Clinical Efficiency of Lasers in Endodontic Treatment of Primary Endodontic Cases: An Umbrella Review of Systematic Reviews

ABSTRACT: Objectives: To evaluate and synthesise the current evidence on the efficacy of laser-activated irrigation in endodontics, with a focus on microbial reduction, postoperative outcomes, and its potential as an adjunct to conventional irrigants. Method: A comprehensive search was conducted to identify relevant systematic reviews. A total of 319 systematic reviews were initially identified. After the removal of 116 duplicates, 203 records were screened. Of these, 22 systematic reviews met the eligibility criteria. However, reviews that included exclusively in vitro studies or were considered to have limited clinical relevance were excluded. Ultimately, 9 systematic reviews were included in this umbrella review, evaluating different laser systems such as Er:YAG, Er,Cr:YSGG, Nd:YAG, and diode lasers in the context of root canal irrigation. This review was registered at PROSPERO (CRD42025599352). For this umbrella review, 5 electronic databases (PubMed/MEDLINE, Cochrane Database of Systematic Reviews, SciELO, Web of Science, and LILACS) were systematically searched from inception through December 2024, with no language or publication date restrictions applied. Study selection followed predefined eligibility criteria, and the methodological quality of the included systematic reviews was assessed using the AMSTAR 2 tool. Conclusions: The available evidence on laser-activated irrigation in endodontics remains limited and heterogeneous. Although some systematic reviews suggest potential benefits in canal disinfection and postoperative outcomes, the findings are inconsistent and largely constrained by variability in laser wavelengths, study designs, and outcome measures. Consequently, further standardised, high-quality clinical research is required before definitive conclusions regarding the clinical effectiveness of laser-activated irrigation can be established. Clinical Significance: Laser-assisted irrigation should currently be regarded as an adjunct with unproven clinical benefit, pending robust evidence from well-designed studies with standardised protocols and clinically relevant outcomes.