Effectiveness of laser-assisted treatments for medication-related osteonecrosis of the jaw: a systematic review.

The feasibility of laser-assisted treatments of medication-related osteonecrosis of the jaw (MRONJ) remains poorly understood, so we have therefore systematically evaluated their effectiveness. We made a comprehensive search of MEDLINE, Pubmed, and Embase to find randomised controlled trials, case-control studies, and prospective cohort studies that assessed them. We assessed the eligible studies in duplicate, and if possible conducted a meta-analysis. Ten studies with a low to high risk of bias met the inclusion criteria. We found that a comparison of pain scores before and after using visible and infrared GaAs laser in the low-level laser treatment based on the Numerical Pain Rating Scale (mean difference 4.28; 95% CI 3.62 to 4.93; p<0.00001), showed that there were significant differences in the amount of pain. The effectiveness of other laser-assisted treatments on the reduction of pain - for example, Er:YAG laser surgical treatment, and laser-assisted treatment plus platelet-rich plasma, and the effect of other techniques on wound healing of laser-assisted treatments, are uncertain. We found that the results of the studies that were deemed to be high-to-low quality and to have high-to-low statistical power suggested that there may be considerable clinical improvement in MRONJ by using laser-assisted treatment; we cautiously consider that low-level laser treatment may manage pain and symptoms in these patients. More randomised studies of good quality and with a low risk of bias are needed to test whether laser-assisted treatment should be a routine part of management of patients with MRONJ.