Spontaneous bone sequestration in patients affected by medication-related osteonecrosis of the jaw: role of photobiomodulation

Background: Medication Related Osteonecrosis of the Jaw (MRONJ) has been reported as a side effect of antiresorptive and antiangiogenic medications. Photobiomodulation (PBM) has been proposed as an adjunctive modality for the management of MRONJ. Objective: To present retrospectively clinical cases of MRONJ showing spontaneous bone sequestration after PBM. Methods: A retrospective study of MRONJ patients who underwent PBM from 2016 to 2019 was done. Inclusion criteria were MRONJ patients with exposed bone and subjected to a minimum one PBM cycle. Exclusion criteria were MRONJ patients subjected to surgical approach. In all patients, controlling oral health conditions, antibiotic therapy, and PBM were done. PBM was applied (8 sessions per cycle) using a multidiodic laser (Lumix C.P.S. Dental, FISIOLINE, Verduno, Cuneo, Italy) emitting simultaneously 650 nm, 810 nm, and 910 nm. The parameters (for session) were Power of 0.6 W, Time of 15 min, Frequency of 30 KHz, and Total Energy of 577.4 J in scanning mode. Results: 6 patients (5 females and 1 male) out of 30 patients showed a spontaneous bone sequestration after PBM. In these patients, the distribution of MRONJ was 83% in maxilla and 17% in mandible. All patients had history of antiresorptive medications administration (bisphosphonates in 4 cases and denosumab in 2 cases). Bone sequestrum was observed after different number of cycles (4 of them after 2 cycles). Conclusions: These clinical cases may highlight the need for further investigations on PBM as an adjunctive modality in the management of MRONJ, especially when the conservative approach is favorable.