Tooth Extractions in High-Risk Patients Under Bisphosphonate Therapy and Previously Affected With Osteonecrosis of the Jaws

Abstract

Trauma during dental surgery is a predisposing factor for medication-related osteonecrosis of the jaws (MRONJ). There are no specific guidelines for the management of dental extractions in patients under bisphosphonate therapy (BPT). The authors proposed in 2013 a successful protocol for tooth extractions in patients under BPT supported by Nd:YAG low-level laser therapy (LLLT). The aim of this study was to validate the safety and efficacy of this protocol reporting the data related to its application in a particular category of patients under BPT at high risk for MRONJ and who were previously affected with MRONJ. Eighty-two tooth extractions were performed in 36 patients previously affected with MRONJ. Antibiotic treatment was administered 3 days before and 2 weeks after tooth extractions. Patients were additionally treated with Nd:YAG LLLT, 5 applications of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. In a total of 82 extractions, minimal bone exposure was observed in 2 cases, treated with Er:YAG laser vaporization and then completely healed. The data confirmed that laser biostimulation is a reliable technique that can be considered in the surgical protocol for patients under BPT.

Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols

“…However, multiple studies suggested a benefit from PBM in the management of medication-related osteonecrosis of the jaw (MRONJ) [98–101]. Vescovi et al proposed a prophylactic protocol including PBM for reducing BRONJ incidence following tooth extractions [102]. Luomanen et al reported about a successful treatment of a patient with MRONJ using Nd:YAG laser [103].…”

The Effectiveness of the Low-Level Laser, Antibiotic and Surgical Therapy in the Treatment of Medication-Related Osteonecrosis of the Jaws: A Case Report

“…35 These facts could explain the beneficial effect of LLL therapy when it is associated with the conventional treatment of MRONJ. 12,22 The laser parameters, including the energy that is delivered, power density, pulse duration, appropriate treatment, timing and repetition, and the appropriate anatomical location must be adequate to create a biostimulatory effect. 23 In this case report, we used the laser emitting GaAlAs at a wavelength of 808 nm with an energy density of 19.4 J/ cm 2 /point (8 points) for a period of 2 months (13 sessions).…”

Absorption Capability of a 645-nm Diode Laser on Swine Soft Tissue Samples: a Preliminary Study in an Ex-Vivo Model Tissue Samples: a Preliminary Study in an Ex-Vivo Mo

“…This finding is particularly relevant due to its possible application in the treatment of patients with impaired healing processes, including those treated with bisphosphonates or other anti-resorptive/angiogenic drugs, those affected by diabetes, or those treated with corticosteroids. 16,17 Apart from patients with systemic diseases or those taking drugs that may interfere with the healing process, the notion that laser light penetrates beyond the irradiated surface, even when used in a low-level energy mode, has implications in other fields of dentistry.…”