Comparative Evaluation of the Effectiveness of Laser-Assisted Irrigation and Ultrasonic Irrigation on Postoperative Pain in Single-Visit Endodontics: A Systematic Review.

Abstract

Effective irrigation plays a critical role in the success of root canal therapy by eliminating residual microbes and debris from inaccessible canal regions. Advanced irrigation techniques have been developed over the years that activate the irrigant leading to increased canal penetration and reduced post-treatment discomfort. These include activation by light, vibration, heat, laser, sonic and ultrasonic methods. The present systematic review compared the effectiveness of laser-activated irrigation (LAI) and ultrasonic irrigation (UI) in reducing postoperative pain following single-visit endodontic treatment. A comprehensive search of electronic databases and grey literature from January 2000 to April 2024 was conducted. Nine randomized controlled trials involving 547 patients met the inclusion criteria. The studies were conducted across four countries and assessed various activation techniques including diode laser, Er:YAG, shock wave-enhanced emission photoacoustic streaming, photon-induced photoacoustic streaming, passive UI, and continuous UI. LAI demonstrated faster pain reduction in the first 24 to 48 hours post-treatment, while UI showed comparable efficacy beyond this period. Both methods were significantly more effective than conventional syringe irrigation. No severe adverse events were reported. The overall risk of bias was found to be low in eight studies, with one study showing some concerns. The results suggest that both LAI and UI are effective in minimizing postoperative pain, with LAI being more effective for early pain control. Integration of either technique is recommended in clinical endodontic protocols to enhance patient comfort and treatment outcomes.