Efficacy of diode Laser compared to conventional irrigation in endodontic treatment of apical periodontitis: a systematic review and meta-analysis.

BACKGROUND

Effective disinfection is essential for the successful management of apical periodontitis. Diode lasers have emerged as a promising adjunct to conventional irrigation techniques in endodontics, offering potential benefits in microbial control and postoperative recovery. However, their comparative clinical efficacy remains uncertain.

OBJECTIVE

This systematic review aims to evaluate the effectiveness and safety of diode laser-assisted irrigation vs. conventional irrigation methods in endodontic treatment of apical periodontitis, focusing on clinical outcomes, radiographic healing, and adverse events.

METHODS

A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase following PRISMA 2020 guidelines. Randomized controlled trials comparing diode laser irrigation with conventional methods were included. Three independent reviewers performed study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. Primary outcomes included bacterial reduction, postoperative pain, and radiographic healing. Secondary outcomes addressed adverse events and procedural complications.

RESULTS

Twelve randomized controlled trials were included, encompassing a total of 863 participants. Diode laser-assisted irrigation demonstrated superior bacterial reduction and postoperative pain control in several studies, particularly when used in conjunction with adjunctive methods such as photodynamic therapy. Radiographic healing outcomes varied across studies, and no serious adverse effects were reported. However, methodological heterogeneity and variability in laser protocols limited comparability.

CONCLUSION

Diode lasers may provide clinical advantages over conventional irrigation in the management of apical periodontitis, particularly in reducing bacterial load and early postoperative pain. Nevertheless, further high-quality trials with standardized protocols are required to confirm these findings and support their widespread clinical adoption.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420251025177.