Different protocols of photobiomodulation for medication-related osteonecrosis of the jaw

Background: Medication-related osteonecrosis of the jaw (MRONJ) is still without consensus on a standard treatment since the first report in 2003. The clinical management of MRONJ is comprised of medical, surgical approach or combined. Objective: This study aims to present our treatment protocols of Photo-biomodulation (PBM) as an adjunct to the management of patients with MRONJ. Materials and methods: A multidiodic laser (Lumix C.P.S. Dental, FISIOLINE, Verduno, Cuneo, Italy) emitting 650nm, 810 nm, and 910 nm wavelengths simultaneously was used with power of 0.6W and spot diameter of 8 mm in scanning mode for 15mins (per session). After a confirmed diagnosis of MRONJ, PBM was applied in three different aspects with antibiotic coverage. In treatment modality (a), PBM (5 sessions per cycle) was applied as an analgesic and anti-inflammatory as the surgical approach was not feasible. In treatment modality (b), it was applied as an adjunct (4 sessions per cycle) to the surgical approach with L-Platelet-Rich Fibrin (PRF). In treatment modality (c), the PBM (8 sessions per cycle) was applied in patients with osteonecrosis and bone exposure to support spontaneous sequestration. Results: In modality A, a significant reduction of pain and inflammation was observed. In modality B, most of the patients showed complete healing after the surgical approach with L-PRF. In modality C, in some patients spontaneous sequestration occurred with complete healing without the need for surgical intervention. Conclusions: The utilization of PBM in different ways according to the patient clinical situation may be a promising adjunctive modality for treating this challenging disease.