Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients

Abstract

Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ) has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT)). Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7%) and the complete healing in 19 sites (27.5%), while surgical approach on 97 sites induced an improvement in 84 sites (86.6%) and the complete healing in 78 sites (80.41%). Improvement and healing were recorded in 31 (81.5%) and 27 (71.5%) out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75%) and in 69 (53.9%) out of the 128 in cancer patients.

The use of low-level light therapy in supportive care for patients with breast cancer: review of the literature

“…Six patients showed a significant reduction in pain score [79]. Vescovi et al treated 32 MRONJ patients with LD-LLLT and was able to show complete remission in nine patients and clinical improvement in 23 patients [80]. In the study by Martins et al 14 patients underwent LD-LLLT in combination with plateletrich plasma (PRP) treatment (seven breast cancer patients).…”

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

“…The dose was mentioned only in two investigations . Two studies did not mention whether the drug was discontinued during LIL therapy . Mandible was affected in 68 cases and maxilla in 34.…”

“…In one study, the interval between sessions was not specified . Laser power ranged from 0.007 to 1.25 W …”

“…A statistically significant difference was observed for reported pain ( P = .000), clinical size ( P = .003), edema ( P = .000), and presence of pus and fistulas ( P = .007 and P = .030, respectively). In the other studies, LIL was associated with antibiotic therapy, conventional surgery, and surgery with Er:YAG laser . The follow‐up period varied from 3 to 30 months.…”

Bisphosphonate-related osteonecrosis of jaws in advanced stage breast cancer was detected from bone scan: a case report

“…Two studies have shown higher healing rate in ONJ treatment with LLLT (Nd: YAG) groups than without LLLT groups (27,28). LLLT is a good choice for BRONJ treatment especially for antibacterial and biostimulant properties (29).…”