Laser GaAlAs (λ860 nm) photobiomodulation for the treatment of bisphosphonate-induced osteonecrosis of the jaw.

OBJECTIVE: The aim of this article is to report a case of bisphosphonate-induced osteonecrosis (ONJ-BP) of the jaw treated by curettage of the necrotic bone, low-level laser therapy (LLLT), and antibiotic therapy. BACKGROUND DATA: ONJ-BP is characterized by painful ulcerations of the oral mucosa, is prone to bone necrosis that does not heal within 8 weeks after diagnosis, and is often difficult to treat. No definitive standard of care has been established for ONJ-BP. LLLT improves wound healing, relieves pain, and appears to be a promising treatment modality for patients with ONJ-BP. MATERIALS AND METHODS: An 82-year-old man taking intravenous bisphosphonate presented with ONJ-BP after tooth extraction. The patient was treated by LLLT using a GaAlAs diode laser with the following settings: wavelength, 860 nm; 70 mW; continuous wave; and spot size 4 mm(2). An energy density of 4.2 J/cm(2) per point was applied in a punctual contact manner every 48 h for 10 days, in association with antibiotic therapy and curettage of the necrotic bone. Reduction in painful symptoms was reported after the second irradiation session, and tissue healing was complete at the end of the third week following oral curettage. The patient was followed up for 12 months and exhibited good oral healt and quality of life. CONCLUSIONS: The therapeutic protocol used in this study had a positive effect on tissue healing and remission of painful symptoms, resulting in better oral health and quality of life for the patient.

Observation of pain control in patients with bisphosphonate-induced osteonecrosis using low level laser therapy: preliminary results.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse side effect associated with bisphosphonate (BP) therapy, especially when parenteral BP administration is used. Patients affected by BRONJ present wide areas of exposed necrotic bone, particularly after surgical oral procedures. The main symptom is pain that is poorly controlled by common analgesic drugs. Recently, many studies have pointed to the beneficial effect of low-level laser therapy (LLLT) in pain reduction for many pathological conditions. The purpose of this study is to investigate whether LLLT could be helpful in managing BRONJ by reducing the problems associated with this condition and the use of analgesic drugs. METHODS: Twelve patients affected by BRONJ were monitored at the Complex Operative Unit of Oral Pathology. Among these patients, only seven referred to pain in necrotic areas and were recruited for LLLT. Laser applications were performed with a double diode laser simultaneously emitting at two different wavelengths (λ = 650 nm and λ = 904-910 nm, spot size = 8 mm). All of the patients were irradiated with a fluence of 0.053 J/cm(2) for 15 min five times over a period of 2 weeks, in a non-contact mode, ∼1 mm from the pathologic area. The patient's maximum and minimum pain was recorded using a numeric rating scale (NRS) evaluation before and after the treatment. Statistical analysis was performed using the Kruskal-Wallis test. RESULTS: Six patients showed significant pain reduction, and only one patient indicated a worsening of the symptoms, which was probably related to a reinfection of the BRONJ site, which occurred during the study. A statistically significant difference (p < 0.05) was found between the NRS rates before and after the protocol. CONCLUSIONS: This pilot study suggests that LLLT may be a valid technique to support the treatment of BRONJ-related pain, even though the low number of cases in this study does not permit any conclusive consideration.

Surgical approach with Er:YAG laser on osteonecrosis of the jaws (ONJ) in patients under bisphosphonate therapy (BPT).

