A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation

BACKGROUND AND OBJECTIVES: This preliminary report describes a new laser-assisted treatment option for the emerging complication of bisphosphonate related osteonecrosis (BON) of the jaw. MATERIALS AND 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. CONCLUSION: 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.