Extracorporeal Shock-Wave Therapy or Low-Level Laser Therapy: Which is More Effective in Bone Healing in Bisphosphonate Treatment?

J Craniofac Surg. 2020 Oct;31(7):2043-2048. doi: 10.1097/SCS.0000000000006506.


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 ESWT+LLLT. 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 ESWT+LLLT 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 LLLT+ESWT. 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.

MeSH terms

  • Animals
  • Diphosphonates / therapeutic use*
  • Extracorporeal Shockwave Therapy* / methods
  • Lasers, Semiconductor
  • Low-Level Light Therapy* / methods
  • Male
  • Molar
  • Periodontal Ligament
  • Rats
  • Rats, Wistar
  • Tooth Extraction
  • Wound Healing*


  • Diphosphonates