title: Early surgical laser-assisted management of bisphosphonate-related osteonecrosis of the jaws (BRONJ): a retrospective analysis of 101 treated sites with long-term follow-up.
abstract: BACKGROUND
  The management of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still controversial.
  
  
  OBJECTIVE
  The purpose of this study was to compare surgical and nonsurgical approaches to the treatment of BRONJ and the possible usefulness of Nd:YAG and Er:YAG lasers.
  
  
  METHODS
  One hundred and twenty-eight patients (33 males, 95 females; 52 with diagnosis of multiple myeloma, 53 with diagnosis of bone metastasis, and 23 with diagnosis of osteoporosis) affected by BRONJ were evaluated at the Unit of Oral Pathology and Medicine and Laser-Assisted Surgery of the University of Parma, Italy, between January 2004 and July 2009. Overall number of BRONJ sites was 151, and number of treated sites was 101. In order to assess the efficacy of different treatments, sites were subclassified as follows: Group 1 (G1): 12 sites treated with medical therapy; Group 2 (G2): 27 sites treated with medical therapy associated with low level laser therapy (LLLT); Group 3 (G3): 17 sites treated with a combination of medical and surgical therapy; Group 4 (G4): 45 sites treated with a combination of medical therapy, surgical (including laser-assisted) therapy, and LLLT. Outcome of treatment was assessed using the staging system proposed by Ruggiero et al. Transition from a higher stage to a lower one for at least 6 months was considered as clinical improvement and suggestive of a successful treatment.
  
  
  RESULTS
  Clinical improvement was achieved in 3 out of 12 (25%) BRONJ sites in G1. Sites if G2 with an improvement were 18 out of 27 (66%). Nine out 17 BRONJ sites (53%) in G3 had a transition to a lower stage after treatment. For sites in G4, a clinical improvement was recorded in 40 out of 45 cases (89%).
  
  
  CONCLUSIONS
  In our experience, the percentage of success obtained with a combined approach based on medical therapy, surgical (including laser-assisted) therapy, and LLLT (G4) is significantly higher than the percentage of improvement obtained in G1, G2, and G3.
authors: Oral Medicine, Pathology and Laser-Assisted Surgery Unit, University of Parma, Parma, Italy.
authors: Paolo
authors: P
authors: Vescovi
authors: Maddalena
authors: M
authors: Manfredi
authors: Elisabetta
authors: E
authors: Merigo
authors: Rebecca
authors: R
authors: Guidotti
authors: Marco
authors: M
authors: Meleti
authors: Giuseppe
authors: G
authors: Pedrazzi
authors: Carlo
authors: C
authors: Fornaini
authors: Mauro
authors: M
authors: Bonanini
authors: Teore
authors: T
authors: Ferri
authors: Samir
authors: S
authors: Nammour
mesh_terms: D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D005260:Female; D006801:Humans; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy; D010024:Osteoporosis / Q000188:drug therapy