Osteonecrosis of the jaw (ONJ) in patients on long-term bisphosphonate Therapy (BPT) has been reported with increasing frequency in literature over the past 4 years. Therapy for this condition is still a dilemma. Temporary suspension of BPT offers no short-term benefits; hyperbaric oxygen has no proven efficacy and therefore is not recommended. Intermittent or continuous antibiotic therapy with surgical debridement can be beneficial to palliate the symptoms. Er:YAG laser can be used to eliminate necrotic bone portions by partial or total resection as an alternative to conventional rotary devices. In our study, 91 patients affected by ONJ-BP lesion, for a total of 115 ONJ sites were observed between January 2004 and May 2008 (Department of Odontostomatology, University of Parma). Fifty-five ONJ sites were considered for this study in four different groups, retrospectively identified on the basis of treatment performed (G1-G4). G1: 13 ONJ-BP sites were treated with medical therapy (amoxicillin 1gr x 3/die per os with metronidazole 250 mg x 2/die per os) for at least 2 weeks; G2: 17 ONJ-BP sites received medical treatment in association with cycles of low-level laser therapy (LLLT) applications performed using an Nd:YAG laser (1,064 nm) once a week for 2 months; G3: 13 ONJ-BP sites were surgically treated (sequestrectomy of necrotic bone, debridement, corticotomy/surgical removal of alveolar and/or cortical bone); G4: 12 ONJ-BP sites were treated with surgical therapy performed using an Er:YAG laser (2,940 nm) in association with LLLT. Clinical success has been defined for each treatment performed as: (a) complete mucosal healing free from signs and symptoms (classified as stage "0") or (b) transition from a higher to a lower stage (Ruggiero staging) for at least 3 months. All the ONJ-BP sites treated with Er:YAG laser (G4 group) had a clinical improvement (100%) and 87.5% of sites had a complete mucosal healing with a mean follow-up of 13 months. The result obtained in the G4 is extremely significant in comparison with those obtained by medical treatment alone or in a traditional surgical approach. Thanks to the high degree of affinity of this wavelength for water and hydroxyapatite, both soft and bone tissues can be easily treated. This technique can also be used for conservative operations whereby necrotic bone is vaporized until healthy bone is reached. In addition, an additional advantage of the Er:YAG laser is its bactericidal and possible biostimulatory action, accelerating the healing of both soft tissues and bone tissues, in comparison to conventional treatments. In conclusion, from our experience, it is possible to observe that an early conservative surgical approach with Er:YAG laser associated with LLLT, for BP-induced ONJ could be considered as more efficient in comparison with medical therapy or other conventional techniques.

Effect of low-level laser irradiation on bisphosphonate-induced osteonecrosis of the jaws: preliminary results of a prospective study.

OBJECTIVE: The aim of this study was to detail the clinical efficacy of low-level laser therapy (LLLT) for the management of bisphosphonate-induced osteonecrosis of the jaws (ONJ-BP). BACKGROUND: ONJ-BP is the correct term, recently emerged, to describe a significant complication in a subset of patients receiving drugs such as zoledronic acid, pamidronate, and alendronate. No definitive standard of care has been set for ONJ-BP and no definitively agreed guidelines have been provided. There is currently no consensus on the correct approach to the issue. MATERIALS AND METHODS: The investigators studied a prospective cohort of 20 patients affected by ONJ-BP, who received biostimulation with a pulsed diode laser (GaAs). Patients were exposed to a 904-nm infrared laser (50 kHz, 28.4 J/cm(2) energy density, 40% duty cycle, spot size 0.8 cm). Outcome variables were the size of lesions, edema, visual analogue score of pain, presence of pus, fistulas, and halitosis. Preoperative results were compared with the postoperative outcome and statistically evaluated. RESULTS: Four weeks after LLLT, a statistically significant difference was observed for reported pain (p = 0.0001), clinical size (p = 0.0034), edema (p = 0.0005), and presence of pus and fistulas (p = 0.0078 and p = 0.03, respectively). CONCLUSION: This study suggests that LLLT would appear to be a promising modality of treatment for patients with ONJ-BP, providing that clinical efficacy is safe and well tolerated, especially by those patients who require conservative treatment. Of course, this needs to be addressed further in larger and randomly controlled studies in different clinical settings.

Eosinophilic granuloma in the jaws.

