Laser-Assisted Biofilm Disruption and Its Role in Periodontal Tissue Regeneration

Laser interventions in periodontology combine targeted biofilm disruption, localized photochemical antimicrobial activity, and modulation of host repair pathways. NdYAG around 1064 nm couples to hemoproteins and penetrates millimeters to enable coagulation and contactless disinfection in vascularized pockets. ErYAG near 2940 nm is absorbed by water and hydroxyapatite and ablates mineral deposits while volatilizing extracellular polymeric substances. Diode lasers from 810 to 980 nm activate porphyrin photosensitizers for photodynamic therapy and provide antimicrobial action with low thermal burden. Short high peak pulses induce photoacoustic cavitation; collapsing bubbles generate microjets and shear that detach 3D biofilm from root furcation and irregular surfaces. Photochemical activation produces singlet oxygen and radicals that oxidize membranes, nucleic acids and matrix components, enhancing antimicrobial penetration and reducing selective pressure associated with prolonged antibiotics. Subablative irradiation modulates mitochondrial redox and downstream signaling, reduces proinflammatory cytokines and promotes fibroblast proliferation, collagen deposition, osteogenic gene expression and VEGF mediated angiogenesis, effects that correspond to measurable gains in probing depth, clinical attachment level and local bone volume. This review aims to synthesize mechanistic insights and clinical considerations to guide parameter selection and future translational research.