Laser-Based Interventions for Preventing and Managing Osteoradionecrosis of the Jaw After Head and Neck Radiotherapy: A Systematic Review.

Abstract

Osteoradionecrosis (ORN) of the jaws remains a severe and functionally debilitating late complication among patients treated with radiotherapy for head and neck cancers. This systematic review evaluates the current evidence on laser-based interventions, including photobiomodulation therapy (PBMT), antimicrobial photodynamic therapy (aPDT), and surgical laser applications for the prevention and management of ORN. Ten studies met the inclusion criteria, consisting of one randomised controlled trial, one retrospective cohort study, one case series, and seven case reports. Across the available evidence, laser-based therapies were generally associated with favourable outcomes, including improved mucosal healing, reduced pain, enhanced tissue repair, and, in some cases, successful prosthetic rehabilitation and reduced recurrence. Despite these promising findings, the current evidence remains early and uneven, constrained by small cohorts, wide variation in laser parameters, limited comparative data, inconsistent staging practices, and a lack of long-term follow-up to confirm the durability of response. Laser therapy represents a potentially transformative adjunct in ORN management, but robust, well-designed clinical trials are essential to establish its true therapeutic value, optimise treatment protocols, and guide future clinical practice.