Journal of Orthopedic Oncology
Open Access

Photobiomodulation; minimal intervention; osteonecrosis of the jaw; bisphosphonates; tissue regeneration

Introduction

Osteonecrosis of the jaw (ONJ) is a serious, progressive condition characterized by necrotic bone exposure, often resulting from antiresorptive therapies such as bisphosphonates, radiation therapy, or localized trauma [1]. ONJ presents significant clinical challenges due to its impact on oral health, function, and quality of life. Traditional management approaches frequently involve invasive surgical procedures, which may not be suitable for all patients and carry a risk of complications. Photobiomodulation (PBM), a non-invasive light-based therapy, has gained attention for its ability to stimulate cellular repair, reduce inflammation, and enhance tissue regeneration [2]. When combined with minimal intervention techniques, PBM offers a synergistic approach to treating ONJ, prioritizing conservative care and improved patient outcomes. This paper explores the integration of PBM with minimally invasive strategies, emphasizing their potential to revolutionize ONJ management through enhanced healing, reduced morbidity, and patient-centered care [3].

Osteonecrosis of the jaw (ONJ) is a debilitating condition characterized by exposed necrotic bone in the maxillofacial region that fails to heal over time. Commonly associated with bisphosphonate therapy, antiresorptive agents, radiation treatment, or localized trauma, ONJ presents significant challenges in oral health management [4]. Patients often experience pain, infection, and functional impairments, which negatively impact their quality of life. Traditional treatment approaches for ONJ, such as aggressive surgical resection, carry risks of complications, including delayed healing, further bone damage, and increased morbidity. These challenges have driven the exploration of alternative therapies that focus on conservative, patient-centered care [5].

Discussion

The management of ONJ requires a delicate balance between alleviating symptoms, controlling infection, and promoting bone and soft tissue regeneration. Traditional surgical approaches, while effective in some cases, may lead to complications such as secondary infections or further bone loss [6]. In this context, minimal intervention strategies such as localized debridement, pharmacologic agents, and supportive therapies offer a less invasive alternative aimed at preserving oral structures and reducing morbidity. PBM enhances the efficacy of these conservative treatments by leveraging the biological effects of low-level laser or light therapy [7]. The anti-inflammatory and pro-healing properties of PBM have been shown to accelerate wound healing, modulate pain, and stimulate osteoblast and fibroblast activity, making it an ideal adjunct to conservative ONJ management. Furthermore, PBM's non-invasive nature and minimal risk profile make it suitable for patients with complex medical conditions who may not tolerate aggressive surgical interventions [8].

Interdisciplinary collaboration among oral surgeons, oncologists, and specialists in PBM is critical to optimizing patient outcomes [9]. By tailoring treatment protocols to individual patient needs, clinicians can achieve better therapeutic outcomes and improved quality of life. Ongoing research into the optimal dosimetry, frequency, and duration of PBM treatment is essential to establish standardized protocols and enhance clinical practice. This synergistic approach reflects a paradigm shift in ONJ management, moving away from aggressive interventions toward more patient-centered and regenerative strategies. The integration of PBM with minimal intervention not only aligns with the principles of conservative care but also underscores the potential for innovative technologies to address complex medical challenges [10].

Conclusion

The integration of photobiomodulation (PBM) with minimal intervention strategies offers a transformative approach to the management of osteonecrosis of the jaw (ONJ). By combining the regenerative benefits of PBM with the conservative principles of minimally invasive treatments, this synergistic approach addresses the multifaceted challenges of ONJ while prioritizing patient comfort and preserving oral function. PBM’s ability to reduce inflammation, enhance tissue repair, and stimulate bone regeneration complements conservative interventions such as localized debridement and pharmacologic therapies, providing a holistic framework for improving clinical outcomes. As patient-centered care becomes increasingly prioritized, the collaborative efforts of interdisciplinary teams are essential for optimizing treatment protocols and tailoring therapies to individual needs. Continued research is needed to refine PBM parameters and validate long-term efficacy, paving the way for broader clinical adoption. This paradigm shift underscores the importance of innovation and collaboration in achieving better therapeutic outcomes and enhancing the quality of life for patients with ONJ.

1. Wilkinson TJ, Sainsbury R (1998) The association between mortality, morbidity and age in New Zealand’s oldest old. Int J Aging Hum Dev 46: 333-343.

Indexed at, Google Scholar, Crossref

2. Gueresi P, Troiano L, Minicuci N, Bonafé M, Pini G, et al. (2003) The MALVA (MAntova LongeVA) study: an investigation on people 98 years of age and over in a province of Northern Italy. Exp Gerontol 38: 1189-1197.

Indexed at, Google Scholar, Crossref

3. Silver MH, Newell K, Brady C, Hedley-White ET, Perls TT, et al. (2002) Distinguishing between neurodegenerative disease and disease-free aging: correlating neuropsychological evaluations and neuropathological studies in centenarians. Psychosom Med 64: 493-501.

Indexed at, Google Scholar, Crossref

4. von Heideken Wågert P, Rönnmark B, Rosendahl E, Lundin-Olsson L, M C Gustavsson J, et al. (2005) Morale in the oldest old: the Umeå 85+ study. Age Ageing 34: 249-255.

Indexed at, Google Scholar, Crossref

5. Andersen HR, Jeune B, Nybo H, Nielsen JB, Andersen-Ranberg K, et al. (1998) Low activity of superoxide dismutase and high activity of glutathione reductase in erythrocytes from centenarians. Age Ageing 27: 643-648.

Indexed at, Google Scholar, Crossref

6. Palmer BW, Heaton SC, Jeste DV (1999) Older patients with schizophrenia:  challenges in the coming decades.Psychiatric Services 50: 1178-1183.

Indexed at, Google Scholar, Crossref

7. Ankri J, Poupard M (2003) Prevalence and incidence of dementia among the very old. Review of the literature. Rev Epidemiol Sante Publique 51: 349-360.

Indexed at, Google Scholar

8. Miles TP, Bernard MA (1992) Morbidity, disability, and health status of black American elderly: a new look at the oldest-old. J Am Geriatr Soc 40: 1047-1054.

Indexed at, Google Scholar, Crossref

9. Nybo H, Petersen HC, Gaist D, Jeune B, Andersen K, et al. (2003) Predictors of mortality in 2,249 nonagenarians—the Danish 1905-Cohort Survey. J Am Geriatr Soc 51: 1365-1373.

Indexed at, Google Scholar, Crossref

10. Stek ML, Gussekloo J, Beekman ATF, Van Tilburg W, Westendorp RGJ, et al. (2004) Prevalence, correlates and recognition of depression in the oldest old: the Leiden 85-plus study. J Affect Disord 78: 193-200.

Indexed at, Google Scholar, Crossref