Drugs that inhibit bone resorption are prescribed most often by orthopedists, hematologists, or oncologists. Dental practice rarely draws attention to their importance and the effects they carry. The problem concerns mainly older people owing to oncological problems or postmenopausal consequences, but everyone can be at risk. Carefully conducted interviews and analysis of history and disease should always be performed before any action is taken by patients taking this type of medicine. Further action should consider possible complications and, above all, the risk of their occurrence. In this article, the most important issues related to the treatment of drug-induced osteonecrosis of the jaws (ONJ) are raised, including medication-related osteonecrosis of the jaw (MRONJ); conservative treatment, including the use of laser; and the impact of vitamin D supplementation on the overall treatment, prognosis, and prevention before complication, which is osteonecrosis of the jaw in the course of treatment with bisphosphonates and other drugs predisposing to MRONJ, such as denosumab and angiogenesis inhibitors. The degree of osteonecrosis is also critical, as it is possible to avoid surgical procedures for only conservative methods that sometimes bring good results. Surgical treatment of advanced stages is complicated and carries a high risk of error and complications. MRONJ is a disease that is easy to avoid, but it is difficult to treat and treatment sometimes leads only to a partial remission of the disease, not a complete cure.

The aim of this double-blind randomised controlled clinical trial was to assess the effectiveness of the Er:YAG laser as an adjunct to conventional surgical treatment compared to surgical treatment alone in managing medication-related osteonecrosis of the jaw (MRONJ). Sixty-five patients diagnosed with stage II or III MRONJ were randomly allocated into 2 groups: a control group (n = 30) treated using conventional surgery alone and a test group (n = 35) treated using conventional surgery with adjunctive Er:YAG laser. All patients received 3-day preoperative and 14-day postoperative antibiotics. Follow-up assessments were scheduled at 1, 2, 4, 12, and 24 weeks postoperatively. Postoperative outcomes, including complications, disease progression, pain, and soft tissue healing, were assessed. Descriptive and inferential statistical analyses were utilised. Compared to conventional surgery alone, adjunctive Er:YAG laser therapy resulted in significantly reduced postoperative complication rates (17.1% vs 60%, P < .001), improved mucosal healing (85.7% vs 26.7%, P < .001), and reduced pain. The laser-assisted procedure, however, was significantly longer (70.03 vs 57.90 minutes, P < .001). Incorporating Er:YAG laser therapy as an adjunct to conventional surgical treatment for MRONJ (stages II and III) positively influenced clinical outcomes by enhancing soft tissue healing and reducing postoperative complications.