Laser Therapy in the Management of Endodontic-Periodontal Lesions: A Comprehensive Review of Clinical Efficacy and Therapeutic Applications.

Introduction

Endodontic-periodontal lesions (EPLs) are diagnostically and therapeutically challenging owing to dual pulpal-periodontal involvement and overlapping clinical features. Conventional management, including scaling and root planing (SRP) and standard endodontic therapy, may fail to achieve predictable outcomes due to persistent microbial contamination and the limitations of mechanical debridement.

Methods

PubMed, Scopus, Web of Science, and Embase were searched for studies published between 1988 and 2025 on laser therapy in EPLs and related endodontic and periodontal conditions. Clinical, experimental, and review articles on diode or other laser approaches relevant to EPL were extracted and qualitatively analyzed.

Results

Two recent randomized clinical trials and one comparative clinical study suggest that an adjunctive 940-nm diode laser may improve probing depth (PD) reduction, clinical attachment level (CAL) gain, and radiographic bone changes when added to conventional endodontic-periodontal therapy. Additional case reports, clinical series, and in vitro studies support the bactericidal effects of diode lasers in root canals and periodontal pockets, as well as enhanced decontamination through laser-activated irrigation and antimicrobial photoactivated disinfection. These studies also highlight benefits for photobiomodulation, wound healing, and pain reduction. However, the evidence base is limited by small sample sizes, heterogeneous laser parameters, variable study designs, and a lack of standardized protocols and long-term outcomes.

Conclusion

Within the limits of the available evidence, diode lasers appear to be a promising adjunct in EPL management, with potential benefits for microbial control and tissue healing when combined with established endodontic and periodontal therapies. Further well-designed studies are required to establish standardized protocols and to confirm long-term efficacy and safety.