Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ) with Er:YaG Laser and Ozone Therapy: A Case Series

The purpose of this study is to evaluate the efficacy of the combination of ozone gel and Er:YAG laser treatment in respect of medication-related osteonecrosis of the jaw (MRONJ) for normal procedures. Consequently, the following techniques are compared in the study: medical therapy (MT); MT + conservative surgery with rotary/piezoelectric instruments; MT + ozone therapy; MT + surgical treatment + laser Er:YAG; and MT + ozone therapy + surgical treatment + laser Er:YAG. Fifty-seven patients with MRONJ stages I, II, and III were treated. The protocol was different for each group of patients and included MT, the application of an ozone gel, an Er:YAG laser surgery session, conservative surgery with rotary/piezoelectric instruments, or surgical treatment, and then the monitoring of healing for at least 12 months. The protocols were performed once a week until complete recovery. Patients were reassessed weekly for the first month after treatment, monthly for the following quarter, and then every 3 months until the end of one year. The radiographic surveys were carried out 6 and 12 months after the last treatment. All of the patients in Group 4 (treated with medical therapy + ozone therapy + surgical treatment + laser Er:YAG) achieved complete clinical and radiographic recovery (100%) with complete remission of osteonecrosis. The proposed combined treatment of ozone therapy using laser Er:YAG and the MT + surgical treatment allowed us to obtain excellent results in the resolution of MRONJ. This success was explained by a series of characteristics specific to laser technology; in fact, thanks to its photoacoustic, photochemical, photothermal, and photomechanical properties, the laser made it possible to reduce the bacterial load at the intervention site.