Eosinophilic granuloma is the most common expression of Langerhans cell histiocytosis and corresponds with typical bone lesions. This disease is of importance to dental professionals because early clinical signs can occur in the jaw and can cause extensive destruction of the periodontal tissues. Pathological fracture is an unusual finding. The purpose of this case report is to describe a case of eosinophilic granuloma in a 28-year-old black man who initially appeared with intense pain from a pathological mandibular fracture.

Conduta do cirugião-dentista frente à necessidade de exodontia em pacientes irradiados na região da cabeça e pescoço / Dentist´s behavior before the need for exodontics in patients irradiated in the region of head and neck

O presente estudo tem por objetivo, com base na literatura vigente, enfatizar aspectos importantes relacionados à realização de exodontia em pacientes submetidos à radioterapia na região da cebeça e pescoço, visando alertar o clínico quanto ao risco de ocorrência de osteorradionecrose (ORN). Percebe-se que o osso irradiado responde de formaperculiar à infecção em virtude da sua condição de hipóxia, hipocelularidade e hipovascularidade. Assim, exodontias durante a após o tratamento redioterápico são contra-indicadas. Na presença de envolvimento pulpar, a terapia endodôntica é considerada a primeira opção de tratamento. Quando esta terapia não for possível, opta-se pela exodontia, que deverá ser conduzida, pelo menos, três semanas antes do início da radioterapia

Histiocytosis X: does radiotherapy still have a role?

Seventeen cases of histiocytosis X are presented (11 children and 6 young adults, with the usual male predominance), having a minimum follow-up of 1 year and a maximum of 20 years. In these age groups, even small doses of radiation should not be given without careful consideration, but fairly low doses carry only a small risk and may be very useful in management. Unlike chemotherapy, radiotherapy can be confined to the affected area, or to the area causing symptoms. All but two of our patients had radiotherapy for bone deposits; only one failed to show a complete response. In addition, the diabetes insipidus of two children responded immediately to radiation of the pituitary. One patient, however, after responding well to radiation for bone deposits, suffered increasing symptoms due to lung involvement and the latter showed no response. This striking contrast in radiosensitivity is hard to explain, given the identical histology obtained by biopsy from each site, but it has been noted many times by others.

[Intravascular laser irradiation of the blood in treating suppurative-necrotic processes of the maxillofacial area]. / Vnutrisosudistoe lazernoe obluchenie krovi v lechenii gnoino-nekroticheskikh protsessov cheliustno-litsevoi oblasti.

The results of investigations evidence a high efficacy of intravascular laser irradiation of the blood in the treatment of maxillofacial pyonecrotic processes. Such treatment is conducive to improvement of the immunologic reactivity, microcirculation, and regeneration. The method is simple, that recommends it for outpatient practice.

[The use of the Uzor laser apparatus for treating inflammatory diseases of the maxillofacial area]. / Primenenie lazernogo apparata "Uzor" dlia lecheniia vospalitel'nykh zabolevanii cheliustno-litsevoi oblasti.

This is a report on the first results of application of "Uzor" laser device in dentistry. Semiconductor lasers are used in it. Bioeffective regimens of magneto-laser therapy were established to treat maxillofacial pathology. A series of techniques is offered to treat some particular diseases: arthritis, alveolitis, sialoadenitis, pericoronitis, jaw fractures.

Central giant cell granuloma of the jaws: experiences in the management of thirty-seven cases.

This report reviews experiences in the management of 37 cases of central giant cell granuloma of the jaws. The statistical analysis includes location, age, sex, size on initial presentation, and other variables relating to incidence and distribution. The technique of curettage or curettage with peripheral ostectomy was used in all cases treated surgically, resulting in no evidence of disease in 21 out of 23 cases followed postoperatively for 2 or more years. Radiation therapy was curative in one instance. Preoperative endodontic therapy for teeth in the field of surgery has proved to be advantageous. The pathogenesis of the giant cell granuloma of the jaws is discussed.