Tooth extractions in high-risk patients under bisphosphonate therapy and previously affected with osteonecrosis of the jaws: surgical protocol supported by low-level laser therapy.
Trauma during dental surgery is a predisposing factor for medication-related osteonecrosis of the jaws (MRONJ). There are no specific guidelines for the management of dental extractions in patients under bisphosphonate therapy (BPT). The authors proposed in 2013 a successful protocol for tooth extractions in patients under BPT supported by Nd:YAG low-level laser therapy (LLLT). The aim of this study was to validate the safety and efficacy of this protocol reporting the data related to its application in a particular category of patients under BPT at high risk for MRONJ and who were previously affected with MRONJ. Eighty-two tooth extractions were performed in 36 patients previously affected with MRONJ. Antibiotic treatment was administered 3 days before and 2 weeks after tooth extractions. Patients were additionally treated with Nd:YAG LLLT, 5 applications of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. In a total of 82 extractions, minimal bone exposure was observed in 2 cases, treated with Er:YAG laser vaporization and then completely healed. The data confirmed that laser biostimulation is a reliable technique that can be considered in the surgical protocol for patients under BPT.
*Center of Oral Laser Surgery and Oral Medicine, Dental School, Department of Biomedical, Biotechnological and Translational Sciences, University of Parma, Italy †Université de Liège, Liège, Belgium.
Paolo
P
Vescovi
Ilaria
I
Giovannacci
Elisabetta
E
Merigo
Marco
M
Meleti
Maddalena
M
Manfredi
Carlo
C
Fornaini
Samir
S
Nammour
D000368:Aged; D000369:Aged, 80 and over; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000628:therapy*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014081:Tooth Extraction / Q000379:methods*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates