Er:YAG Laser Osteotomy Efficacy In MRONJ Management

To compare the efficacy of Er:YAG laser osteotomy versus cortical perforation technique in managing medication-related osteonecrosis of the jaw (MRONJ) by a randomized controlled trial. Eighteen MRONJ patients (mean age: 66.4 years; 50% female) treated between June 2023 and March 2025 were randomly allocated to Er:YAG laser (n=9) or cortical perforation (n=9) groups. Both groups comprised eight cases within stage II and one cases within stage III each. Lesion distribution showed similar patterns: maxilla (n=3), mandible (n=3), and combined (n=3) in the laser group versus maxilla (n=3), mandible (n=5), and combined (n=1) in the cortical perforation group. Postoperative pain was assessed via visual analog scale (VAS) at days 1, 3, and 5, while healing status and complications were evaluated at 1, 3, and 6 months. The study protocol received ethical approval. Results demonstrated significantly lower VAS scores in the laser group compared to the cortical perforation group at all postoperative timepoints (P<0.05). Complete mucosal coverage without inflammation or fistula formation was achieved in 88.9% (8/9) of patients in both groups by 6 months. Two cases (one per group) exhibited partial bone exposure at mandibular sites at 2 weeks post-surgery, with complete healing following secondary laser intervention. These findings suggest Er:YAG laser osteotomy may offer comparable therapeutic outcomes to osteotomy with cortical perforation while providing superior postoperative pain control for MRONJ patients. Further large-scale studies are needed to validate these preliminary results.