Authors and affiliations:
Clara Hernandez 1, Catarina Vasconcelos1, Filomena Salazar 1,2, Fernando Figueira1, Luis Monteiro1,2
1 Oral Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), Gandra 4585-116, Portugal
2 Oral Cancer Research Center, CESPU, University Institute of Health Sciencies (IUCS), Gandra 4585-116, Portugal
INTRODUCTION: Medication-related osteonecrosis of the jaws (MRONJ) is an aggressive usually post-surgery complication caused by antiresorptive. Treatment options might be challenging due to the severity and complexity that osteonecrosis can achieve. The aims of this work is to show the usefulness of the combination of two different wavelengths lasers in treatment of a stage III MRONJ.
METHODS: A 75-year-old female patient with obesity, type-II diabetes mellitus, cardiac insufficiency and osteoporosis was referred to our oral medicine department with a painful non- healing ulcer, in the posterior right jaw, after an extraction of a third molar after long a history of oral bisphosphonates. After a diagnosis of a stage III MRONJ the patient was initially indicated to surgery with general anaesthesia but refused due to her health problems. She was referred to Laser treatment to our department. We performed a combined treatment of a superficial Er:YAG-laser vaporization of exposed necrotic tissue and 2 sets of a series of photobiomodulation using 635nm-diode (~8J/cm2) and 1064nm-Nd:YAG (0.5 W/cm2) lasers with, twice a week for 6 weeks and with an interval of 4 months between them.
RESULTS: Firstly, a reduction in pain was observed, and after the second set a closure of mucosal tissue with improvement on ossification was observed. After 14 months a complete ossification of the lesion was noted on radiograph as well as absence of pain and no signs of mucosal loss of integrity.
CONCLUSION: Photobiomodulation has been described as a potential minimally invasive treatment to MRONJ as we described here improve the quality of the patient’s life.
