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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/).

4.3. The Effect of Irrigation Systems/Activation Methods in Endodontic Therapy

Laser technology has gained prominence in dental protocols, especially in endodontics, focusing on disinfection and postoperative pain relief. Lasers with near-infrared wavelengths (810–1064 nm) have photothermal effects on chromophores such as melanin in some microorganisms and penetrate up to 1000 µm into dentin [22,157]. This results in effective microbial destruction without altering adjacent structures. Mid-infrared lasers (2780–2940 nm) create cavitation effects in irrigants, enhancing the removal of microorganisms and biofilms [158]. These lasers have been proposed as an alternative to sodium hypochlorite due to their ability to penetrate dentinal tubules, which is attributable to their high absorption by hydroxyl groups (OH−) and water molecules. The cavitation effect generated by mid-infrared lasers using distilled water or a saline solution may substitute for conventional irrigants, such as sodium hypochlorite, yielding comparable radiographic healing outcomes for apical lesions over follow-up periods of up to 12 months [64].

Effectiveness of Irrigation Protocols in Endodontic Therapy: An Umbrella Review. © 2025 by the authors. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).

Discussion

The present three-arm randomized controlled trial demonstrated that both 1064 nm Nd:YAG and 940 nm diode laser-assisted minimally invasive periodontal therapy, following LANAP® principles, were associated with greater immediate suppression of the relative qPCR-derived levels of T. denticola and P. intermedia compared with SRP alone. Although all groups showed significant within-group improvement, the laser-treated groups demonstrated significantly lower post-treatment relative microbial values and superior short-term clinical attachment gain at 3 months than SRP alone. These findings suggest that adjunctive near-infrared laser therapy may provide incremental microbiological and clinical benefits in the treatment of stage II periodontitis.

1064 nm Nd:YAG versus 940 nm diode laser-assisted periodontal therapy in stage II periodontitis: a randomized controlled trial. © The Author(s) 2026. Creative Commons Attribution 4.0 International (https://creativecommons.org/licenses/by/4.0/).