Bisphosphonates and osteonecrosis: an open matter

Osteonecrosis of the Jaw (ONJ) in patients on long-term Bisphosphonate Therapy (BPT) is being reported in the last ten years in the literature with increasing frequency. The therapy for this condition is a real dilemma. Temporary suspension of BPT offers no short term benefits, hyperbaric oxygen has no proven efficiency and therefore is not recommended, intermittent or continuous antibiotic with surgical debridement can be beneficial to palliate the symptoms. Er:YAG laser can be used to eliminate necrotic portions of the bone by partial or total resection of the jaws as an alternative to conventional rotary tools. The high degree of affinity of this wavelength for water and hydroxyapatite means the soft tissue and bone can both be treated. The technique can also be used for conservative interventions by gradually evaporating the part of necrotic bone, getting close to the healthy area. One certain advantage of the Er:YAG laser is its bactericidal and biostimulatory action, inducing the healing of the soft tissues and the bone, quicker than in conventional treatments. In conclusion, from our experience, it is possible to observe that an early conservative surgical approach with Er:YAG laser associated to biostimulation, LLLT (Low Level Laser Therapy), for BRONJ could be considered as more efficacious in comparison to medical therapy or other techniques.