MRONJ is a multifactorial disease, and it is therefore difficult to realize an aetiological therapy.
MRONJ management is controversial: there are no evidence-based guidelines in the literature, in particular with regard to surgical procedures possibly associated with good results during a long-term follow-up.
The literature recommends a conservative treatment as initial therapy for pain control and elimination of acute inflammatory signs before any surgical option, for all stages of disease.
Laser applications at low intensity (low-level laser therapy—LLLT) have been reported in the literature for the treatment of MRONJ. Biostimulant effects of laser improve reparative process, increase inorganic matrix of bone and osteoblast mitotic index and stimulate lymphatic and blood capillary growth. It has been reported that LLLT has anti-inflammatory actions and it can help to control pain as well. LLLT also holds biostimulatory properties with favourable actions on bacterial control and wound healing. The review of the literature confirmed the superiority of the LLLT association with antibiotic therapy in comparison to other noninvasive approach to MRONJ management.
In our experience, more than 60% of MRONJ patients treated with laser biostimulation and antibiotic therapy (2 g of amoxicillin and 1 g of metronidazole a day for 2 weeks) have had improvement of their symptomatology, and 35% have had complete mucosal healing during 6 months of follow-up.
This therapy is easy to administer and useful also for aged and compromised patients, and it is not associated with any known side effect.
A soft surgical approach performed with laser, in patients unresponsive to antibiotic therapy or LLLT, represents a good solution: it is rapid and poorly invasive and can be performed under local anaesthesia in day-surgery regimen. The erbium-doped yttrium aluminium garnet (Er:YAG) laser has emerged as a possible alternative to conventional methods of bone ablation as the main components of bone have a high absorption of laser light at the wavelength of 2.94 μm. The histological findings of bone treated with erbium laser highlighted vital lamellar bone at the lased margins without microscopic evidence of inflammation or osteoclastic activity. Some recent researches reported that Er:YAG laser irradiation stimulates the secretion of platelet-derived growth factor in osteotomy sites and has bactericidal effect against Actinomyces and anaerobes. Results confirm that the laser surgery represents the best therapeutic option for minimally invasive treatment of the early stages of the disease also in immunocompromised patients.
The association of the Er:YAG laser and autofluorescence examination seems to be highly useful in removing additional minimal necrotic bone after osteoplasty. It is possible to use laser evaporation in areas in which absence of fluorescence or hypofluorescence has been revealed. Moreover, the previously cited biological advantages of Er:YAG surgery combined with the biomodulation of the soft and hard tissues induced by LLLT seem to integrate a valid approach for MRONJ treatment.
MEDICATION-related osteonecrosis of the jaw (MRONJ) Low-level laser therapy (LLLT) Laser jaw bone surgery Erbium laser Diode laser Nd:YAG laser
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