study:

• To evaluate the efficacy of Er:YAG laser treatment combined with biostimulation (LLLT) for managing ONJ.
• To compare the outcomes of this novel approach with conventional medical and surgical interventions.

Main Methods:

• Utilized Er:YAG laser for conservative debridement and resection of necrotic bone in ONJ patients.
• Applied low-level laser therapy (LLLT) for biostimulation to promote soft tissue and bone healing.
• Compared outcomes with standard medical management and conventional surgical debridement.

Main Results:

• Er:YAG laser demonstrated effective removal of necrotic bone with precise targeting of healthy tissue.
• The laser's bactericidal and biostimulatory effects accelerated soft tissue and bone healing.
• Early conservative Er:YAG laser treatment showed greater efficacy compared to medical therapy.

Conclusions:

• Er:YAG laser therapy, particularly when combined with LLLT biostimulation, presents a promising alternative for ONJ management.
• This approach offers potential for improved healing and symptom palliation in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ).
• An early, conservative surgical strategy using Er:YAG laser is suggested as more efficacious than existing treatments.