Impact of photobiomodulation in the management of medication-related osteonecrosis of the jaw : a systematic review.

Medication-related osteonecrosis of the jaw (MRONJ) are localized aggressive necrotic bone complications occurring post-tooth avulsion in patients receiving bone antiresorptive agents. Photobiomodulation is used in the medical field for its ability to accelerate wound healing. This study aimed to evaluate the efficacy of photobiomodulation in the prevention or management of MRONJ. A systematic review following the PRISMA guidelines was performed across the databases PubMed, Science Direct, Scopus, Cochrane, Lilacs, and Google Scholar. The review was registered on Prospero under the number CRD42024581951. A total of 947 articles were screened, from which 10 were included in this systematic review. For Group A, the 5 cohorts found a MRONJ incidence of 0,93% (IC[1,3%-3,4%]) at a mean follow-up of 15 months. For Group B, the 3 cohorts identified clinical improvement for all lesions, with complete healing rates reaching up to 91.67% (IC[54.57%-68.34%]). The 3 non-randomized studies found a significant difference favoring photobiomodulation for clinical improvement, but only 2 studies reported a significant difference for complete healing. The studies presented various clinical application protocols, yet converged on the use of a laser with a wavelength greater than 980 nanometers, continuous emission, single-point application, over 8 sessions, with a session duration of 5 min. No adverse effects were reported. Photobiomodulation may reduce the incidence of MRONJ following tooth avulsions, and could improve their treatment (decreasing treatment time and improving prognosis). Further randomized, double-blind, studies are necessary to consolidate these results.