Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser
Osteonecrosis of the jaws caused by bisphosphonates: evaluation of a new therapeutic approach using the Er:YAG laser
复制标题
DOI：
10.1007/s10103-009-0654-7
复制
发表时间：
2009-11-01
影响因子：
2.1
通讯作者：
Romanos, George E.
中科院分区：
文献类型：
--
作者：
Angiero, Francesca;Sannino, Carolina;Romanos, George E.
对 49 名诊断为骨坏死且全部接受最新一代双磷酸盐治疗的患者进行回顾性回顾，以评估掺铒：钇、铝和石榴石激光 (Er:YAG) 的临床结果，并从临床治疗的角度审视当前趋势。对过去 7 年提交的下颌骨或上颌骨标本的病理学报告进行了审查； 49名患者被确认患有颌骨坏死。对每个病例的病史和概况进行了评估； 19 例接受保守治疗，20 例接受根治性手术，10 例接受 Er:YAG 激光（2,940 nm）治疗。在接受手术治疗（骨包、刮除术、坏死骨隔离切除术）的 20 名患者中，一些患者需要重新治疗，导致骨折。所有患者均未得到成功治疗。 19例保守治疗后症状有所改善，但病变并未缓解。在接受 Er:YAG 激光治疗的 10 名患者中，6 名患者的体征和症状完全缓解，4 名患者有所改善，1 名患者需要重新治疗。我们目前的方法是建议在使用双膦酸盐之前进行强化预防性护理，即使在刮宫等简单操作中也建议非常谨慎，因为这可能会加剧无血管过程。 Er:YAG 激光的使用似乎很有前途（在我们的经验范围内）。可以得出的结论是，在激光手术一年后，该治疗导致临床参数显着改善，并且可能代表一种有效的替代方案，尽管需要进行更大规模的研究。
A series of 49 patients diagnosed with osteonecrosis and all treated with latest-generation bisphosphonates was reviewed retrospectively to evaluate the use of erbium-doped: yttrium, aluminum, and garnet laser (Er:YAG) in terms of clinical outcome, and examine current trends from the clinical-therapeutic standpoint. Pathology reports on specimens submitted over the previous 7 years from either the mandible or the maxilla were reviewed; 49 patients were identified as having osteonecrosis of the jaws. For each of these cases, the medical history and profile were evaluated; 19 were treated with conservative therapy, 20 with radical surgery, and 10 with Er:YAG laser (2,940 nm). Of the 20 patients treated surgically (bone baquette, curettage, sequestrectomy of the necrotic bone), some required re-treatment, which resulted in bone fracturing. None of the patients were treated successfully. The 19 cases treated conservatively produced an improvement in symptoms, but not remission of the lesions. Of the ten patients treated with Er:YAG laser, six achieved total remission of signs and symptoms, four an improvement, and re-treatment was required in one case. Our present approach is to recommend intensive prophylactic care before the administration of bisphosphonates, and great caution is advised even in simple maneuvers like curettage, because this may exacerbate the avascular process. The use of Er:YAG laser appears to be promising (within the limits of our experience). It can be concluded that at 1 year of laser surgery, the treatment led to significant improvements in clinical parameters, and may represent a valid alternative, although studies on a larger scale are needed.