Supportive pain management with super-pulsed low-level laser therapy of patients with medication related osteonecrosis of the jaw: clinical trial

The aim of this study is to share our experience in the application of Low-Level Laser Therapy (LLLT) coupled with the conventional treatment protocol as a supportive pain management modality on a large scale of patients with Medication Related Osteonecrosis of the Jaw (MRONJ) with a history of anti-resorptive administration (Bisphosphonates or Denosumab). This would be through pain evaluation before and after laser application. Materials and Methods: 25 positive MRONJ patients, after improving their oral health conditions and starting of antibiotics (Amoxicillin + Clavulanic acid and Metronidazole), were exposed to a double diode laser (650nm and 904–910nm, with spot diameter = 8mm), with total energy = 34.8J, for 11 minutes five times over a period of two weeks, in scanning mode at ~1mm. The related pain was observed using a Numeric Rating Scale (NRS) before and after laser application. Results: A significant decrease of pain was observed in all the cases. 88% of the cases were with NRS values less than 4 points at the end of the study. A statistically significant difference has been recorded for the reported pain (p<0.0001). Discussion: The management objectives of MRONJ are alleviation of pain, control of infection and prevention of osteonecrosis progression. Till now, there is no definitive standard of care for MRONJ patients. LLLT was introduced as a valid modality of pain management in MRONJ patients coupled with the conventional treatment protocols. Conclusion: The results of this study were like those obtained by other sets of investigators. Further investigations are needed with taking in consideration the size of lesions, other patient data, the presence of controlled and placebo group to establish results that confirm the validity of LLLT as a supportive pain management modality, and finally the exact laser parameters for each case.