Photobiomodulation in Medication-Related Osteonecrosis of the Jaw: Outcomes in Stage I and Its Adjunctive Role in Advanced Cases

<b>Background/Objectives</b>: The development of pharmacotherapy, particularly in antiangiogenic drugs, has led to the emergence of MRONJ as a significant side effect. With the increasing incidence of cancer, the management of MRONJ poses a growing challenge for clinicians. The aim of the study is to evaluate the effectiveness of photobiomodulation (PBM) in treating patients with stage I, II, and III medication-related osteonecrosis of the jaw (MRONJ). <b>Methods</b>: A total of 31 patients were divided into two groups: Group 1 (n = 14 patients), with Stage 1 MRONJ; and Group 2 (n = 17 patients), with Stage II and III MRONJ. In total, 10 patients had osteoporosis and 21 underwent cancer treatment. The sole variable under investigation was the stage of MRONJ, as all patients underwent the same photobiomodulation (PBM) procedure. For treatment protocol, PBM with a diode laser was used (Lasotronix Smart M Pro, Piaseczno, Poland) with the following parameters: 100 mW; continuous wave; 635 nm; 4 J/cm² for 20 s; irradiance for one point: 0.398 W/cm²; fluency for one point: 7.96 J/cm², and for four points, which was one appointment: 31.83 J/cm²; and tip diameter 8 mm (three points from buccal surface, perpendicular for the lesion and one point on the floor of the mouth) during each session. The protocol assumed 10 sessions at 3 days intervals. Antibiotic therapy (amoxicillin with clavulanic acid 875 mg + 125 mg or clindamycin 600 mg every 12 h) was started 3 days before PBM and continued for 14 days. Antibiotics were taken for 14 days in total. Pain was measured with VAS scale. Follow-up was after 3 and 6 months. <b>Results</b>: Among the 14 patients in Group 1, none exhibited any clinical signs or symptoms of MRONJ during the 3 months follow-up, and complete cure was achieved. While PBM resolved inflammation and pain in stage II MRONJ, further surgical intervention was necessary to fully address the condition. <b>Conclusions</b>: PBM is an effective treatment for achieving complete recovery in patients with Stage 1 MRONJ. However, in Stages II and III MRONJ, PBM significantly alleviates symptoms but requires complementary surgical intervention to achieve full resolution. A beneficial aspect is the reduction in pain symptoms and the extent of surgical intervention.