A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation.
OBJECTIVE
This preliminary report describes a new laser-assisted treatment option for the emerging complication of bisphosphonate related osteonecrosis (BON) of the jaw.


METHODS
In eight tumour patients (three women, five men) ten bony lesions in the maxilla and mandible in the course of intravenous bisphosphonate therapy were treated with a variable square pulsed (VSP) Er:YAG laser. For the treatment, the Er:YAG laser was applied with a pulse energy of 1,000 mJ, a pulse duration of 300 microseconds, and a frequency of 12 Hz (energy density 157 J/cm(2)). The spot size was 0.9 mm and the handpiece was kept at a distance of about 10 mm from the bone surface. The diseased bone was ablated exclusively with the Er:YAG laser by subsequently sweeping the bone surface in a well directed scanning mode.


RESULTS
The surgical procedure and postoperative wound healing were without any complications and a complete soft tissue recovering was achieved within 4 weeks. During follow-up examinations over 12 months soft tissue conditions were stable. The pulsed laser ablation caused a characteristic microstructured and craggy bone surface without a condensation or a smear layer on the laser rims.


CONCLUSIONS
The bone ablation technique using a VSP Er:YAG laser yielded promising clinical results without impairment of wound healing. A further analyse of the chemical, physical and pharmacological aspects of laser assisted treatment of BON lesions is necessary to get a safe and reliable treatment protocol for bisphosphonate-related osteonecrosis of the jaw.
Stübinger
Stefan
S
Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Basel, Switzerland. sstuebinger@uhbs.ch
Dissmann
Jan-Philipp
JP
Pinho
Nicole Chambron
NC
Saldamli
Belma
B
Seitz
Oliver
O
Sader
Robert
R
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D015331:Cohort Studies; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008334:Mandible; D008437:Maxilla; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004164:Diphosphonates