Purpose: Medication-Related Osteonecrosis of the Jaw (MRONJ) is an oral complication in patients on ongoing or previous treatment with antiresorptive or antiangiogenic drugs. Many treatments have been proposed, but the management of MRONJ lesions is still challenging. The objective of this article is to present a literature review on aPDT and PBM in the management of MRONJ. Accompanying the review, a protocol and its outcome, for treating MRONJ in a cancer patient, where the association of photobiomodulation (PBM) therapy and antimicrobial photodynamic therapy (aPDT) was applied is presented.
Methods: This is the clinical case report of a 58-year-old male patient, with prostate cancer presenting a bone metastasis that was treated with chemotherapy and intravenous antiresorptive Zometa®. On intraoral clinical examination, in the region of the lower alveolar ridge, a lesion with necrotic bone exposed was observed. After clinical and radiographic evaluation of the lesion, it was diagnosed as MRONJ. The association of PBM and aPDT was applied at pre, trans and post-surgery. The pre-surgical phase lasted about two months. The post-surgical protocol was implemented 48 hours after surgery and lasted two months.
Results: The search included articles in the databases MEDLINE/Pubmed and Scopus. Nine studies were included 6 of combined aPDT and PBM and 3 studies investigated isolated aPDT published in English from 2016 to 2023. The proposed protocol resulted in the complete closure of the lesion. The patient was undergoing clinical follow-up for 3 years without recurrences.
Conclusion: Based on the positive outcome of the proposed phototherapy protocol, one can infer that the combination of PBM and aPDT in the pre, trans and post-surgery showed to be efficient in the treatment of MRONJ lesion.
