Abstract
Several studies have shown a positive effect of low-level laser therapy (LLLT) using different wavelengths (argon, CO2, He-neon, Er:YAG, diode, Nd:YAG, and KTP) on the healing process in a wide range of cutaneous, mucosal, and bone disorders. LLLT reportedly stimulates osteoclast activity to promote bone resorption and remodeling. Soft-tissue healing is also improved by LLLT. The transformation of fibroblasts into myofibroblasts can accelerate the healing of skin and mucosa. In particular, in conditions characterized by avascular necrosis, such as bisphosphonates-induced osteonecrosis of the jaw (BIONJ), it is essential to stimulate vascularization and soft-tissue tropism through an increase in blood flow by means of angiogenesis, capillary growth, and an increase in growth factor release. Laser can be used in the conservative surgical treatment of BIONJ patients. The procedure involves the vaporization of necrotic bone until healthy bone is reached. The minimal penetration of the erbium laser (0.1 mm) guarantees safety and allows for precise, minimally invasive surgery, inducing a much lower increase in bone temperature than conventional rotary tools (cold ablation). One undoubted advantage of this technique for BIONJ patients is the bactericidal action of the laser beam, in particular versus Actinomyces and anaerobes species. These considerations support the effectiveness of LLLT in the treatment of jawbone and mucosal defects related to BIONJ development or following tooth extractions in patients under bisphosphonates therapy. Thus, minimally invasive laser-assisted surgical treatment appears to be a promising approach for BIONJ management.
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References
Sonis ST, Watkins BA, Lyng GD, Lerman MA, Anderson KC (2009) Bony changes in the jaws of rats treated with zoledronic acid and dexamethasone before dental extractions mimic bisphosphonate-related osteonecrosis in cancer patients. Oral Oncol 45:164–172
Fleisch H (1998) Bisphosphonates: mechanisms of action. Endocr Rev 19:80–100
Sarin J, DeRossi SS, Akintoye SO (2008) Updates on bisphosphonates and potential pathobiology of bisphosphonate-induced jaw osteonecrosis. Oral Dis 14:277–285
Reid IR, Bolland MJ, Grey AB (2007) Is bisphosphonate-associated osteonecrosis of the jaw caused by soft tissue toxicity? Bone 41:318–320
Landesberg R, Cozin M, Cremers S et al (2008) Inhibition of oral mucosal cell wound healing by bisphosphonates. J Oral Maxillofac Surg 66:839–847
Green JR (2004) Bisphosphonates: preclinical review. Oncologist 9:3–13
Vescovi P, Merigo E, Meleti M, Manfredi M (2006) Bisphosphonate-associated osteonecrosis (BON) of the jaws: a possible treatment? J Oral Maxillofac Surg 64:1460–1462
Gutknecht N (2007) Proceedings of the 1st international workshop of evidence-based dentistry on laser in dentistry. Quintessence Publishing, Chicago
Khadra M, Kasem N, Haanaes HR, Ellingsen JE, Lyngstadaas SP (2004) Enhancement of bone formation in rat calvarial bone defects using low-level laser therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:693–700
Bradley P, Tunér J (2007) Laser phototherapy in dentistry. In: Proceedings of the 1st international workshop of evidence-based dentistry on laser in dentistry. Quintessence Publishing, Chicago
Bjordal JM, Couppé C, Chow RT, Tunér J, Ljunggren EA (2003) A systematic review of low level laser therapy with location-specific doses for pain from chronic disorders. Aust J Physiother 49:107–116
Bjordal JM (2005) Can a Cochrane review in controversial areas be biased? A sensitivity analysis based on the protocol of a systematic Cochrane review low level laser therapy in osteoarthritis. Photomed Laser Surg 23:453–458
Garavello-Freitas I, Baranauskas V, Joazeiro PP et al (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
Medrado AR, Pugliese LS, Reis SR, Andrade ZA (2003) Influence of low level laser therapy on wound healing and its biological action upon myofibroblasts. Lasers Surg Med 32:239–244
Bayat M, Vasheghani MM, Razavi N (2006) Effect of low-level helium-neon laser therapy on the healing of third-degree burns in rats. J Photochem Photobiol B 83:87–93
Pessoa ES, Melhado RM, Theodoro LH, Garcia VG (2004) A histologic assessment of the influence of low-intensity laser therapy on wound healing in steroid-treated animals. Photomed Laser Surg 22:199–204
Rabelo SB, Villaverde AB, Nicolau R, Salgado MC, Melo Mda S, Pacheco MT (2006) Comparison between wound healing in induced diabetic and nondiabetic rats after low-level laser therapy. Photomed Laser Surg 24:474–479
Sedghizadeh PP, Kumar SK, Gorur A, Schaudinn C, Shuler CF, Costerton JW (2008) Identification of microbial biofilms in osteonecrosis of the jaws secondary to bisphosphonate therapy. J Oral Maxillofac Surg 66:767–775
