Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review

Abstract

Bisphosphonate-related osteonecrosis of the jaw is a well-known potential side effect of long-term bisphosphonate therapy; the primary objective of the treatment should be to improve patient quality of life through pain and infection management, to prevent the development of new lesions, and to slow disease progression. In recent years, the use of laser for bisphosphonate-related osteonecrosis of the jaw has become more widespread, due to its use of administration and widely reported beneficial effects on tissue healing. The present systematic review of the literature sought to elucidate whether low-level laser therapy has positive effects on the treatment of bisphosphonate-related osteonecrosis of the jaw. We conducted a systematic search of the PubMed, EMBASE, and Cochrane Library electronic databases, with no restrictions on language or year of publication. Search strategies were formulated using keywords and Boolean operators. The electronic search strategy retrieved 55 records. From 55 articles, 16 were selected for full-text review, and of these, 10 were ultimately included for data analysis in this review. Our findings show that treatment modalities including laser were associated with superior outcomes in terms of cure or improvement of bisphosphonate-related osteonecrosis of the jaw lesions as compared with conventional surgical and/or conservative drug therapy. It can be concluded that combined treatment with antibiotics, minimally invasive surgery (including Er:YAG laser surgery), and low-level laser therapy in the early stages of the disease should be the gold standard for bisphosphonate-related osteonecrosis of the jaw management.

Medication-Related Osteonecrosis of the Jaws (MRONJ). Case Report And Update.

“…Because of this, different studies have shown effective results in the treatment of ONJ, especially when used in combination with drugs and minimally invasive surgery [11,12]. DOI: 10.9790/0853-1605067883 www.iosrjournals.org 82 | Page…”

Collagen sponge and rhBMP-2 improve socket healing in rats treated with zoledronic acid

“…13,22,23,24 BRONJ is one of the most serious and well-known potential complications of long-term bisphosphonate therapy. 25 The treatment for BRONJ poses a challenge to oral and maxillofacial surgeons, pathologists, and oncologists. 25 Many hypotheses regarding the pathogenesis of BRONJ -including toxicity to the oral epithelium, altered wound healing, high turnover of the bone cells of the jaw, oral biofilm formation, infection and inflammation, antiangiogenesis, suppression of bone turnover, changes in immune surveillance, and osteoblast death -have been proposed.…”

“…25 The treatment for BRONJ poses a challenge to oral and maxillofacial surgeons, pathologists, and oncologists. 25 Many hypotheses regarding the pathogenesis of BRONJ -including toxicity to the oral epithelium, altered wound healing, high turnover of the bone cells of the jaw, oral biofilm formation, infection and inflammation, antiangiogenesis, suppression of bone turnover, changes in immune surveillance, and osteoblast death -have been proposed. 6,16,21,26 Its etiopathogenesis is multifactorial, 27 and decreased bone turnover, antiangiogenic effects, and infection are the main hypotheses suggested for the pathogenesis of BRONJ to date.…”

Therapy for bisphosphonate-related osteonecrosis of the jaw: a systematic review

“…[1][2][3][4][5][6][7] In the literature regarding ONJ prevalence in patients treated with bisphosphonates, some studies found no bisphosphonate -related osteonecrosis of the jaw (BRONJ), while others found BRONJ, with a prevalence of up to 7.8%, mainly in intravenous administrations. [1][2][3][4][5][6][7] Risk also increases significantly when the patient is subjected to dental procedures, especially tooth extraction and mainly when intravenous bisphosphonates are used. 3 Other dental procedures may trigger BRONJ, such as periodontal surgeries and clinical or surgical endodontic interventions.…”

“…3,8 The temporary discontinuation of bisphosphonates does not seem to provide any short -term advantage, while the long -term discontinuation, if systemic conditions allow, may benefit the stabilization of ONJ sites and reduce clinical symptoms. [1][2][3][4][5][6][7] Local and systemic antimicrobial drugs have been used independently or along with surgery, and sometimes associated with therapies that accelerate healing, such as laser therapy, hyperbaric oxygen, and platelet -rich plasma. [8][9][10][11][12][13][14] This systematic review aimed to assess the treatments available for BRONJ.…”