Efficacy of Photobiomdoulation in a conservative non surgical management of stage II medication-related osteonecrosis of the jaw (MRONJ): a case report

Background: Medication Related Osteonecrosis of the Jaw (MRONJ) has been reported as a side effect of antiresorptive and antiangiogenic medications. Risk factors in addition to antiresorptive therapy have been identified. These include oral surgical procedures with extractions, radiation therapy, chemotherapy, diabetes and smoking. Photobiomodulation (PBM) is a non invasive method with biostimulating effects on soft and hard tissues. Aim of the Study: To propose a non-surgical conservative treatment through photobiomodulation for the osteonecrosis of the jaws related to the drug - stage 2. Methods: A female Patient attended at Department of Oral and Maxillofacial Sciences of Sapienza University of Rome. She was treated with zoledronic acid for lung carcinoma and osteoprosis; subsequently developed MRONJ in the maxilla (26, 27). The management protocol included oral hygiene, antibacterial mouth rinses (chlorhexidine), 2g per day of Amoxicillin and Clavulanic Acid, 1g per day of Metronidazole and photobiomdodulation (3Cycles) was performed by using a multi-diode laser. The PBM applications consist in 8 sessions per cycle using a multi-diode laser (Lumix C.P.S. Dental, FISIOLINE, Verduno, Cuneo, Italy) emitting simultaneously at 650nm,810 nm, and 910nm, total power 0.6 W,30 kHz, 15mins, and Total Energy of 577.4J in scanning mode. Results: After 13 months; healing of the MRONJ site was observed. PBM stands out among supportive approaches because of its favorable effects on tissue healing. Conclusion: This case may suggest that this kind of combined approach during MRONJ treatment allows performing a faster with more comfortable healing process and it represents an innovative, conservative non surgical protocol.