Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis

Abstract

Purpose

The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment.

Methods

This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis.

Results

Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008).

Conclusion

Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F (2014) American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2014 update. J Oral Maxillofac Surg 72(10):1938–1956. https://doi.org/10.1016/j.joms.2014.04.031

  2. 2.

    Filleul O, Crompot E, Saussez S (2010) Bisphosphonate-induced osteonecrosis of the jaw: a review of 2,400 patient cases. J Cancer Res Clin Oncol 136(8):1117–1124

  3. 3.

    Ruggiero SL, Drew SJ (2007) Osteonecrosis of the jaws and bisphosphonate therapy. J Dent Res 86(11):1013–1021

  4. 4.

    Ruggiero SL (2007) Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Cases Miner Bone Metab 4(1):37–42

  5. 5.

    Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws—2009 update. J Oral Maxillofac Surg 67(5):2–12

  6. 6.

    Ruggiero SL (2013) An office-based approach to the diagnosis and management of osteonecrosis. Atlas Oral Maxillofac Surg Clin North Am 21(2):167–173

  7. 7.

    Mester E, Spiry T, Szende B, Tota JG (1971) Effect of laser rays on wound healing. Am J Surg 122(4):532–535

  8. 8.

    Gál P, Vidinský B, Toporcer T, Mokrý M, Mozes S, Longauer F, Sabo J (2006) Histological assessment of the effect of laser irradiation on skin wound healing in rats. Photomed Laser Surg 24(4):480–488. https://doi.org/10.1089/pho.2006.24.480

  9. 9.

    Gál P, Mokrý M, Vidinský B, Kilík R, Depta F, Harakalová M, Longauer F, Mozes S, Sabo J (2009) Effect of equal daily doses achieved by different power densities of low-level laser therapy at 635 nm on open skin wound healing in normal and corticosteroid-treated rats. Lasers Med Sci 24(4):539–547. https://doi.org/10.1007/s10103-008-0604-9

  10. 10.

    Ozcelik O, Cenk Haytac M, Kunin A, Seydaoglu G (2008) Improved wound healing by low-level laser irradiation after gingivectomy operations: a controlled clinical pilot study. J Clin Periodontol 35(3):250–254. https://doi.org/10.1111/j.1600-051X.2007.01194.x

  11. 11.

    Amorim JC, de Sousa GR, de Barros SL, Prates RA, Pinotti M, Ribeiro MS (2006) Clinical study of the gingiva healing after gingivectomy and low-level laser therapy. Photomed Laser Surg 24(5):588–594. https://doi.org/10.1089/pho.2006.24.588

  12. 12.

    Markovic A, Todorovic L (2007) Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: a clinical trial. Int J Oral Maxillofac Surg 36(3):226–229. https://doi.org/10.1016/j.ijom.2006.10.006

  13. 13.

    Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adão CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG (2007) Low-power laser in the prevention of induced oral mucositis in bone marrow transplantation patients: a randomized trial. Blood 109(5):2250–2255. https://doi.org/10.1182/blood-2006-07-035022

  14. 14.

    Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M, Rocca JP, Nammour S (2008) Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg 26(1):37–46. https://doi.org/10.1089/pho.2007.2181

  15. 15.

    Hale GM, Querry MR (1973) Optical constants of water in the 200-nm to 200-microm wavelength region. Appl Opt 12(3):555–563

  16. 16.

    Sasaki KM, Aoki A, Ichinose S, Yoshino T, Yamada S, Ishikawa I (2002) Scanning electron microscopy and Fourier transformed infrared spectroscopy analysis of bone removal using Er:YAG and CO2 lasers. J Periodontol 73(6):643–652. https://doi.org/10.1902/jop.2002.73.6.643

  17. 17.

    Sasaki KM, Aoki A, Ichinose S, Ishikawa I (2002) Ultrastructural analysis of bone tissue irradiated by Er:YAG laser. Lasers Surg Med 31(5):322–332. https://doi.org/10.1002/lsm.10110

  18. 18.

