Objective: To research an efficient treatment for the management of bisphosphonate-associated osteonecrosis. Background Data: Necrosis of the jawbone has recently been described in association with systemic bisphosphonate therapy with drugs including zoledronic acid, pamidronate, and alendronate. The extent and clinical characteristics of bisphosphonate-associated osteonecrosis (BON) of the jaw are extremely variable, and range from the presence of fistulae in the oral mucosa or orofacial tissues, to large exposed areas of necrotic bone within the oral cavity. Clinical signs and symptoms commonly reported include pain, swelling, the presence of pus, loose teeth, ill-fitting dentures, and paresthesias of the inferior alveolar nerve when the necrosis affects the mandible. Fractures have also been reported. The treatment of BON of the jaw is still controversial since no therapy has proven to be efficacious as shown by the literature on the subject. Materials and Methods: In this study we report results achieved with 28 patients affected by BON of the jaw, who received treatment with the Nd:YAG laser alone or in combination with conventional medical or surgical treatment. Clinical variables such as severity of symptoms, presence of pus, and closure of mucosal flaps before and after therapy were evaluated to establish the effectiveness of laser irradiation. The 28 patients with BON were subdivided into four groups: eight patients were treated with medical therapy only (antibiotics with or without antimycotics and/or antiseptic rinses), six patients were treated with medical and surgical therapy (necrotic bone removal and bone curettage), six patients were treated with medical therapy associated with laser biostimulation, and eight patients were treated with medical therapy associated with both surgical therapy and laser biostimulation. Results: Of the 14 patients who underwent laser biostimulation, nine reported complete clinical success (no pain, symptoms of infection, or exposed bone or draining fistulas), and three improved their symptomatology only, with a follow-up of between 4 and 7 mo. Conclusions: While the results reported in this study are not conclusive, they indicate that laser therapy has potential to improve management of BON.

Objective : The aim of this clinical study was to observe and evaluate the surgical management efficiency of soft tissues during orthodontic treatment. Materials and Methods : Thirty-seven young patients were selected and treated by laser-assisted surgery before or during orthodontic treatment and were classified by sex, age, and type of surgical management. Three different wavelengths were used (diode 810 nm, diode 980 nm, and Nd:YAG 1064 nm) in different surgical situations: maxillary vestibular and lingual frenectomies, surgical exposure and alignment of ectopic or retained teeth, and re-contouring gingival overgrowth. Results : In all evaluated patients, the laser treatment was performed without local anesthesia or sutures. Only topical anesthetic was needed. Conclusion : These use of these wavelengths of laser energy was a noticeable aid in the surgical management of soft tissues before or during orthodontic treatment. The benefits of laser treatment include reduced bleeding during surgery with consequent reduced operating time and rapid postoperative hemostasis, thus eliminating the need for sutures. The lack of need for anesthetics and sutures, as well as improved postoperative comfort and healing, make this technique particularly useful for very young patients.