Thesis title: CLINICAL EVALUATION OF THE EFFICACY OF PHOTOBIOMODULATION IN THE PREVENTION AND ADJUVANT THERAPY OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW: A 10-YEARS RETROSPECTIVE STUDY
Aim
This study aimed to evaluate the preventive and therapeutic efficacy of PBM therapy in
the management of MRONJ, analyzing its role as a non-invasive and adjuvant modality alongside medical and surgical approaches.
Introduction
MRONJ is a serious adverse effect of antiresorptive and anti-angiogenic drugs, predominantly affecting maxillofacial bones. Its risk depends on drug type, dose, and duration, being highest with intravenous bisphosphonates. PBM, by stimulating mitochondrial activity and angiogenesis, promotes healing and reduces inflammation, providing preventive and therapeutic advantages.
Materials and Methods
A retrospective analysis was conducted on patients treated between 2014 and 2024. 72 patients at risk for MRONJ (Group A, n=72) who underwent PBM therapy in conjunction with dental extractions were evaluated for preventive outcomes. Additional cohorts of MRONJ-diagnosed patients were analyzed to assess PBM’s therapeutic and adjuvant effects in combination with medical and surgical therapies (Group B, n=73) . Clinical outcomes were evaluated at 6-month follow-ups, assessing complete, partial, or absent healing. Statistical analyses included Chi-square tests with significance set at p<0.05.
Results
Among patients at risk, complete mucosal healing occurred in 59 cases (81.94%), while MRONJ developed in 13 (18.05%) (p < 0.001). The risk was higher in those receiving high-dose or intravenous antiresorptive therapy. In MRONJ-diagnosed subgroups, complete healing was comparable among Group B1 (53.8%), Group B2 (54.55%), and Group B3 (58.8%). However, clinical improvement was more frequent in Group B1 (23.1%) compared with Group B2 (9.1%) and Group B3 (17.6%). When used as an adjunct to surgery (Group B4), especially with L-PRF, PBM markedly improved outcomes (B1 vs B4; 58.8% vs. 100%). Overall, it demonstrated rapid and sustained biostimulatory effects, enhancing tissue regeneration and reducing inflammation, thereby supporting its role as an effective adjuvant therapy in MRONJ management.
Conclusion
PBM therapy is a safe, reproducible, and effective adjunctive modality for both prevention and treatment of MRONJ. It promotes faster mucosal healing, mitigates inflammation, and reduces disease progression, especially in high-risk or surgically treated patients. Integrating PBM into standardized dental and surgical protocols may improve clinical outcomes. Future large-scale, prospective, and randomized studies are needed to validate PBM parameters and optimize its clinical application in MRONJ management.