Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of the jaws: Case series and long-term follow-up

Photodiagnosis Photodyn Ther. 2020 Mar:29:101651. doi: 10.1016/j.pdpdt.2020.101651. Epub 2020 Jan 7.


Background: Medication-Related Osteonecrosis of the Jaws (MRONJ) incidence are increasing among elderly. Treatment can be challenging. Prevent or treatment protocols that control evolution of the lesion are warranted.

Objective: To observe long-term outcomes of two protocols based on photonics [antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBM)] for prevention and treatment of MRONJ lesions.

Methods: In a prospective study, patients who needed oral surgery and had been exposed to antiresorptive drugs were long-term followed-up. For MRONJ prevention, immediately after tooth extraction aPDT was applied. For aPDT a 0.01 % methylene blue solution was applied inside socket for 5 min followed by irradiation with a diode laser [660 nm, 0.028cm2, 0.1 W, 3.57 W/cm2, 90 s and 9 J per point, 321 J/cm2, at least at in 3 points (laser probe was placed at central, and two equidistant points) and total energy of 27J]. Irradiation was repeated weekly until total tissue repair. MRONJ treatment included preoperative aPDT sessions until signs and symptoms of infection had reduced. Then, after necrotic bone removal, aPDT was applied inside surgical wounds and re-applied weekly until healing. Antibiotics were administered pre or postoperatively for no longer than 7 days. PBM therapy was applied with 808 nm diode laser, 0.028cm2, 0.1 W, 3.57 W/cm2, 30 s, 107 J/cm², 3 J and total energy of 12 J until evidence of remission.

Results: Eighteen patients underwent preventive protocol, and none presented signs of MRONJ after a follow-up of at least 6 months. Seventeen patients presented with MRONJ underwent aPDT protocol and sixteen of them showed total regression of lesions.

Practical implications: aPDT and PBM therapy protocols appear to be effective as adjuvant approach not only for preventing MRONJ development due to tooth extraction but for treating MRONJ lesions at early stages with no adverse effects.

Keywords: Bisphosphonates; Low-level laser; MRONJ; Photobiomodulation; Photodynamic therapy.

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / diagnostic imaging
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / prevention & control
  • Bisphosphonate-Associated Osteonecrosis of the Jaw / therapy*
  • Combined Modality Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Low-Level Light Therapy / methods*
  • Male
  • Methylene Blue / administration & dosage
  • Photochemotherapy / methods*
  • Photosensitizing Agents / administration & dosage
  • Prospective Studies


  • Anti-Bacterial Agents
  • Photosensitizing Agents
  • Methylene Blue