Romeo Umberto, Galanakis Alexandros, Marias Christos, Vecchio Alessandro Del, Tenore Gianluca, Palaia Gaspare, Vescovi Paolo, Polimeni Antonella
Department of Oral Sciences, "Sapienza" University of Rome, Italy.
Photomed Laser Surg. 2011 Jul;29(7):447-52. doi: 10.1089/pho.2010.2835. Epub 2011 Jan 16.
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse side effect associated with bisphosphonate (BP) therapy, especially when parenteral BP administration is used. Patients affected by BRONJ present wide areas of exposed necrotic bone, particularly after surgical oral procedures. The main symptom is pain that is poorly controlled by common analgesic drugs. Recently, many studies have pointed to the beneficial effect of low-level laser therapy (LLLT) in pain reduction for many pathological conditions. The purpose of this study is to investigate whether LLLT could be helpful in managing BRONJ by reducing the problems associated with this condition and the use of analgesic drugs.
Twelve patients affected by BRONJ were monitored at the Complex Operative Unit of Oral Pathology. Among these patients, only seven referred to pain in necrotic areas and were recruited for LLLT. Laser applications were performed with a double diode laser simultaneously emitting at two different wavelengths (λ = 650 nm and λ = 904-910 nm, spot size = 8 mm). All of the patients were irradiated with a fluence of 0.053 J/cm(2) for 15 min five times over a period of 2 weeks, in a non-contact mode, ∼1 mm from the pathologic area. The patient's maximum and minimum pain was recorded using a numeric rating scale (NRS) evaluation before and after the treatment. Statistical analysis was performed using the Kruskal-Wallis test.
Six patients showed significant pain reduction, and only one patient indicated a worsening of the symptoms, which was probably related to a reinfection of the BRONJ site, which occurred during the study. A statistically significant difference (p < 0.05) was found between the NRS rates before and after the protocol.
This pilot study suggests that LLLT may be a valid technique to support the treatment of BRONJ-related pain, even though the low number of cases in this study does not permit any conclusive consideration.
双膦酸盐相关颌骨坏死（BRONJ）是与双膦酸盐（BP）治疗相关的一种不良副作用，尤其是在使用肠外BP给药时。受BRONJ影响的患者存在大面积暴露的坏死骨，特别是在口腔外科手术后。主要症状是疼痛，普通镇痛药难以控制。最近，许多研究指出低强度激光疗法（LLLT）对许多病理状况的疼痛减轻具有有益作用。本研究的目的是调查LLLT是否有助于通过减少与该病症相关的问题以及镇痛药的使用来管理BRONJ。
在口腔病理学综合手术单元对12例受BRONJ影响的患者进行监测。在这些患者中，只有7例提到坏死区域疼痛，并被招募接受LLLT治疗。使用双二极管激光器进行激光照射，该激光器同时以两种不同波长（λ = 650 nm和λ = 904 - 910 nm，光斑尺寸 = 8 mm）发射。所有患者在2周内以非接触模式，距病变区域约1 mm，以0.053 J/cm²的能量密度照射15分钟，共照射5次。在治疗前后使用数字评分量表（NRS）评估记录患者的最大和最小疼痛程度。使用Kruskal - Wallis检验进行统计分析。
6例患者疼痛明显减轻，只有1例患者症状恶化，这可能与研究期间BRONJ部位再次感染有关。在治疗方案前后的NRS评分之间发现有统计学意义的差异（p < 0.05）。
这项初步研究表明，LLLT可能是支持治疗BRONJ相关疼痛的一种有效技术，尽管本研究中的病例数量较少，无法进行任何确定性的考量。