    Lewandrowski KU, Lorente C, Schomacker KT, Flotte TJ, Wilkes JW, Deutsch TF (1996) Use of the Er:YAG laser for improved plating in maxillofacial surgery: comparison of bone healing in laser and drill osteotomies. Lasers Surg Med 19(1):40–45. https://doi.org/10.1002/(SICI)1096-9101(1996)19:1<40::AID-LSM6>3.0.CO;2-Q

  19. 19.

    Nelson JS, Orenstein A, Liaw LH, Berns MW (1989) Mid-infrared erbium: YAG laser ablation of bone: the effect of laser osteotomy on bone healing. Lasers Surg Med 9(4):362–374

  20. 20.

    Pourzarandian A, Watanabe H, Aoki A, Ichinose S, Sasaki KM, Nitta H, Ishikawa I (2004) Histological and TEM examination of early stages of bone healing after Er:YAG laser irradiation. Photomed Laser Surg 22(4):342–350. https://doi.org/10.1089/pho.2004.22.342

  21. 21.

    Coleman K, Norris S, Weston A, Grimmer-Sommers K, Hillier S, Merlin T (2015) NHMRC additional levels of evidence and grades for recommendations for developers of guidelines

  22. 22.

    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186

  23. 23.

    Atieh MA, Ibrahim HM, Atieh AH (2010) Platform switching for marginal bone preservation around dental implants: a systematic review and meta-analysis. J Periodontol 81(10):1350–1366. https://doi.org/10.1902/jop.2010.100232

  24. 24.

    Annibali S, Bignozzi I, Cristalli MP, Graziani F, La Monaca G, Polimeni A (2012) Peri-implant marginal bone level: a systematic review and meta-analysis of studies comparing platform switching versus conventionally restored implants. J Clin Periodontol 39(11):1097–1113. https://doi.org/10.1111/j.1600-051X.2012.01930.x

  25. 25.

    Angiero F, Sannino C, Borloni R, Crippa R, Benedicenti S, Romanos GE (2009) Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser. Lasers Med Sci 24(6):849–856. https://doi.org/10.1007/s10103-009-0654-7

  26. 26.

    Altay MA, Tasar F, Tosun E, Kan B (2014) Low-level laser therapy supported surgical treatment of bisphosphonate related osteonecrosis of jaws: a retrospective analysis of 11 cases. Photomed Laser Surg 32(8):468–475. https://doi.org/10.1089/pho.2014.3742

  27. 27.

    Manfredi M, Merigo E, Guidotti R, Meleti M, Vescovi P (2011) Bisphosphonate-related osteonecrosis of the jaws: a case series of 25 patients affected by osteoporosis. Int J Oral Maxillofac Surg 40(3):277–284. https://doi.org/10.1016/j.ijom.2010.11.002

  28. 28.

    Martins MA, Martins MD, Lascala CA, Curi MM, Migliorati CA, Tenis CA, Marques MM (2012) Association of laser phototherapy with PRP improves healing of bisphosphonate-related osteonecrosis of the jaws in cancer patients: a preliminary study. Oral Oncol 48(1):79–84. https://doi.org/10.1016/j.oraloncology.2011.08.010

  29. 29.

    Scoletta M, Arduino PG, Reggio L, Dalmasso P, Mozzati M (2010) Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of a prospective study. Photomed Laser Surg 28(2):179–184. https://doi.org/10.1089/pho.2009.2501

  30. 30.

    Stübinger S, Dissmann JP, Pinho NC, Saldamli B, Seitz O, Sader R (2009) A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation. Lasers Surg Med 41(1):26–30. https://doi.org/10.1002/lsm.20730

  31. 31.

    Vescovi P, Merigo E, Meleti M, Manfredi M (2006) Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment? J Oral Maxillofac Surg 64(9):1460–1462. https://doi.org/10.1016/j.joms.2006.05.042

  32. 32.

