PHOTOBIOMODULATION WITH ACTIVE OXYGEN AND LACTOFERRIN IN THE TREATMENT OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW. A CASE REPORT

Abstract

Medication-related osteonecrosis jaw (MRONJ) affects about 5% of patients treated with bisphosphonates and other similar drugs. This case report describes the management of a case of MRONJ using photobiomodulation therapy (FBM) combined with active oxygen and lactoferrin (Blue®M). This is a 62-year-old patient with hypertension, rheumatoid arthritis and osteoporosis treated with Bonames®. After extraction, she presented exposed bone in the alveolar ridge of quadrant III. Under informed consent, minimally invasive surgery was performed with electrical instruments (Piezotome®). Histopathological analysis revealed necrotic bone tissue with chronic inflammatory infiltrate. The treatment included Blue®M teeth&bone once a day for 30 days, topical application of Blue®M gel every morning for 15 days and FBM with 808nm diode laser (Therapy-DMC®). The laser sessions were daily until day 3, and then twice a week for four weeks. The patient also performed mouthwashes with Blue®M every night for 30 days. Initially, the patient reported pain of 3/10 on the visual analog scale, which decreased to 0/10 at the end of treatment. Clinically, soft tissue healing was observed at 30 days and 60 days and the CT scan showed hyperdense cancellous bone with well-formed cortical and no alterations. Finally, this case suggests that the combination of FBM with topical active oxygen therapy and lactoferrin, along with minimally invasive surgical intervention, holds promise for the management of MRONJ.