Piezoelectric Surgery, Er:YAG Laser Surgery and Nd:YAG Laser Photobiomodulation: A Combined Approach to Treat Medication-Related Osteonecrosis of the Jaws (MRONJ)

Author:

Vescovi Paolo1,De Francesco Pierpaolo2ORCID,Giovannacci Ilaria1,Leão Jair Carneiro3ORCID,Barone Antonio2ORCID

Affiliation:

1. Oral Medicine and Oral Surgery Laser Unit, University Centre of Dentistry, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy

2. Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126 Pisa, Italy

3. Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife 50670-901, Brazil

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a drug complication that can occur in patients taking antiresorptive or antiangiogenic drugs. Although it is a well-documented disease, there is no widely accepted treatment. However, several therapeutic approaches have been proposed. The surgical approach in many advanced cases appears inevitable; however, the results are not yet defined and predictable. This study aimed to propose a combined surgical approach with a piezoelectric device and laser (Er:YAG for bone ablation and Nd:YAG laser for photobiomodulation) in a young patient with breast cancer and bone metastasis under denosumab treatment, affected by spontaneous stage 3 MRONJ with maxillary sinus involvement. The patient under study reported no post-operative discomfort, with painkiller intake limited to the day after surgery. Total mucosal healing was observed without recurrences for more than 4 years after surgery. According to the results of our preliminary study, a combined surgical approach using a piezoelectric device and laser therapy is effective in managing patients affected by MRONJ, leveraging the clinical and biological advantages of these different techniques.

Publisher

MDPI AG

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