aPDT Applied in Osteonecrosis of the Jaws: A Randomized Controlled Trial

OBJECTIVE: To evaluate the effectiveness of antimicrobial photodynamic therapy in patients with osteoradionecrosis and medication-related osteonecrosis of the jaws. METHODS: Sixty patients diagnosed with osteoradionecrosis (n = 21) or medication-related osteonecrosis of the jaws (n = 39) were randomized to receive either standard therapy (0.12% chlorhexidine irrigation and systemic antibiotics when indicated; n = 28) or standard therapy plus antimicrobial photodynamic therapy (n = 32). The antimicrobial photodynamic therapy protocol consisted of a topical methylene blue application followed by low-level laser irradiation (660 nm, 4 J, 100 mW, 40 s per point), performed weekly. The primary endpoint was complete healing. RESULTS: Complete healing was observed in 40.6% of patients treated with antimicrobial photodynamic therapy (13/32), whereas no cases were observed in the standard therapy group (0/28) (OR 39.5; 95% CI 2.21-704; p < 0.001). CONCLUSIONS: Antimicrobial photodynamic therapy improved healing outcomes and reduced the need for surgical intervention in patients with osteonecrosis of the jaws. These findings support aPDT as a promising conservative adjunct in the management of osteoradionecrosis and medication-related osteonecrosis of the jaws.