Comprehensive management of endo-periodontal lesions using laser technology

Relevance. Endo-periodontal lesions (EPLs) are characterized by the simultaneous involvement of periodontal tissues and the pulp-endodontic system, requiring a comprehensive approach to both diagnosis and treatment. This complexity necessitates close interdisciplinary collaboration between endodontists and periodontists. Despite the availability of modern treatment methods, including combined therapeutic approaches, the risk of complications remains high. These pathologies have a multifactorial etiology due to anatomical and microbiological interconnections between the root canal system and periodontal tissues, which significantly complicates the clinical picture and the selection of optimal treatment strategies. In light of this, contemporary dentistry is actively exploring and implementing adjuvant treatment methods aimed at enhancing the effectiveness of standard therapeutic protocols and improving long-term clinical outcomes. One promising approach involves the use of laser technologies, which, owing to their physico-biological properties, demonstrate the ability to decontaminate, stimulate tissue regeneration, and modulate the inflammatory response in affected periapical and periodontal tissues. The biological effects of laser radiation depend on the wavelength, energy density, and pulse characteristics, which determine tissue penetration depth and the nature of tissue interaction. Numerous clinical studies confirm that combining conventional treatment with laser therapy provides more stable clinical outcomes by improving microcirculation, reducing pro-inflammatory mediator levels, and stimulating reparative processes. These effects are particularly attributed to photobiomodulation and cavitational decontamination, which promote faster healing and reduce bacterial load. Collectively, this makes laser therapy a valuable and reasonable adjunct to standard treatment protocols for periodontal and periapical diseases. Aim of this study was to evaluate the effectiveness of laser irradiation with wavelengths of 2780, 980, and 650 nm in the comprehensive treatment of endo-periodontal lesions. Materials and Methods. The study included 15 patients aged 37–57 years diagnosed with EPLs classified according to D. Herrera et al. (2018) as endo-periodontal lesions without root damage in patients without periodontitis, stage 2 – characterized by a wide and deep periodontal pocket localized to the surface of a single tooth. The treatment protocol included: de-epithelialization (ablation) and physical decontamination (cavitation) of affected periodontal areas using an erbium laser (2780 nm, 400 μm fiber, 1.5 W, 40 Hz, 80% water and 40% air); professional mechanical plaque removal and root surface smoothing; elimination of local irritants; physicochemical decontamination of the periodontal pocket by irrigation with 3% hydrogen peroxide followed by irradiation using a diode laser with a wavelength of 980 nm (non-initiated 300 μm fiber, 0.5 W/CW, 30 s); photobiomodulation therapy to stimulate reparative processes was performed three times at 48-hour intervals using a 650 nm laser (0.5 cm fiber, 0.2 W/CW, 30 s/0.5 cm2 ). Results. Clinical and radiological evaluations demonstrated that the adjunctive use of laser therapy alongside standard treatment protocols resulted in positive dynamics in the course of endo-periodontal lesions over a 6-month follow-up period. Specifically, the integration of laser irradiation with wavelengths of 2780, 980, and 650 nminto comprehensive therapy contributed to the activation of healing processes, reparative regeneration of periodontal tissues, and achievement of stable clinical remission. Conclusions. The findings support the feasibility of incorporating laser irradiation with wavelengths of 2780, 980, and 650 nm into the comprehensive treatment of endo-periodontal lesions to enhance overall therapeutic efficacy and reduce the risk of complications. It is advisable to conduct further research involving a larger sample size to validate or challenge the findings reported in this study.