Diode laser photobiomodulation: mechanisms, clinical applications, and future perspectives

This review synthesizes current evidence on diode-laser photobiomodulation (PBM), spanning cellular mechanisms (mitochondrial stimulation, ROS/NO tuning, MAPK/PI3K–Akt/NF-κB signaling), experimental evidence (in vitro, animal models), and clinical applications in dermatology/aesthetic medicine, neurology (tPBM), musculoskeletal rehabilitation, and dentistry. We emphasize the biphasic dose–response, the centrality of dosimetry (wavelength, fluence, irradiance, beam/spot, exposure time, CW vs pulsed), and recurring methodological limitations (parameter heterogeneity, incomplete reporting, reproducibility). We propose a practical path to standardization by combining patient-specific optical modeling (e.g., Monte Carlo) to estimate target-absorbed dose with real-time device feedback (power-at-tissue auditing, stand-off/spot control, thermal guardrails), thus tightening therapeutic windows in vivo. Future directions include multi-wavelength protocols, 3D/organ-on-chip platforms, sham-controlled multicenter RCTs with harmonized endpoints, and multi-omics to personalize PBM parameters. Overall, the work aims to help PBM evolve from empirical practice to a quantitative, reproducible, and scalable light-based therapy.