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

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.