LLLT IN NON-SURGICAL MANDIBULAR MRONJ MANAGEMENT: A CASE REPORT

AIM
Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication associated with the long-term use of bisphosphonates. This clinical condition is characterized by exposed bone that fails to heal. Diagnosis is established when necrotic bone is present in the maxilla or mandible for at least 8 weeks in patients who have not undergone head and neck radiotherapy. MRONJ may cause pain or remain completely asymptomatic. The aim of this study is to present a clinical case involving the non-invasive use of Low-Level Laser Therapy (LLLT), with a focus on the improvement of hard tissue defects.

METHODS
A 57-year-old female patient presented to the Complex Unit of Odontostomatology in May 2024 with purulent discharge and pain around two mandibular implants in the symphysis region. The patient had been taking alendronate (oral) for osteoporosis from April to June 2024 every ten days. She underwent orthopantomography and cone-beam computed tomography (CBCT), which revealed an area of sclerotic bone surrounding existing implants. The patient was treated with intramuscular ceftriaxone (1g) and oral metronidazole (250mg) every day for two weeks. Due to the patient’s medical history and the size of the lesions, the authors opted not to perform surgery, but instead to use LLLT (980 nm, CW, 1 W), using a dedicated handpiece for photobiomodulation. The lesion received 4 minutes of defocused irradiation (150-200 J) once a week for four months.

RESULTS
The patient underwent clinical follow-up weekly and radiological follow-up monthly until a reduction in lesion size was observed.

CONCLUSIONS
LLLT is a simple, non-invasive procedure that resulted in pain reduction and a decrease in lesion size in this case. This technique can be considered for patients who are not candidates for surgery due to other underlying conditions or the size of the lesion.