Does the use of laser therapy enhance healing and reduce the size of periapical lesions? A Systematic Review and Meta-analysis

• Adjunctive laser therapy did not improve periapical healing compared with conventional endodontic treatment. • Both treatment approaches resulted in significant reductions in Periapical Index (PAI) scores. • Evidence remains inconclusive regarding the added value of laser therapy in periapical healing. • The use of adjunctive laser therapy for periapical healing may be considered in individual clinical contexts. 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. 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. 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 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. Conventional endodontic treatment is sufficient for periapical healing, and routine adjunctive laser use may not be justified.