Does the use of laser therapy enhance healing and reduce the size of periapical lesions? A systematic review and meta-analysis

INTRODUCTION AND OBJECTIVE: Laser therapy has been proposed as an adjunct to conventional endodontic treatment due to its potential photobiomodulatory and antimicrobial effects on apical periodontitis. This systematic review and meta-analysis aimed to evaluate whether adjunctive laser therapy enhances the healing of periapical lesions. STUDY SELECTION AND SOURCES: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science. Randomized and non-randomized studies assessing periapical lesion healing using the Periapical Index (PAI) and comparing conventional endodontic treatment with and without adjunctive laser therapy were included. Meta-analysis was performed using a random-effects model, risk of bias was assessed with RoB 2.0 and ROBINS-I and the evidence certainty was rated using GRADE. RESULTS: Six studies met the inclusion criteria. All included studies reported significant reductions in PAI in both experimental and control groups. However, meta-analysis demonstrated no significant difference between adjunctive laser therapy and conventional endodontic treatment (mean difference = 0.17; 95% CI: -0.14 to 0.47; p = 0.28), with moderate heterogeneity (I² = 52%). All randomized controlled trials were judged as presenting some concerns of bias, the single non-randomized clinical study was judged to have a critical risk of bias and the certainty of evidence was rated as low CONCLUSIONS: Current evidence does not consistently demonstrate a significant additional benefit of adjunctive laser therapy over conventional endodontic treatment in terms of radiographic healing of periapical lesions assessed by PAI. CLINICAL SIGNIFICANCE: Conventional endodontic treatment is sufficient for periapical healing, and routine adjunctive laser use may not be justified.