Abstract
Introduction: Bisphosphonates are drugs that act on bone metabolism, inhibiting calcium precipitation and bone resorption. When used for long periods to control osteoporosis, these drugs can cause adverse effects, such as osteonecrosis of the jaws (Bisphosphonate-Related Osteonecrosis of the Jaws - BRONJ), which is more frequent in 8% to 12% of patients when administered intravenously. However, it should be noted that complications, when they occur, are very severe and mutilating, greatly impairing the quality of life of these patients. Energy-based devices (EBD), described in the biophotonic literature, reveal effective anti-inflammatory, analgesic, neoangiogenic, and reparative action. Objective: It was conducted a systematic review to present the main clinical considerations and consequences of the use of bisphosphonates in the occurrence of osteonecrosis of the jaw, as well as to discuss the treatments of photobiomodulation and magnetotherapy. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2024 to January 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 118 articles were found, 30 articles were evaluated in full and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 31 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=88.5%>50%. It is concluded that with the increasing use of bisphosphonates against osteoporosis especially in cases of postmenopausal women with osteopenia, a proportionally higher incidence of the main adverse effect of these drugs in the maxillomandibular region, osteonecrosis of the jaw, has emerged. The "gold standard" therapy of choice proposed for this disease is surgical treatment. Complications, when present, are very severe and mutilating, greatly impairing the quality of life of these patients. Morbidities include extensive resections, secondary infections, lack of tissue for primary closure, dehiscence, and fistulas, which can evolve into multilateral wounds with serious consequences, such as sepsis. In this regard, photobiomodulation therapy and magnetotherapy demonstrated safety and efficacy in the treatment of bisphosphonate-related osteonecrosis of the jaw, through reduction of inflammatory signs, faster healing, and reduction of postoperative morbidity. Thus, it was demonstrated that only four applications of low-intensity laser and magnetotherapy were sufficient to reduce the inflammatory process in the surgical wound, stimulate the tissue repair process, and provide postoperative analgesia.