Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser

A series of 49 patients diagnosed with osteonecrosis and all treated with latest-generation bisphosphonates was reviewed retrospectively to evaluate the use of erbium-doped: yttrium, aluminum, and garnet laser (Er:YAG) in terms of clinical outcome, and examine current trends from the clinical-therapeutic standpoint. Pathology reports on specimens submitted over the previous 7 years from either the mandible or the maxilla were reviewed; 49 patients were identified as having osteonecrosis of the jaws. For each of these cases, the medical history and profile were evaluated; 19 were treated with conservative therapy, 20 with radical surgery, and 10 with Er:YAG laser (2,940 nm). Of the 20 patients treated surgically (bone baquette, curettage, sequestrectomy of the necrotic bone), some required re-treatment, which resulted in bone fracturing. None of the patients were treated successfully. The 19 cases treated conservatively produced an improvement in symptoms, but not remission of the lesions. Of the ten patients treated with Er:YAG laser, six achieved total remission of signs and symptoms, four an improvement, and re-treatment was required in one case. Our present approach is to recommend intensive prophylactic care before the administration of bisphosphonates, and great caution is advised even in simple maneuvers like curettage, because this may exacerbate the avascular process. The use of Er:YAG laser appears to be promising (within the limits of our experience). It can be concluded that at 1 year of laser surgery, the treatment led to significant improvements in clinical parameters, and may represent a valid alternative, although studies on a larger scale are needed.