    Vescovi P, Merigo E, Meleti M, Fornaini C, Nammour S, Manfredi M (2007) Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment. Br J Oral Maxillofac Surg 45(8):628–632. https://doi.org/10.1016/j.bjoms.2007.03.016

  33. 33.

    Vescovi P, Manfredi M, Merigo E, Meleti M, Fornaini C, Rocca JP, Nammour S (2010) Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT). Lasers Med Sci 25(1):101–113. https://doi.org/10.1007/s10103-009-0687-y

  34. 34.

    Vescovi P, Manfredi M, Merigo E, Guidotti R, Meleti M, Pedrazzi G, Fornaini C, Bonanini M, Ferri T, Nammour S (2012) Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up. Photomed Laser Surg 30(1):5–13. https://doi.org/10.1089/pho.2010.2955

  35. 35.

    Vescovi P, Merigo E, Meleti M, Manfredi M, Guidotti R, Nammour S (2012) Bisphosphonates-related osteonecrosis of the jaws: a concise review of the literature and a report of a single-centre experience with 151 patients. J Oral Pathol Med 41(3):214–221. https://doi.org/10.1111/j.1600-0714.2011.01091.x

  36. 36.

    Vescovi P, Merigo E, Meleti M, Manfredi M, Fornaini C, Nammour S (2012) Surgical approach and laser applications in BRONJ osteoporotic and cancer patients. J Osteoporos 2012:585434. https://doi.org/10.1155/2012/585434

  37. 37.

    Favia G, Tempesta A, Limongelli L, Crincoli V, Maiorano E (2018) Medication-related osteonecrosis of the jaw: surgical or non-surgical treatment? Oral Dis 24(1–2):238–242. https://doi.org/10.1111/odi.12764

  38. 38.

    Atalay B, Yalcin S, Emes Y, Aktas I, Aybar B, Issever H, Mandel NM, Cetin O, Oncu B (2011) Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Lasers Med Sci 26(6):815–823. https://doi.org/10.1007/s10103-011-0974-2

  39. 39.

    Fedele S, Porter SR, D'Aiuto F, Aljohani S, Vescovi P, Manfredi M, Arduino PG, Broccoletti R, Musciotto A, Di Fede O (2010) Nonexposed variant of bisphosphonate-associated osteonecrosis of the jaw: a case series. Am J Med 123(11):1060–1064

  40. 40.

    Ruggiero SL (2013) Emerging concepts in the management and treatment of osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am 25(1):11–20

  41. 41.

    Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, Moon RE, Piantadosi CA (2012) What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg 70(7):1573–1583. https://doi.org/10.1016/j.joms.2012.04.001

  42. 42.

    Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL (2004) Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 62(5):527–534

  43. 43.

    Madrid C, Bouferrache K, Abarca M, Jaques B, Broome M (2010) Bisphosphonate-related osteonecrosis of the jaws: how to manage cancer patients. Oral Oncol 46(6):468–470. https://doi.org/10.1016/j.oraloncology.2010.03.016

  44. 44.

    Ferlito S, Puzzo S, Palermo F, Verzì P (2012) Treatment of bisphosphonate-related osteonecrosis of the jaws: presentation of a protocol and an observational longitudinal study of an Italian series of cases. Br J Oral Maxillofac Surg 50(5):425–429. https://doi.org/10.1016/j.bjoms.2011.08.004

  45. 45.

    Saussez S, Javadian R, Hupin C, Magremanne M, Chantrain G, Loeb I, Decaestecker C (2009) Bisphosphonate-related osteonecrosis of the jaw and its associated risk factors: a Belgian case series. Laryngoscope 119(2):323–329. https://doi.org/10.1002/lary.20076

  46. 46.

