Photobiomodulation and antimicrobial photodynamic therapy as adjunct in the treatment and prevention of osteoradionecrosis of the jaws: a case report.

Abstract Background Treatment of osteoradionecrosis is complex and challenging. Although surgical removal along with antibiotics is the treatment of choice, there are controversies regarding this modality. Therefore, adjuvant therapeutic modalities, such as low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT) have been reported. Case Report Here, we report a patient with a history of radiotherapy in the head and neck region exhibiting necrotic bone exposure associated with fistula and purulent exudation in the mandible, with the diagnosis of stage 3 osteoradionecrosis, in addition to a periapical cyst in the maxillary anterior region and multiple root remnants. An antibiotic coverage protocol with amoxicillin and metronidazole was prescribed for subsequent necrotic bone removal. The surgical procedure was performed along with the aPDT using methylene blue and red light, followed by coaptation of the edges of the surgical wound and the healing protocol with LLLT. The extraction of non-rehabilitated teeth was performed two per session using antibiotic coverage, aPDT, and LLLT and mouthwash with 0.12% chlorhexidine was prescribed until the complete closure of the surgical wound was achieved. Additionally, two aPDT sessions and four LLLT protocols were performed for complete healing of the surgical sites. Extra and intraoral examinations and panoramic and periapical radiographs were performed. No emergence or recurrence of osteonecrosis was observed after 12 months of follow-up. Conclusion The adjuvant therapy combining aPDT and LLLT with minimally invasive surgical procedures and antibiotic therapy was successful in the treatment and prevention of osteoradionecrosis in the patient after radiotherapy, without recurrence or new lesion emergence after 1-year of follow-up.