Conservative Surgical Treatment of Bisphosphonate-Related Osteonecrosis of the Jaw with Er,Cr:YSGG Laser and Platelet-Rich Plasma: A Longitudinal Study

Abstract

Introduction The management of bisphosphonate-related osteonecrosis of the jaw (BRONJ), with no evidence-based guidelines, remains controversial. We aimed to evaluate the efficiency of a conservative surgical treatment combining Er,Cr:YSGG laser and platelet-rich plasma (PRP) for the treatment of BRONJ in cancer patients. Methods We performed a longitudinal cohort study. Inclusion criteria were (1) age ≥ 18 years; (2) cancer diagnosis; (3) treatment with NBP because of the underlying cancer. Results We consecutively recruited ten patients diagnosed with BRONJ in stage I or II. These patients underwent a surgical laser-assisted therapy together with autologous PRP. At the latest follow-up at 12 months, clinical improvement was observed in eight patients. Registration Number is IRCT20180329039159N1. Conclusion We could successfully manage the BRONJ utilizing this combined protocol to heal the 30% of surgically treated sites and to improve the 50% of patients' lesions clinically. Our findings suggest that a surgical approach combined with Er,Cr:YSGG laser and PRP benefit cancer patients with general health issues.

Adjuvant therapies in the management of medication‐related osteonecrosis of the jaws: Systematic review

“…Four did not meet the eligibility criteria and were excluded (Table ) . The remaining four articles were included in the qualitative synthesis (Table ) and in the final review …”

“…Two investigations specified the dose: 4 mg of zoledronate or 90 mg of pamidronate. The route of administration was mentioned in three studies (IV). Frequency of drug administration included every 3 to 4 weeks or monthly infusions .…”

“…The route of administration was mentioned in three studies (IV). Frequency of drug administration included every 3 to 4 weeks or monthly infusions . The duration of the BP treatment was reported by Curi et al (1‐7 years; ±2.3 years), Longo et al (4‐62 months), and Mauceri et al (31.8 ± 25.76 months).…”

“…All patients discontinued BP therapy in one paper, whereas the drug therapy was not interrupted during and after the surgical procedure in other investigation . In two studies, this information was unclear …”

“…Three studies specified the affected jaw, being the mandible most affected. Two studies staged the lesions according to the AAOMS, and one study staged according to the Italian Society of Oral and Maxillofacial Surgery–Italian Society of Oral Pathology and Medicine clinical and radiological staging system. For Longo et al, the surgeries did not show a significant difference in the success of the outcome between the different stages.…”