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Peer-reviewedCC BY 4.0Cureus

Er:YAG Laser-Assisted Versus Conventional Surgery for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Critical Appraisal of Randomised Evidence

  • Mohamed Xamza1
  • Jaylani Xamza2
  • Abbas Hussein3
  • Mohamed Baalawi4
  • Nora Arbe5
  • Raees Samli6
  • Abdelmadjid Zinet7
7 affiliations
  1. 1General Surgery, Homerton University Hospital NHS Foundation Trust, London, GBR
  2. 2Dentistry, Queen Mary University of London, London, GBR
  3. 3Intensive Care Unit, North Middlesex University Hospital NHS Trust, London, GBR
  4. 4Emergency Medicine, Barts Health NHS Trust, London, GBR
  5. 5Neurology, North Middlesex Hospital, London, GBR
  6. 6Intensive Care Unit, Royal Blackburn Teaching Hospital, Blackburn, GBR
  7. 7Orthopaedics and Trauma, Northwick Park Hospital, London, GBR
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Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapy. Er:YAG (erbium-doped yttrium aluminium garnet) laser-assisted surgery has been proposed as an adjunct to conventional debridement, but randomised evidence is limited.

This PROSPERO-registered systematic review (CRD420261509183), conducted according to PRISMA 2020, searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library through September 10, 2026 for randomised studies comparing laser-assisted surgery with conventional surgical treatment of MRONJ. Thirteen full-text articles were assessed, and one randomised controlled trial met eligibility criteria. The trial report contains inconsistent participant accounting; its methods and results state that 72 patients were randomised and 65 completed follow-up, whereas the abstract and trial registry report 65 participants. No meta-analysis was performed. In complete-case analyses over 24 weeks of follow-up, adjunctive Er:YAG laser surgery was associated with higher short-term complete mucosal healing (85.7% vs 26.7%; review-calculated risk ratio (RR) 3.21, 95% CI 1.75-5.91), fewer postoperative complications (17.1% vs 60.0%; RR 0.29, 95% CI 0.13-0.63), and lower pain scores at three and six months, with longer procedure duration. Extreme-case sensitivity analyses for seven patients without reported healing outcomes did not change the direction of effect. Risk of bias raised some concerns for all outcomes. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) certainty was low for healing, complications, and pain, very low for necrosis, and moderate for procedure duration. These apparent benefits derive from a single small trial, with low to very low certainty for all clinical outcomes, and apply only to adjunctive Er:YAG ablation in stage II-III MRONJ. They should not be extrapolated to photobiomodulation, other laser modalities, or other disease stages. Independent randomised evidence is required before its effectiveness can be established.

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Cite

BibTeXRIS
BibTeX
@article{xamza2026eryag,
  title = {{Er:YAG Laser-Assisted Versus Conventional Surgery for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Critical Appraisal of Randomised Evidence}},
  author = {Mohamed Xamza and Jaylani Xamza and Abbas Hussein and Mohamed Baalawi and Nora Arbe and Raees Samli and Abdelmadjid Zinet},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117540},
  url = {https://doi.org/10.7759/cureus.117540},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Er:YAG Laser-Assisted Versus Conventional Surgery for Medication-Related Osteonecrosis of the Jaw: A Systematic Review and Critical Appraisal of Randomised Evidence
AU  - Mohamed Xamza
AU  - Jaylani Xamza
AU  - Abbas Hussein
AU  - Mohamed Baalawi
AU  - Nora Arbe
AU  - Raees Samli
AU  - Abdelmadjid Zinet
PY  - 2026
DA  - 2026/10/06
JO  - Cureus
DO  - 10.7759/cureus.117540
UR  - https://doi.org/10.7759/cureus.117540
AB  - Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of antiresorptive and antiangiogenic therapy. Er:YAG (erbium-doped yttrium aluminium garnet) laser-assisted surgery has been proposed as an adjunct to conventional debridement, but randomised evidence is limited.  This PROSPERO-registered systematic review (CRD420261509183), conducted according to PRISMA 2020, searched PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library through September 10, 2026 for randomised studies comparing laser-assisted surgery with conventional surgical treatment of MRONJ. Thirteen full-text articles were assessed, and one randomised controlled trial met eligibility criteria. The trial report contains inconsistent participant accounting; its methods and results state that 72 patients were randomised and 65 completed follow-up, whereas the abstract and trial registry report 65 participants. No meta-analysis was performed. In complete-case analyses over 24 weeks of follow-up, adjunctive Er:YAG laser surgery was associated with higher short-term complete mucosal healing (85.7% vs 26.7%; review-calculated risk ratio (RR) 3.21, 95% CI 1.75-5.91), fewer postoperative complications (17.1% vs 60.0%; RR 0.29, 95% CI 0.13-0.63), and lower pain scores at three and six months, with longer procedure duration. Extreme-case sensitivity analyses for seven patients without reported healing outcomes did not change the direction of effect. Risk of bias raised some concerns for all outcomes. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) certainty was low for healing, complications, and pain, very low for necrosis, and moderate for procedure duration. These apparent benefits derive from a single small trial, with low to very low certainty for all clinical outcomes, and apply only to adjunctive Er:YAG ablation in stage II-III MRONJ. They should not be extrapolated to photobiomodulation, other laser modalities, or other disease stages. Independent randomised evidence is required before its effectiveness can be established.
SN  - 2168-8184
ER  -