Treatment of Medication-Related Osteonecrosis at Dental Implants Utilizing CO2 (9.3 µm) Laser and Sticky Bone: A Case Series

  Scott Froum, Stephen Kelleher, Paras Ahmad, Georgios E Romanos, and Nathan E. Estrin 

ABSTRACT (Click here for full study)

Objectives:

Medication-related osteonecrosis of the jaw (MRONJ) is a significant challenge for clinicians with limited treatment
options. In this case series, a CO₂ laser (9.3µm) was utilized in conjunction with platelet-rich fibrin (PRF) mixed with allograft to create sticky bone. 

Methods:

 Four consecutive patients with MRONJ at implant sites were treated at a private practice setting. The necrotic bone
was removed, and the sites were irradiated with a CO₂ laser and ethelylenediaminetetraacetate (EDTA). Platelet-rich fibrin (PRF) mixed with BioOss Collagen particulate to create sticky bone to graft in the defect sites and secured with a solid-PRF membrane. Herbal-based mouth rinses in place of chlorehexidine was utilized as a post-surgical rinse. Follow-up time for the cases ranged from 6 months to 7 years. 

Results:

All patients healed uneventfully without any post-operative complications. In one case, a new implant was placed without any post-operative complications with a 2-year follow-up. 

Conclusion:

This case series demonstrates successful outcomes of treating MRONJ at implant sites utilizing CO₂ laser to decontaminate the implant surface and sticky bone for regenerative therapy. Additional controlled clinical studies are necessary to validate this technique.