Abstract
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.
Similar content being viewed by others
References
Marx RE, Stern D (2003) Oral and maxillo-facial pathology: a rationale for diagnosis and treatment. 1st edn; Quintessence, Carol Stream, pp 36–38
Marx RE (2003) Letters to the editor. Pamidronate (Aredia) and zoledronate (Zometa) induced vascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 61:1115–1157. doi:10.1016/S0278–2391(03)00720–1
Migliorati CA (2003) Bisphosphonates and oral cavity avascular bone necrosis. J Clin Oncol 21:4253–4254. doi:10.1200/JCO.2003.99.132
Wang J, Goodger NM, Pogrel MA (2003) Osteonecrosis of the jaws associated with cancer chemotherapy. J Oral Maxillofac Surg 61:1104–1117. doi:10.1016/S0278–2391(03)00328–8
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. doi:10.1016/j.joms.2004.02.004
Ruggiero SL, Gralow J, Marx R, Hoff AO, Schubert MM, Huryn JM (2006) Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Pract 2:7–14. doi:10.1200/JOP.2.1.7
Woo SB, Hellstein JW, Kalmar JR (2006) Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761
Woo SB, Solomon DH (2007) Bisphosphonate therapy for cancer and prevalence of inflammatory jaw conditions. J Natl Cancer Inst 99(13):986–987. doi:10.1093/jnci/djm029
Rogers MJ, Gordon S, Benfored HL, Coxon FP, Luckman SP, Monkkonen J et al (2000) Cellular and molecular mechanisms of action of bisphosphonates: skeletal complications of malignancy. Cancer 88:2961–2978. doi:10.1002/1097–0142(20000615)88:12 + <2961::AID-CNCR12>3.0.CO;2-L
Van Beek ER, Lowick CW, Papapoulos SE (2002) Bisphosphonates suppress bone resorption by a direct effect on early osteoclast precursors without affecting the osteoclastogenic capacity of osteogenic cells. The role of protein geranylgeranylation in the action of nitrogen-containing bisphosphonates or osteoclast precursors. Bone 30:64–70. doi:10.1016/S8756–3282(01)00655-X
Nagasaka A, Kato K, Negishi A (1991) Bone regeneration effect of low level lasers including argon laser. Laser Ther 3:59–62
Tang XM, Chai BP (1986) Effect of CO2 laser irradiation on experimental fracture healing: a transmission electron microscopic study. Lasers Surg Med 6:346–352. doi:10.1002/lsm.1900060309
Braverman B, McCarthy RJ, Ivankovich AD, Forde DE, Overfield M, Bapna MS (1989) Effect of helium–neon and infrared laser irradiation on wound healing in rats. Lasers Surg Med 9:50–58. doi:10.1002/lsm.1900090111
Nissan J, Assif D, Gross MD, Yaffe A, Binderman I (2006) Effect of low intensity laser irradiation on surgically created bony defects in rats. J Oral Rehabil 33:619–624. doi:10.1111/j.1365–2842.2006.01601.x
Nicola RA, Jorgetti V, Rigau J, Pacheco MT, dos Reis LM, Zangaro RA (2003) Effect of low-power GaAlAs laser (660 nm) on bone structure and cell activity: an experimental animal study. Lasers Med Sci 18:89–94. doi:10.1007/s10103–003–0260-z
Abe T (1990) Diode laser LLLT-enhanced bone fusion of femoral shaft fracture complicated of chronic osteomyelitis: a case report. Laser Ther 2:175–178
Ninomiya T, Miyamoto Y, Ito T, Yamashita A, Wakita M, Nishisaka T (2003) High-intensity pulsed laser irradiation accelerates bone formation in metaphyseal trabecular bone in rat femur. J Bone Miner Metab 21:67–73. doi:10.1007/s007740300011
Kujawa J, Zavodnik L, Zavodnik I, Buko V, Lapshyna A, Bryszewska M (2004) Effect of low-intensity (3.75–25 J/cm2) near-infrared (810 nm) laser radiation on red blood cell ATPase activities and membrane structure. J Clin Laser Med Surg 22:111–117. doi:10.1089/104454704774076163
