Radiographic and Clinical Outcomes of Laser-Enhanced Disinfection in Endodontic Therapy

Background and Objectives: The success of endodontic treatment depends on effective disinfection, periapical healing, and bone regeneration. Cone-beam computed tomography (CBCT) offers superior accuracy in monitoring periapical lesion resolution over time. This study evaluates the impact of laser-assisted disinfection combined with EDTA irrigation on periapical healing compared to conventional chemical irrigation, across different bone densities (D1-D5) and time intervals. Materials and Methods: 120 patients were included, divided into an experimental group (n=60, laser + EDTA) and a control group (n=60, chemical irrigation only). CBCT images were analyzed pre-treatment and at follow-ups to assess changes in periapical lesion size and CBCT-PAI index scores. Lesions were classified as cystic granulomas or chronic apical periodontitis (CAP). Statistical analyses were performed using paired t-tests and ANOVA to compare healing rates. Results: The experimental group showed significantly greater lesion reduction and CBCT-PAI improvement at all time points (e.g., p < 0.001 at 2.5 years). Healing was notably enhanced in low-density bone (D4–D5), and the laser group achieved higher complete healing rates for both cystic granulomas (89.5% vs. 68.4%) and chronic apical periodontitis (81.8% vs. 59.1%). Post-hoc power analysis confirmed statistical robustness (Cohen’s d = 3.48, power > 0.99). Conclusions: Laser-assisted endodontic disinfection accelerates periapical healing and enhances bone regeneration, particularly in low-density bone. CBCT imaging confirms its clinical efficacy over conventional irrigation methods.