Extracorporeal shock-wave therapy or low-level laser therapy: which is more effective in bone healing in bisphosphonate treatment?

Objectives: Bisphosphonate-related osteonecrosis of the jaw is potential side effect of long-term bisphosphonate therapy. Different treatment modalities have been used in this and investigate the effects of low-level laser therapy (LLLT) and extracorporeal shockwave therapy (ESWT) on socket healing after tooth extraction in rats given long-term bisphosphonates. Methods: Forty male Wistar-Albino rats were used in this experimental study. About 0.1 mg/kg zoledronic acid was administered intraperitoneally to all animals 3 times per week for 8 weeks. Four groups were made which were control, LLLT, ESWT, and ESWTþLLLT. Upper right first molar teeth extraction was performed in all groups; no treatment was given to the control group after molar tooth extraction. About 810 nm wavelength GaAlAs laser was used in LLLT group. In ESWT group, 1000 pulses, 0.21 mJ/mm ESWT was applied, and the 2 treatment methods were applied to the last ESWTþLLLT group at the same time. All the 4 groups were divided into 2 subgroups according to sacrification time 4 and 8 weeks. Steorologic, histologic, and immunohistochemical examinations were performed. Results: The highest new bone volume was observed in the early LLLTþESWT. New vessel volume and CD31 expression were found to be high in the LLLT group. matrixmetalloproteinaze (MMP)-2 expression was found increased by the application of LLLT and ESWT. Conclusion: The LLLT and ESWT have similar effect on socket healing in the early period and that co-use is more effective upon healing. The LLLT has been shown to increase CD31 expression and increase vascularization and soft-tissue healing.