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 26:37–46. doi:10.1089/pho.2007.2181
Rochkind S, Kogan G, Luger EG et al (2004) Molecular structure of the bony tissue after experimental trauma to the mandibular region followed by laser therapy. Photomed Laser Surg 22:249–253. doi:10.1089/1549541041438579
Fujihara NA, Hiraki KR, Marques MM (2006) Irradiation at 780 nm increases proliferation rate of osteoblasts independently of dexamethasone presence. Lasers Surg Med 38:332–336. doi:10.1002/lsm.20298
Khadra M, Ronold HJ, Lyngstaddas SP, Ellingsen JE, Haanaes HR (2004) Low-level laser therapy stimulates bone implant interaction: an experimental study in rabbits. Clin Oral Implants Res 15:325–332. doi:10.1111/j.1600–0501.2004.00994.x
Garavello-Freitas I, Baranauskas V, Joazeiro PP, Padovani CR, Dal Pai-Silva M, Cruz-Hofling MA (2003) Low power laser irradiation improves histomorphometrical parameters and bone matrix organization during tibia wound healing in rats. J Photochem Photobiol B 70:81–89. doi:10.1016/S1011–1344(03)00058–7
Muniz Renno AC, Mendes de Moura F, Andrade dos Santos NS, Passarelli Tirico R, Bossini PS, Parizotto NA (2006) Effects of infrared-830 nm laser, used in two doses, on biochemical properties on osteopenic rats femora. Photomed Laser Surg 24:202–206. doi:10.1089/pho.2006.24.202
Abramovitch-Gottlib L, Gross T, Naveh D et al (2005) Low level laser irradiation stimulates osteogenic phenotype of mesenchymal stem cells seeded on a three-dimensional biomatrix. Lasers Med Sci 20:138–146. doi:10.1007/s10103–005–0355–9
Stein A, Benayahu D, Maltz L, Oron U (2005) Low level laser irradiation promotes proliferation and differentiation of human osteoblasts in vitro. Photomed Laser Surg 23:161–166. doi:10.1089/pho.2005.23.161
Hale GM, Querry MR (1973) Optical constants of water in the 200-nm to 200-m wavelength region. Appl Opt 12:555–563. doi:10.1364/AO.12.000555
Sasaki KM, Aoki A, Ichinose S, Ishikawa I (2002) Ultrastructural analysis of bone tissue irradiated by Er:YAG Laser. Lasers Surg Med 31:322–332. doi:10.1002/lsm.10110
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 19:40–45. doi:10.1002/(SICI)1096–9101(1996)19:1<40::AID-LSM6>3.0.CO;2-Q
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 9:362–374. doi:10.1002/lsm.1900090409
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 22:342–350. doi:10.1089/pho.2004.22.342
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 73:643–652. doi:10.1902/jop.2002.73.6.643
Mizutani K, Aoki A, Takasaki AA, Kinoshita A, Hayashi C, Oda S, Ishikawa I (2006) Periodontal tissue healing following flap surgery using an Er:YAG laser in dogs. Lasers Surg Med 38:314–324. doi:10.1002/lsm.20299
American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw (2007). J Oral Maxillofac Surg 65:369–376
Ficarra G, Beninati F, Rubino I, Vannucchi A, Longo G, Tonelli P et al (2005) Osteonecrosis of the jaws in periodontal patients with a history of bisphosphonates treatment. J Clin Periodontol 32:1123–1128. doi:10.1111/j.1600–051X.2005.00842.x
Freiberger JJ, Padilla-Burgos R, Chhoeu AH, Kraft KH, Boneta O, Moon RE et al (2007) Hyperbaric oxygen treatment and bisphosphonate-induced osteonecrosis of the jaw: a case series. J Oral Maxillofac Surg 65:1321–1327. doi:10.1016/j.joms.2007.03.019
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Angiero, F., Sannino, C., Borloni, R. et al. Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser. Lasers Med Sci 24, 849–856 (2009). https://doi.org/10.1007/s10103-009-0654-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10103-009-0654-7