From surgical debridement to laser-guided bone repair: An integrative approach to mandibular osteomyelitis

Chronic mandibular osteomyelitis is a challenging condition due to impaired vascularization, necrotic bone, and persistent infection, often requiring combined therapeutic approaches. We report the case of a 49-year-old male presenting with severe mandibular pain, purulent discharge, and radiographic evidence of bone sequestration and pathological fracture following tooth extraction. The patient was treated conservatively with surgical debridement associated with antimicrobial photodynamic therapy using 0.01% methylene blue activated by a 660 nm laser, followed by adjunctive low-level infrared laser therapy for photobiomodulation. Clinical and radiographic follow-up demonstrated resolution of infection, reduction of pain and inflammation, and progressive bone repair without adverse effects. This case highlights that the combination of photodynamic therapy and photobiomodulation may represent a safe and effective adjunctive approach in the management of chronic mandibular osteomyelitis, particularly in patients seeking less invasive alternatives to radical surgical procedures.