The Effectiveness of Laser Assisted Irrigation in Endocanalary Disinfection and Hard Tissue Debris Removal: A Systematic Review

Introduction: The control of the bacterial load during an endodontic treatment is challenging; the usual chemomechanical procedures such as conventional needle irrigation (CNI) has not always shown satisfying outcomes. Hence, the necessity of finding complementary methods such as passive ultra-sonic irrigation (PUI), sonic activated irrigation (SAI) and laser assisted irrigation (LAI) in order to achieve the most complete disinfection of the endodontic system. The aim of our study is to systematically review and critically analyze the current evidence of the effectiveness of laser assisted irrigation when compared to CNI, PUI, SAI. Materials and methods: Electronic search on four data-bases: PubMed, Scopus, ScienceDirect and Cochrane Library was done looking for Systematic reviews, in-vitro and clinical controlled trials assessing the effectiveness of LAI in removing bacteria and dentine debris. Articles were selected, deduplicated than assessed. The studies that met all the inclusion criteria were included and were further screened in order to extract their data and evaluate their methodological quality. Results: The electronic search yielded a total of 895 potentially eligible record. After the final stage of selection, 25 studies, that are all in-vitro were included; the risk of bias and quality assessment was done through the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute critical appraisal Checklist. All in all, LAI showed better results when compared to CNI in both removal of bacteria and smear layer, yet when compared to PUI and SAI, the studies could not testify significantly for the superiority of an activation method over another. Conclusion: The use of LAI increased the potential of the irrigant within the endodontic system, especially when compared to CNI. Yet the current data could not give a conclusive judgment of the effectiveness of LAI when compared to PUI and to SAI; eventually further studies need to be performed.