PHOTOBIOMODULATION VS PHOTODYNAMIC THERAPY AS ADJUVANT TREATMENTS IN PATIENTS WITH MEDICATION-RELATED OSTEONECROSIS OF THE JAW (MRONJ): A PILOT STUDY.

Medication-related osteonecrosis of the jaw (MRONJ) is a well-known potential side effect of antiresorptive treatment. A growing body of literature indicates photobiomodulation (PBM) and photodynamic therapy (PDT) as adjuvant therapies against MRONJ. Aim of this pilot study was to assess and compare effectiveness of PBM and PDT. From September 2019 to January 2020, 18 patients with clinic-radiographic MRONJ were enrolled and assigned to 2 groups of 9 patients each. Group 1: 7 F, 2 M; mean age: 71.3 ± 12.76 years; 7 cancer patients and 2 osteoporotic patients; Group 2: 8 F, 1 M; age range: 53-87 years; mean age: 71.4 ± 11.52 years; 6 cancer patients and 3 osteoporotic patients. Group 1 was exposed to a two-week protocol of 4 PBM sessions (GaAIAs 810 nm laser; output power: 50 mW; energy: 3750 J, duration: 300 s). Group 2 was treated with a two-week protocol of 4 PDT session (GaAIAs 810 nm laser combined with blue-purple methylene photosensitizer output power: 600 mW; energy: 24 J, duration: 40s/cm2). Four parameters were investigated before (T0) and after (T1) end of protocol: NRS for subjective pain, Masse Healing scale, probing depth, and size of lesion. Statistical evaluation showed a quasi-significant reduction of Masse healing scale in Group 1 (p = 0.06), and a significant reduction in Group 2 (p = 0.01) after PBM and PDT treatment, respectively. Comparison between Group 1 and Group revealed a significant difference in probing depth at T0, and no significant differences for any of the 4 parameters in T1 (p > 0.05). Despite the limited number of patients enrolled, PBM and PDT displayed an overlapping therapeutic outcome, since both provided an objective improvement of MRONJ lesion appearance, without a significant pain relief. Further studies with larger samples, in a randomized controlled setting, are warranted for further evaluations.