Rocca J-P (2008) Les lasers en odontologie. Editions CdP—Wolters Kluver France—Avril
Gutknecht N, Raoufi P, Frenzen R, Lampert F (2002) Reduction of specific microorganism in periodontal pockets with the aim of an Nd:YAG laser. An in vivo study. J Oral Laser Appl 2:175–180
Folwaczny M, Mehl A, Jordan C, Hickel R (2002) Antibacterial effects of pulsed Nd:YAG laser radiation at different energy settings in root canals. J Endod 1:24–29
Vescovi P, Merigo E, Conti S et al (2010) Bactericidal effect on Nd:YAG laser on Staphylococcus aureus and Actinomyces israelii: preliminary results. Lasers Med Sci 25:S42
Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini M, Bonanini M, Rocca JP, Nammour S (2008) Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated necrosis of the jaw: clinical experience in 28 cases. Photomed Laser Surg 26:37–46
Scoletta M, Arduino PG, Reggio L, Delmasso P, Mozzati M (2010) Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of prospective study. Photomed Laser Surg 110:46–53
Romeo U, Galanakis A, Marias C et al (2011) Observation of pain control in patients with bisphosphonate-induced osteonecrosis using low level laser therapy: preliminary results. Photomed Laser Surg (Epub ahead of print)
Vescovi P, Merigo E, Meleti M, Manfredi M (2008) Early surgical approach preferable to medical therapy for bisphosphonate-related osteonecrosis of the jaw. J Oral Maxillofac Surg 66:931–933
Wutzl A, Biedermann E, Wanschitz F et al (2008) Treatment results of bisphosphonate-related osteonecrosis of the jaws. Head Neck 30:1224–1230
Markose G, Mackenzie FR, Currie WJ, Hislop WS (2009) Bisphosphonate osteonecrosis: a protocol for surgical management. Br J Oral Maxillofac Surg 47:294–297
Van den Wyngaert T, Claeys T, Huizing MT, Vermorken JB, Fossion E (2009) Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaws (ONJ) and predictor outcomes. Ann Oncol 2:331–336
Stockmann P, Vairaktaris E, Wehrhan F et al (2010) Osteotomy and primary wound closure in bisphosphonate-associated osteonecrosis of the jaw: a prospective clinical study with 12 months follow-up. Support Care Cancer 18:449–460
Vescovi P, Romeo U, Merigo E et al (2011) Use of laser therapy in the treatment of jaw bone diseases. Dent Cadmos 79:133–148
Pourzarandian A, Watanabe H, Aoki A et al (2004) Histological and TEM examination of early stages of bone healing after Er:YAG laser irradiation. Photomed Laser Surg 22:343–350
de Mello ED, Pagnoncelli RM, Munin E et al (2008) Comparative histological analysis of bone healing of standardized bone defects performed with the Er:YAG laser and steel burs. Lasers Med Sci 23:253–260
Romeo U, Del Vecchio A, Palaia G, Tenore G, Visca P, Maggiore C (2009) Bone damage induced by different cutting instruments. An in vitro study. Braz Dent J 20:162–168
Vescovi P, Merigo E, Manfredi M et al (2009) Surgical treatment of maxillary osteonecrosis due to bisphosphonates using an Er:YAG (2940 nm) laser. Discussion of 17 clinical cases. Rev Belge Med Dent 64:87–95
Vescovi P, Manfredi M, Merigo E et al (2010) Surgical approach with Er:YAG laser on Osteonecrosis of the Jaws (ONJ) in patients under Bisphosphonate Therapy (BPT). Lasers Med Sci 25:101–113
Merigo E, Vescovi P, Manfredi M et al (2010) Surgical Er:YAG laser assisted treatment of BRONJ (Bisphosphonate-Related Osteonecrosis of the Jaws). Lasers Med Sci 25:S43
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. Laser Med Sci 24:849–856
Stubinger 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 41:28–30
Vescovi P, Campisi G, Fusco V et al (2011) Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) not associated to invasive dental procedures: a retrospective analysis of 567 cases in an Italian multicenter study. Oral Oncol 47:191–194
Mavrokokki T, Cheng A, Stein B, Gos A (2007) Nature and frequency of bisphosphonate-associated osteonecrosis in Australia. J Oral Maxillofac Surg 65:415–423
Malden N, Beltes C, Lopes V (2009) Dental extractions and bisphosphonates: the assessment, consent and management, a proposed algorithm. Br Dent J 206:93–98
Vescovi P, Fornaini C, Merigo E et al (2009) Use of Nd:YAG laser biostimulation for dental extractions scheme in patients under bisphosphonates therapy. Lasers Med Sci 24:S44
Vescovi P, Nammour S (2010) Bisphosphonate-related osteonecrosis of the jaw (BRONJ) therapy. A critical review. Minerva Stomatol 59:181–213
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Vescovi, P. (2012). Conservative Treatment: LASER (Biostimulation and Minimally Invasive Surgical Treatment). In: De Ponte, F. (eds) Bisphosphonates and Osteonecrosis of the Jaw: A Multidisciplinary Approach. Springer, Milano. https://doi.org/10.1007/978-88-470-2083-2_12
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