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

Authors

  • Stefan Stübinger DDS,

    Corresponding author
    1. Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, CH-4031 Basel, Switzerland
    2. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    • Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
    Search for more papers by this author
  • Jan-Philipp Dissmann,

    1. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    Search for more papers by this author
  • Nicole Chambron Pinho MD, DDS,

    1. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    Search for more papers by this author
  • Belma Saldamli DDS,

    1. Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, CH-4031 Basel, Switzerland
    2. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    Search for more papers by this author
  • Oliver Seitz MD, DDS,

    1. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    Search for more papers by this author
  • Robert Sader PhD, MD, DDS

    1. Hightech Research Center of Cranio-Maxillofacial Surgery, University of Basel, Schanzenstrasse 46, CH-4031 Basel, Switzerland
    2. Department of Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Johann Wolfgang Goethe-University Medical School, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
    Search for more papers by this author

Abstract

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/cm2). 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. Lasers Surg. Med. 41:26–30, 2009. © 2008 Wiley-Liss, Inc.

Ancillary