The Role of the Laser Photobiomodulation (PBM) in the Management of Patients at Risk or Affected by MRONJ

Abstract

Medication-Related Osteo-Necrosis of the Jaws (MRONJ) is a severe painful complication of the long-lasting administration of bisphosphonates and anti-resorptive and anti-angiogenetic drugs in neoplastic and dysmetabolic patients, secondary to minor surgical oral interventions or chronic epithelial decubitus ulcers. Its pathogenesis is still largely unknown even if the activity change of the osteoclasts plays a relevant role in bone remodeling. The management of these patients aims to prevent the onset of the pathology or to reduce the pain and remove the necrotic bone, promoting the healing of the pathological area. Photobiomodulation therapy (PBMT), the therapeutic application of low-energy laser or LED lights, was recently introduced in the management of this condition. Thanks to its therapeutic and biomodulating action on the irradiated tissues, PBM can be used alone or in combination with antibiotic and antibacterial therapies as a preventive, antalgic or palliative tool, and in support of surgery in a combined multi-protocol that leads to a positive and better resolution and healing of the pathologic process, with great improvement of the Quality of Life (QoL) of the patients. In this narrative review, a wide analysis of the various applications of PBM in MRONJ patients’ management is analyzed, emphasizing its role as supportive care for this condition.