Integrating photobiomodulation therapy (PBMT), also known as red light therapy, into dental practices is gaining momentum as clinicians seek non-invasive ways to enhance tissue healing, reduce inflammation, and improve surgical outcomes. This innovation may be particularly useful in a high-risk patient group with a history of bisphosphonate use.
Bisphosphonates, widely prescribed for osteoporosis and certain cancers, are known to improve bone density but also carry an elevated risk of osteonecrosis of the jaw (ONJ) following oral surgery. Though somewhat rare in patients treated for osteoporosis, this complication poses a significant treatment challenge due to impaired bone healing.
Could red light therapy offer a supportive role in mitigating risk for these patients? Let’s explore the current science and clinical potential of this adjunctive tool.
Understanding the Challenge: Bisphosphonates and Oral Surgery
Bisphosphonates (e.g., Fosamax®, Boniva®, Reclast®) are antiresorptive agents that inhibit osteoclast activity to preserve bone density. However, altering bone turnover and blood flow can delay healing post-surgery and increase susceptibility to ONJ, particularly after extractions or implant placement.
“Patients with a bisphosphonate history—especially those on IV formulations or long-term therapy—require a modified surgical protocol and enhanced healing strategies,” explains Dr. Marielaina Perrone, DDS, a cosmetic and implant dentist in Henderson NV.
“That’s where red light therapy may play a valuable adjunctive role.”
What Is Photobiomodulation Therapy?
Photobiomodulation therapy (PBMT) involves using low-level red or near-infrared light (typically 600–1000 nm wavelengths) to stimulate cellular activity. The mechanism is rooted in the light’s interaction with cytochrome c oxidase in mitochondria, leading to increased ATP production, reduced oxidative stress, and enhanced tissue repair.
In dentistry, PBMT has shown promise for:
Emerging evidence also points to its potential benefit in compromised bone healing scenarios, including those involving bisphosphonates. This promising potential of PBMT in oral surgery should instill a sense of hope and optimism in dental professionals.
Potential Applications for Bisphosphonate Patients
For patients with a bisphosphonate history, PBMT may be used:
- Pre-operatively, to improve local circulation and reduce oxidative stress in target tissues
- Immediately post-operatively, to support soft tissue repair and angiogenesis
- During wound healing, to help modulate inflammation and potentially enhance osseointegration or socket healing
“The non-invasive nature of red light therapy makes it a low-risk option with potentially high reward in these cases,” says Dr. Perrone. “We’re not replacing surgical precautions—but supporting them.”
What the Research Says
While large-scale randomized trials are still lacking, smaller studies and case reports suggest that PBMT:
- May reduce the risk of ONJ development in high-risk patients when used adjunctively
- Can improve epithelialization and soft tissue closure post-extraction
- Is associated with reduced post-op discomfort and edema
- May enhance bone remodeling in the context of dental implants or grafts
One pilot study found that PBMT accelerated bone healing in bisphosphonate-treated animals, while other in vitro research shows improved osteoblastic activity under red light stimulation.
“We’re seeing more literature exploring PBMT’s influence on bone cell metabolism,” adds Dr. Perrone. “This could be a meaningful therapeutic addition for dental patients with compromised healing.”
Clinical Considerations
When incorporating PBMT in patients with bisphosphonate exposure, consider the following:
? Wavelengths & Settings
- Red (630–660 nm) for superficial tissue healing
- Near-infrared (810–980 nm) for deeper bone and connective tissue penetration
? Timing
- Begin pre-operatively when possible (1–2 sessions prior)
- Continue immediately post-op and at intervals (e.g., every 48–72 hours) for 1–2 weeks
? Safety
- No known adverse effects at therapeutic dosages
- Avoid use over known malignancies or in photosensitive individuals
? Integration
- PBMT should be complementary, not a replacement for traditional surgical protocols
- Ensure informed consent and documentation when used in high-risk medical cases
Conclusion: A Promising Adjunct for a High-Risk Population
Patients with a bisphosphonate history require careful, informed surgical planning. While red light therapy is not a cure-all, its ability to enhance wound healing, support mitochondrial activity, and reduce inflammation makes it a valuable tool to consider—especially in high-risk oral surgery contexts.
“Our role as clinicians is to stay informed and open-minded,” Dr. Perrone concludes. “Photobiomodulation may not eliminate ONJ risk—but it offers an extra layer of support that’s safe, non-invasive, and biologically grounded.”
As research evolves, red light therapy could become a standard adjunct in oral surgery protocols for medically complex dental patients.
About the Author
Dr. Marielaina Perrone, DDS, is an experienced general and cosmetic dentist based in Henderson, NV. With a career spanning over 20 years, she has gained extensive experience in comprehensive care, including smile makeovers, implants, and medically informed dental treatment. Her passion for integrating science-backed innovations into clinical care, with a focus on functional and aesthetic outcomes, makes her a trusted voice in the dental community.