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4.5. Laser-Assisted Irrigation (LAI) Subgroup

The favorable outcomes associated with laser-assisted irrigation may be explained by the unique photoacoustic phenomena generated by laser activation. In Er:YAG-based systems such as photon-induced photoacoustic streaming (PIPS) and shock-wave enhanced emission photoacoustic streaming (SWEEPS), the high absorption of laser energy by irrigant solutions generates photoacoustic shock waves that improve irrigant penetration, fluid movement, and biofilm disruption throughout the root canal system [46,47]. Other laser systems, including Er,Cr:YSGG and Nd:YAG lasers, have also been investigated for endodontic disinfection, although their mechanisms of action differ because of their distinct absorption characteristics and interactions with irrigant solutions. These technologies may contribute to bacterial reduction and enhanced cleaning of inaccessible anatomical areas, which could favor periapical healing. The present findings are consistent with previous experimental studies demonstrating superior irrigant activation and biofilm removal with laser-assisted techniques compared with conventional irrigation [46,47]. However, clinical evidence remains limited, and the available studies differ considerably in terms of laser wavelength, activation protocols, outcome definitions, and follow-up periods. Therefore, although the current results suggest a potentially greater benefit of laser-assisted irrigation than passive ultrasonic irrigation, direct comparisons between these activation methods should be interpreted cautiously. Additional randomized controlled trials with standardized protocols and long-term radiographic assessment are needed to establish the true magnitude of the clinical benefit associated with laser-assisted irrigation.

Prognosis of Periapical Lesions Treated by Activated Disinfection (PUI, Laser) Without the Use of Systemic Antibiotics: Systematic Review and Meta-Analysis. © 2026 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Introduction

Although they were extensively studied, all the above-mentioned lasers might not show their full potential in reducing the bacterial load and complete smear removal. The benefit of this technique depends on the various laser irradiation parameters, type of laser used and physical properties of tissues that ultimately govern the laser tissue interactions. These parameters can cause changes in photomechanical and photoacoustic energy emission where laser pulses with high pulse energy are delivered ultimately causing photothermal changes to the tissues causing a beneficial therapeutic effect at the targeted site (7). Although lasers show a beneficial effect in root canal disinfection there is a scarcity of evidence to suggest a superior laser regimen due to the wide range of characteristics which has to be considered in traditional RCT. In the current study, LAI was done using Er: YSGG 2940 nm laser (Waterlase® iPlus, BIOLASE, USA). Current systematic review (8), although pointed out the heterogeneity among the various parameters employed. The literature evidence has shown the beneficial pain reduction, at 6 hours post-treatment with similar parameters employed in the current study.

Comparison of postoperative pain reduction following laser, ultrasonic activation and conventional needle irrigation after root canal treatment – A randomized clinical trial. Copyright: © 2023 Medicina Oral S.L. Creative Commons Attribution 2.5 International (https://creativecommons.org/licenses/by/2.5/).

4. Discussion

In a systematic review published in 2024 evaluating the effects of lasers on the healing of periapical lesions, it was concluded that laser systems accelerate and enhance bone healing in the periapical region [48]. Achieving complete chemical debridement of the root canal is highly important in the healing process after endodontic treatment. Laser activation techniques have been shown to enhance the removal of pulpal tissue residues, smears and debris by delivering the solution to hard-to-reach areas [26,27]. Additionally, it has been reported to be highly effective in eliminating bacterial biofilms from infected root canals [13]. This high cleaning efficiency may explain the significant lesion reduction in the laser groups compared with that in the CSI group in the present study. Similarly to the present study, Uslu et al. reported that neither PIPS nor SWEEPS was superior to the other in terms of smear layer removal [30]. In addition, another study revealed that both laser applications showed similar efficacy in eliminating E. faecalis, the most frequently isolated bacterium in endodontic treatment failures [29].

Do Laser-Activated Irrigation Protocols Improve Endodontic Success? A Prospective Clinical Comparison of 1-Year Periapical Healing with Sonic, Ultrasonic, Manual Dynamic and Conventional Techniques. © 2026 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).