Conservative Treatment: Laser (Biostimulation and Minimally Invasive Surgical Treatment)

Several studies have shown a positive effect of low-level laser therapy (LLLT) using different wavelengths (argon, CO2, He-neon, Er:YAG, diode, Nd:YAG, and KTP) on the healing process in a wide range of cutaneous, mucosal, and bone disorders. LLLT reportedly stimulates osteoclast activity to promote bone resorption and remodeling. Soft-tissue healing is also improved by LLLT. The transformation of fibroblasts into myofibroblasts can accelerate the healing of skin and mucosa. In particular, in conditions characterized by avascular necrosis, such as bisphosphonates-induced osteonecrosis of the jaw (BIONJ), it is essential to stimulate vascularization and soft-tissue tropism through an increase in blood flow by means of angiogenesis, capillary growth, and an increase in growth factor release. Laser can be used in the conservative surgical treatment of BIONJ patients. The procedure involves the vaporization of necrotic bone until healthy bone is reached. The minimal penetration of the erbium laser (0.1 mm) guarantees safety and allows for precise, minimally invasive surgery, inducing a much lower increase in bone temperature than conventional rotary tools (cold ablation). One undoubted advantage of this technique for BIONJ patients is the bactericidal action of the laser beam, in particular versus Actinomyces and anaerobes species. These considerations support the effectiveness of LLLT in the treatment of jawbone and mucosal defects related to BIONJ development or following tooth extractions in patients under bisphosphonates therapy. Thus, minimally invasive laser-assisted surgical treatment appears to be a promising approach for BIONJ management.