Antimicrobial photodynamic and photobiomodulation adjuvant therapies for medication-related osteonecrosis of the jaw – Report of two cases with long-term follow-up

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare condition with high morbidity. In this study, we report the management of two recalcitrant cases of MRONJ in the mandibles of two older women who received treatment with alendronate for osteoporosis. Sequestrectomies, combined with antimicrobial photodynamic therapy (aPDT) and photobiomodulation (PBMT), were performed in both patients. During perioperative and weekly postoperative aPDT sessions, a diode laser treated three anatomical points by emitting a continuous gallium-aluminum-arsenide wave at 660 nm (red laser), 0.028 cm2, 0.1 W, 3.57 W/cm2 for 90 s per point, 9 J per point, 321 J/cm2, and a total energy of 27 J. PBMT was applied weekly after surgery at 808 nm wavelength (other parameters being equal) for wound healing and pain relief. Both patients were followed-up for two years without any report of recurrence. Thus, aPDT and PBMT can be considered non-invasive adjuvant therapies for MRONJ without any adverse effects.