title: Doxycycline fluorescence-guided Er:YAG laser ablation combined with Nd:YAG/diode laser biostimulation for treating bisphosphonate-related osteonecrosis of the jaw.
abstract: Laser therapy and fluorescence-guided surgery are highly reliable and predictable methods, but their combination has not been found to yield useful outcomes. We present a new therapeutic approach combining fluorescence-guided Er:YAG laser ablation with Nd:YAG/diode laser biostimulation for bisphosphonate-related osteonecrosis of the jaw (BRONJ). A woman was treated with zoledronic acid for bone metastasis from clear cell renal cell carcinoma and subsequently developed BRONJ in the left jaw. The management protocol included perioperative medical therapy (1% chlorhexidine gel, rifamycin, and doxycycline for 10 preoperative and 7 postoperative days), Er:YAG laser ablation guided by doxycycline fluorescence in vital bone under UV light, and Nd:YAG/diode laser biostimulation. The lesion regressed from stage 3 to stage 1 and showed nearly complete healing after laser therapy (3 and 23 cycles of ablation and biostimulation, respectively). These preliminary findings suggest the feasibility of the new approach, which is minimally invasive and biostimulative and causes very low morbidity.
authors.affiliation: Oral Surgery Specialist, Department of Translational Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Porcaro
authors.affiliation: Postgraduate student, Department of Translational Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. Electronic address: e.amosso@virgilio.it.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Amosso
authors.affiliation: Postgraduate student, Department of Translational Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Scarpella
authors.affiliation: Research Professor, Department of Translational Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Carini
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D028022:Low-Level Light Therapy / Q000379:methods*; D008336:Mandibular Diseases / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008875:Middle Aged; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed