Main clinical findings of oral and maxillofacial osteonecrosis, bisphosphonates and alternative treatment with photobiomodulation and magnetotherapy: a systematic review

Abstract

Introduction: Bisphosphonates are drugs of a class widely used in several medical specialties. Its main property is to inhibit calcium phosphate precipitation, decrease bone calcification and reabsorption, and reduce osteoclastic action by inducing apoptosis in these cells. Bisphosphonates have anti-angiogenic effects. Low Power Laser is widely used for surgical purposes and it acts through various effects, such as photothermal, photomechanical-acoustic, photoionizing, and photoablation. Laser with low power can be divided into 2 groups, according to the respective types of photoreceptors: Low-Intensity Laser (LIL), with endogenous action, and Photodynamic Therapy (PDT), acting in the exogenous environment, as well as magnetotherapy. Objective: It was to highlight the main clinical findings of oral and maxillofacial osteonecrosis through the use of bisphosphonates, as well as an alternative treatment with photobiomodulation and magnetotherapy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from December 2022 to February 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 1985 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 320 articles were found, 59 articles were evaluated in full and 39 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 101 studies with a high risk of bias and 42 studies that did not meet GRADE. Patients being treated with bisphosphonates should be informed about the potential risk of bisphosphonates-related osteonecrosis of the jaws. In addition, providers responsible for breastfeeding therapy would be advised to refer patients for dental check-ups before starting treatment, allowing for patient follow-up by a multidisciplinary team. Although the morbidity of this pathology is not high, prevention must be mandatory, thus avoiding mutilating and painful processes. However, if the surgical procedure is required, the use of these new adjuvant therapies such as low-intensity laser and magnetotherapy.