Er:YAG laser surgery for treatment osteonecrosis of the jaw due biphoshonates (BRONJ). A predictable technique

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious oral complication resulting from oral or intravenous bisphosphonates. The patient reported in this paper developed BRONJ after treatment with zoledronic acid for multiple myeloma. BRONJ stage II was determined on the basis of clinical and radiographic evaluations. Once a week, the necrotic area was cleansed, in the hospital with sterile saline solution and was disinfected with 0,8% hydroxide hydrogen gel. Additionally, the patient was instructed to disinfect and medicate the area at home 3 times a day after meals with gauze soaked in sterile saline of NaCl 0.9% and every 24 h with 0,8% hydroxide hydrogen gel. Surgery was performed under local anesthesia; a mucoperiosteal flap was realized and the lesion was evidenced; Er:YAG laser surgery was performed under continuous irrigation using the following parameters: continuous mode; wavelength, 2490 nm; energy, 250 mJ; frequency, 20 Hz; and power, 5 W. In this report, complete healing occurred after 1 laser therapy session demonstrating the effectiveness of this approach.