    Hayashida S, Soutome S, Yanamoto S, Fujita S, Hasegawa T, Komori T, Kojima Y, Miyamoto H, Shibuya Y, Ueda N, Kirita T, Nakahara H, Shinohara M, Umeda M (2017) Evaluation of the treatment strategies for medication-related osteonecrosis of the jaws (MRONJ) and the factors affecting treatment outcome: a multicenter retrospective study with propensity score matching analysis. J Bone Miner Res 32(10):2022–2029. https://doi.org/10.1002/jbmr.3191

  47. 47.

    Marx RE, Cillo JE, Ulloa JJ (2007) Oral bisphosphonate-induced osteonecrosis: risk factors, prediction of risk using serum CTX testing, prevention, and treatment. J Oral Maxillofac Surg 65(12):2397–2410

  48. 48.

    Boonyapakorn T, Schirmer I, Reichart PA, Sturm I, Massenkeil G (2008) Bisphosphonate-induced osteonecrosis of the jaws: prospective study of 80 patients with multiple myeloma and other malignancies. Oral Oncol 44(9):857–869. https://doi.org/10.1016/j.oraloncology.2007.11.012

  49. 49.

    Wutzl A, Biedermann E, Wanschitz F, Seemann R, Klug C, Baumann A, Watzinger F, Schicho K, Ewers R, Millesi G (2008) Treatment results of bisphosphonate-related osteonecrosis of the jaws. Head Neck 30(9):1224–1230. https://doi.org/10.1002/hed.20864

  50. 50.

    Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 2000 36:59–97. https://doi.org/10.1111/j.1600-0757.2004.03679.x

  51. 51.

    Schwarz F, Aoki A, Becker J, Sculean A (2008) Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 35(8 Suppl):29–44. https://doi.org/10.1111/j.1600-051X.2008.01259.x

  52. 52.

    Schwarz F, Bieling K, Bonsmann M, Latz T, Becker J (2006) Nonsurgical treatment of moderate and advanced periimplantitis lesions: a controlled clinical study. Clin Oral Investig 10(4):279–288. https://doi.org/10.1007/s00784-006-0070-3

  53. 53.

    Stübinger S, von Rechenberg V, Zeilhofer HF, Sader R, Landes C (2007) Er:YAG laser osteotomy for removal of impacted teeth: clinical comparison of two techniques. Lasers Surg Med 39(7):583–588. https://doi.org/10.1002/lsm.20528

  54. 54.

    Statkievicz C, Toro LF, de Mello-Neto JM, de Sá DP, Casatti CA, Issa JPM, Cintra LTA, de Almeida JM, Nagata MJH, Garcia VG, Theodoro LH, Ervolino E (2018) Photomodulation multiple sessions as a promising preventive therapy for medication-related osteonecrosis of the jaws after tooth extraction in rats. J Photochem Photobiol B 184:7–17. https://doi.org/10.1016/j.jphotobiol.2018.05.004

  55. 55.

    Theodoro LH, Assem NZ, Longo M, Alves MLF, Duque C, Stipp RN, Vizoto NL, Garcia VG (2018) Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: a randomized clinical trial. Photodiagn Photodyn Ther 22:217–222. https://doi.org/10.1016/j.pdpdt.2018.04.003

  56. 56.

    Garcia VG, Gualberto EC, Ervolino E, Nagata MJH, de Almeida JM, Theodoro LH (2018) aPDT for periodontitis treatment in ovariectomized rats under systemic nicotine. Photodiagn Photodyn Ther 22:70–78. https://doi.org/10.1016/j.pdpdt.2018.02.017

Download references

Author information

Correspondence to Leonardo Perez Faverani.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applied.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Momesso, G.A.C., Lemos, C.A.A., Santiago-Júnior, J.F. et al. Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis. Oral Maxillofac Surg (2020). https://doi.org/10.1007/s10006-020-00831-0

Download citation

Keywords

  • Low-level laser therapy
  • Medication-associated osteonecrosis of the jaw
  • Laser therapy
  • Bisphosphonate