Abstract Aim The study aims to retrospectively assess and share the experience of the use of photobiomodulation (PBM) as an adjunctive to surgical extraction in patients at-risk for medication-related osteonecrosis of the jaw (MRONJ) due to a treatment history with bone-modifying agents. Methods The department database and medical records were examined in the period between 2016 and 2023. The inclusion criteria were; at-risk patients for MRONJ with current or previous treatment with bone-modifying agents, with or without a history of antiangiogenic agents administration, who underwent single or multiple dental extractions, subjected to PBM preventive protocol, and without a diagnosis or history of MRONJ development. The PBM protocol consisted of four sessions, two sessions before the intervention and two sessions after the intervention. The PBM parameters (per session) were; total power of 0.6 W, time of 15 min, frequency of 30 kHz, and total energy of 577.4 J. Results A total of 62 patients (58 females and 4 males) fulfilled the inclusion criteria with a mean age of 67.5 years. Complete healing without the development of MRONJ was shown in 50 (80.65%) patients, and the development of MRONJ was shown in 12 (19.35%) patients. The statistical analysis revealed a higher risk of MRONJ in patients with a history of administration of zoledronic acid (p = 0.029) and in patients undergoing corticosteroid therapy (p = 0.039). While a lower risk was observed in patients in treatment for thyroid pathology (p = 0.055). Conclusions The majority of the included at-risk MRONJ patients showed complete healing after surgical extraction with the use of PBM as an adjunctive modality. Corticosteroid treatment as a systemic risk factor and zoledronic acid as a drug-related risk factor show significant associations with the development of MRONJ.