Use of antimicrobial photodynamic therapy in the treatment of medication-related osteonecrosis of the jaw

  • Nizyara Costa da Silva Costa da Silva Universidade Potiguar – UNP. Brasil
  • Felipe Lima e Silva Universidade Potiguar – UNP. Brasil
  • Leonardo Magalhães Carlan Universidade Federal do Rio Grande do Norte – UFRN. Brasil
  • Hannah Gil de Farias Morais Universidade Federal do Rio Grande do Norte – UFRN. Brasil
  • Weslay Rodrigues Silva Universidade Federal do Rio Grande do Norte
  • Maria de Lourdes Silva de Arruda Morais Universidade Estadual do Rio Grande do Norte – UERN / Liga Norte Riograndense Contra o Câncer - LNRCC . Brasil
Palavras-chave: Osteonecrosis, Photochemotherapy, Diphosphonates


Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating complication associated with antiresorptive agents, in which treatment can be quite challenging. This study aimed to report two cases of cancer patients with MRONJ treated in a complementary manner by antimicrobial photodynamic therapy (aPDT). Both patients were male, 84 and 82 years old, respectively, and had a diagnosis of prostate adenocarcinoma and bone metastasis, treated with intravenous injections of bisphosphonates. The dental history for both was toothache, followed by extraction of dental elements that culminated with the appearance of necrotic bone in the mandibular region, which was confirmed with imaging exams and histopathological reports. The treatment protocol for both cases consisted of performing the aPDT once a week, associated with the use of 10 volumes hydrogen peroxide and 0.12% chlorhexidine digluconate for continuous use after oral brushing and amoxicillin with clavulanate three times a day for 7 days. The patient in case 1 performed 27 sessions, responded well to treatment, however, due to complications of the underlying neoplasm, he died without complete resolution of the osteonecrosis. In case 2, 32 sessions were carried out, with a good evolution of the symptoms. The patient is being followed up for 14 months, with no need for surgical intervention to date. Based on the reported cases and the literature survey, it can be concluded that aPDT can be an effective alternative in cases of MRONJ. The patients in the study in question showed success and control of the clinical picture.


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Marx RE. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg. 2003;61(9):1115-17.

Holtmann H, Lommen J, Kübler NR, Sproll C, Rana M, Karschuck P et al. Pathogenesis of medication-related osteonecrosis of the jaw: a comparative study of in vivo and in vitro trials. J Int Med Res. 2018;46(10):4277-96.

Hasegawa T, Hayashida S, Kondo E, Takeda Y, Miyamoto, H, Kawaoka Y et al. Medication-related osteonecrosis of the jaw after tooth extraction in cancer patients: a multicenter retrospective study. Osteoporosis Int. 2019;30(1):231-39.

Shin WJ, Chul-Hwan K. Prognostic factors for outcome of surgical treatment in medication-related osteonecrosis of the jaw. J Korean Assoc Oral Maxillofac Surg. 2018;44:174-81.

Coléte JZ, Hadad H, Momesso GAC, Santos Filho H, Fernandes BR, Garcia Junior IR. Implantes em pacientes com osteonecrose dos maxilares associado ao uso de bifosfonatos. Relato de caso e revisão de literatura. Arch Health Invest. 2019;8(1):20-7.

Weber JBB, Camilotti RS, Ponte ME. Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review. Lasers Med Sc. 2016;31(6):1261-72.

Castro MS, Ribeiro NV, Carli ML, Pereira AAC, Sperandio FF, Hanemann JAC. Photodynamically dealing with bisphosphonate-related osteonecrosis of the jaw: Successful case reports. Photodiagn Photodyn. 2016;16: 72-5.

Tartaroti NC, Marques MM, Graça Naclério-Homem M, Migliorati CA, Zindel Deboni MC. Antimicrobial photodynamic and photobiomodulation adjuvant therapies for prevention and treatment of medication-related osteonecrosis of the jaws: case series and long-term follow-up. Photodiagn Photodyn. 2020;1-27.

Vescovi P, Merigo E, Manfredi M, Meleti M, Fornaini C, Bonanini M et al. Nd:YAG laser biostimulation of bisphosphonate-associated necrosis of the jawbone with and without surgical treatment. Br J Oral Maxillofac Surg. 2007;45(8):628-32.

Mânea HC, Urechescu HC, Balica NC, Pricop MO, Baderca F, Poenaru M et al. Bisphosphonates-induced osteonecrosis of the jaw - epidemiological, clinical and histopathological aspects. Rom J Morphol Embryol. 2018;59(3):825-31.

Atalay B, Yalcin S, Emes Y, Aktas I, Aybar B, Issever H et al. Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Lasers Med Sci. 2011;26(6):815-23.

Altay MA, Tasar F, Tosun E, Kan B. Low-Level Laser Therapy Supported Surgical Treatment of Bisphosphonate Related Osteonecrosis of Jaws: A Retrospective Analysis of 11 Cases. Photomed Laser Surg. 2014;32(8):468–475.

Baba A, Goto TK, Ojiri H, Takagiwa M, Hiraga C, Okamura M et al. CT Imaging Features of Antiresorptive agent-Related Osteonecrosis of the Jaw/ Medication-Related Osteonecrosis of the Jaws. Dentomaxillofac Rad. 2018;47(4):20170323.

Goller-Bulut D, Özcan G, Avci F. Changes in dimension of neurovascular canals in the mandible and maxilla: A radiographic finding in patients diagnosed with MRONJ. Med Oral Patol Oral Cir Bucal. 2018;;23(3):e282-9.

Antoni CC, Matsumoto MA, Silva AA, Curi MM, Santiago Júnior JF, Sassi LM et al. Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study. Braz Oral Res. 2018;32:e23.

American Association of Oral and Maxillofacial Surgeons (AAOMS). Position paper on bisphosphonate-related osteonecrosis of the jaws. J Oral Maxillofac Surg. 2007;65(3):369-76.

Latifyan S, Genot MT, Klastersky J. Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy. Support Care Cancer. 2016;24(9):3687-693.

Otto S, Pautke C, Van den Wyngaert T, Niepel D, Schiødt M. Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev. 2018;69:177-87.

Tandon S, Lamba AK, Faraz F, Aggarwal K, Chowdhri K. A case report of Bisphosphonate Related Osteonecrosis of the Jaw treated by photodynamic therapy. Photodiagn Photodyn. 2019;26:313-15.

Como Citar
da Silva, N. C. da S. C., e Silva, F. L., Carlan, L. M., de Farias Morais, H. G., Silva, W. R., & Silva de Arruda Morais, M. de L. (2021). Use of antimicrobial photodynamic therapy in the treatment of medication-related osteonecrosis of the jaw. ARCHIVES OF HEALTH INVESTIGATION, 10(6), 970-974.
Original Articles