# Current Trends in Adjuvant Therapies for Medication-Related Osteonecrosis of the Jaw
## 3 Results and Discussion
### Photobiomodulation  
Photobiomodulation (PBM) is a light therapy that uses nonionizing light sources in the visible and near-infrared spectrum. Many fields of medicine and dentistry use PBM because of its beneficial effects such as good wound healing, tissue generation, and analgesic and anti-inflammatory effects [56]. In dentistry, for example, PBM protects oral tissues by improving wound healing and enhancing epithelization. In addition, it stimulates cell proliferation and regeneration of bone, lymphatic, and blood vessels [56]. Owing to its antibacterial and biostimulating effects on soft and hard tissues, PBM is becoming a popular, non-invasive adjuvant therapy for MRONJ treated with conservative or surgical approaches. Furthermore, it is considered an attractive alternative approach to aggressive surgical treatment in elderly patients prone to surgical issues and relatively slow recovery. Recently, its role in patients who underwent conservative or surgical treatment of MRONJ has been investigated, and several clinical studies and systemic reviews have been published.  
Conservative or surgical treatment combined with PBM shows better results than either treatment alone in patients with MRONJ [57]. Early laser-assisted conservative surgical treatment with PBM is a better approach than conservative medical therapy [58]. A systematic review of laser therapy in MRONJ reported that PBM combined with conventional surgical/medical therapy has superior results over either treatment alone [59]. Preoperative PBM combined with surgery and medical therapy offers better clinical outcomes than the conventional treatment for MRONJ [60]. Interestingly, PBM therapy after invasive dental treatments such as tooth extraction prevents MRONJ [61]. Because prevention is better than treatment, further studies on the role of PBM in MRONJ prevention are needed. Published human studies on PBM in MRONJ are summarized in Table 4.  
Although several studies have shown clinically favorable results of PBM in treating patients with MRONJ, they included only a few patients at stage 3 of the disease with severe symptoms. Therefore, the lack of evidence hinders using PBM in the later stages of the disease. As no randomized controlled trial related to PBM in MRONJ exists, careful decision-making and operator experience are detrimental to PBM treatment. In addition, setting a standard protocol for PBM is challenging due to various variables that have to be considered, such as laser type, application time, output power and frequency, laser distance from applied tissue, and treatment period. Follow-up studies should address these shortcomings and aim to establish a standard protocol.  
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline
**Reference** & **Total Pt** & \begin{tabular}{c} **Medical** \\ **Condition** \\ \end{tabular} & \begin{tabular}{c} **BP** \\ **Route** \\ \end{tabular} & \begin{tabular}{c} **Duration** \\ **(Years)** \\ \end{tabular} & \begin{tabular}{c} **Trigger** \\ **Event** \\ \end{tabular} & \begin{tabular}{c} **Stage** \\ \end{tabular} & \begin{tabular}{c} **Surgical Tx** \\ \end{tabular} & \
\begin{tabular}{c} **Outcome** \\ \end{tabular} \\ \hline [PERSON] et al. (2012) [50] & 25 & OP/BM & NA & 2-8 & NA & NA & 83\% & Favorable \\ [PERSON] et al. (2015) [53] & 1 & OP & Oral & 2 & Ext & 2 & 100\% & Favorable \\ [PERSON] et al. (2020) [54] & 1 & NA & NA & NA & NA & 0 & 100\% & Favorable \\ [PERSON] et al. (2020) [55] & 1 & MM & IV & 1 & Ext & 2 & 100\% & Favorable \\ [PERSON] et al. (2021) [52] & 143 & OP/BM & Oral/IV & 1–5 &
\begin{tabular}{c} Spon/Ext/ \\ Imp/Perio \\ \end{tabular} & 2 or 3 & 76\% & Favorable \\ \hline \hline \end{tabular}  
\begin{tabular}{c} Pt, patient; BP, bisphosphonate; Tx, treatment; OP, osteoporosis; BM, bone metastasis; MM, multiple myeloma; NA, not available; IV, intravenous; Spon, spontaneous; Ext, extraction; Imp, implant; Perio, periodontitis. \\ \end{tabular}
\end{table}
Table 3: Human studies of hyperbaric oxygen (HBO) administration for MRONJ treatment in the past 10 years.