Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ)
Abstract
:1. Introduction
- Patients at risk: No apparent necrotic bone in asymptomatic patients treated with IV or oral antiresorptive therapy.
- Stage 0 (non-exposed bone variant): Patients with no clinical evidence of necrotic bone but who present with non-specific symptoms or clinical and radiographic findings.
- Stage 1: Exposed and necrotic bone or fistula that probes the bone in asymptomatic patients with no evidence of infection/inflammation.
- Stage 2: Exposed and necrotic bone, or fistula that probes the bone, with evidence of infection/inflammation. The patients were symptomatic.
- Stage 3: Exposed and necrotic bone or fistulae that probe into the bone, with evidence of infection, and one or more of the following:
- Exposed necrotic bone extending beyond the region of alveolar bone
- Pathologic fracture
- Extraoral fistula
- Oral–antral/oral–nasal communication
- Osteolysis extending to the inferior border of the mandible or sinus floor
1.1. Ultrasonic Bone Surgery
1.2. Laser Nd:YAG
1.3. Laser Er:YAG
2. Materials and Methods
- Current or previous treatment with antiresorptive or antiangiogenic agents.
- Exposed bone or bone that can be probed through an intra-oral or extraoral fistula in the maxillofacial region that has persisted for more than 8 weeks.
- No history of radiation therapy in the jaws or obvious metastatic disease in the jaws.
Treatment Protocol
3. Results
4. Discussion
- Antiseptic therapy based on 0.2% clorexidine rinses and hydrogen peroxide 3 times a day in association with antibiotic therapy (amoxicillin 1 g/twice a day + metronidazole 500 g/twice a day) and photobiomodulation laser once a week for five weeks;
- Suspension for 1 month;
- Second cycle of antiseptic therapy with antibiotics and photobiomodulation lasers;
- If complete healing is not achieved, patients are treated with surgical laser assistance.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | N° Patients | Follow-Up (Months) | Clinical Improvement | Complete Healing |
---|---|---|---|---|
J. Freiberger et al. (2007) [47] Hyperbaric oxygen therapy | 16 | 87.5 | 12.5% | |
C.I. Ripamonti et al. (2011) [48] Ozone + antibiotic therapy | 24 | 100% | 25% | |
Migliorati CA et al. (2011) [49] | ||||
No surgery (120 sites) | 599 | 24–48 | 17.6% | |
Surgery (debridement) (118 sites) | 24–48 | 17.3% | ||
Surgery (flap and/or resection) (316 sites) | 24–48 | 46.3% | ||
A. Agrillo et al. (2012) [50] Ozone + antibiotic therapy + surgery | 94 | 14.3 | 60% | |
Martins et al. (2012) [13] | ||||
CHX + antibiotic therapy | 3 | 6 | 33.3% | |
Surgery + antibiotic therapy | 5 | 6 | 60% | |
Antibiotic therapy + surgery + PRP + LLLT | 14 | 6 | 85.7% | |
Rupel K et al. (2014) [51] | ||||
No surgery | 77 | 23.4% | ||
Surgery (debridement) | 236 | 75.4% | ||
Surgery (traditional techniques) | 221 | 90% | ||
Surgery (laser) | 56 | 89.3% | ||
P. Lopez-Jornet et al. (2016) [52] PRP + surgery | 123 | 86% | ||
F. Goker et al. (2020) [53] Ozone + antibiotic therapy + piezosurgery | 14 | 90% | 64.2% | |
Morishita et al. (2020) [54] Teriparatide therapy | 29 | 75.9% | 65.5% | |
Yüce et al. (2021) [55] | ||||
Surgery + concentrated growth factor (CGF) | 14 | 78.6% | ||
Surgery without CGF | 14 | 57.1% | ||
Sahin et al. (2021) [56] Piezosurgery + leukocyte and platelet-rich fibrin concentrate (L-PRF) +Nd:YAG laser | 21 | 100% | ||
Otsuru et al. (2022) [57] Marginal mandibulectomy Segmental mandibulectomy | ||||
155 | 67.1% | |||
13 | 92.3% | |||
Parise et al. (2022) [58] | ||||
Surgery + fibrin-rich platelets and leukocytes (L-PRF) + antibiotic therapy | 5 | 80% | ||
Surgery + without L-PRF + antibiotic therapy | 7 | 57% | ||
P. Vescovi et al. (2012) [8] | ||||
G1 (28 sites): medical therapy; G2 (32 sites): medical therapy and LLLT | 151 | G1: 25% G2: 71.8% G3: 64.7% G4: 81.8% G5: 96.5% | G1: 17.8% G2: 28.1% G3: 64.7% G4: 72.7% G5: 89.6% | |
G3 (17 sites): medical and conventional surgical therapy | ||||
G4 (33 sites): medical therapy, conventional surgical therapy, and LLLT | ||||
G5 (29 sites): medical therapy, Er:YAG laser surgical therapy, and LLLT |
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Vescovi, P.; De Francesco, P.; Giovannacci, I.; Leão, J.C.; Barone, A. Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ). Dent. J. 2024, 12, 261. https://doi.org/10.3390/dj12080261
Vescovi P, De Francesco P, Giovannacci I, Leão JC, Barone A. Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ). Dentistry Journal. 2024; 12(8):261. https://doi.org/10.3390/dj12080261
Chicago/Turabian StyleVescovi, Paolo, Pierpaolo De Francesco, Ilaria Giovannacci, Jair Carneiro Leão, and Antonio Barone. 2024. "Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ)" Dentistry Journal 12, no. 8: 261. https://doi.org/10.3390/dj12080261