Laser surgery in management of medication-related osteonecrosis of the jaws: a meta-analysis

• Published in: Oral and maxillofacial surgery Vol. 24; no. 2; pp. 133 - 144
• Main Authors: Momesso, Gustavo Antonio Correa, Lemos, Cleidiel Aparecido Araújo, Santiago-Júnior, Joel Ferreira, Faverani, Leonardo Perez, Pellizzer, Eduardo Piza
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2020; Springer Nature B.V
• Subjects: Aged; Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Dentistry; Diphosphonates; Female; Humans; Jaw; Laser surgery; Laser Therapy; Maxillofacial surgery; Medicine; Medicine & Public Health; Meta-analysis; Oral and Maxillofacial Surgery; Osteonecrosis; Review Article; Low-level laser therapy; Medication-associated osteonecrosis of the jaw; Bisphosphonate; Laser therapy
• ISSN: 1865-1550; 1865-1569
• DOI: 10.1007/s10006-020-00831-0

Purpose
The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment.
Methods
This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis.
Results
Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (
P
 = 0.006), and surgical treatment was more effective than LLLT (
P
 = 0.008).
Conclusion
Laser surgery was significantly superior to LLLT (
p
 < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.