Photo Biomodulation-Assisted Regenerative Endodontics: Effects on Stem Cell Proliferation, Angiogenesis and Dentin-Pulp Regeneration

Regenerative endodontics represents a biologically oriented approach intended to restore the function and structural integrity of the dentin-pulp complex rather than merely replacing infected pulp tissue with an inert filling material. Photobiomodulation (PBM), formerly described as low-level laser or low-level light therapy, has emerged as a potential adjunct to regenerative endodontic procedures because of its ability to modulate cellular metabolism, proliferation, migration, differentiation, angiogenesis and tissue repair. Dental pulp stem cells possess substantial regenerative and odontogenic potential and are central to contemporary cell-homing and tissue-engineering concepts. Experimental evidence indicates that appropriate PBM parameters can enhance the proliferation and viability of dental pulp stem cells, stimulate the expression of angiogenic mediators such as vascular endothelial growth factor, and promote odontogenic differentiation and mineralised tissue formation. PBM may additionally influence mitochondrial activity, adenosine triphosphate production, reactive oxygen species, nitric oxide and intracellular signalling pathways, thereby creating a favourable microenvironment for regeneration. Recent studies have demonstrated effects on dentin-derived transforming growth factor-β1 release, stem-cell migration and cellular viability. Nevertheless, substantial variation exists in wavelength, energy density, irradiation frequency and delivery technique, while clinical evidence remains limited. This review discusses the biological rationale, cellular mechanisms, effects on stem cells and angiogenesis, implications for dentin-pulp regeneration, clinical applications and limitations of PBM-assisted regenerative endodontics.