Do Laser-Activated Irrigation Protocols Improve Endodontic Success? A Prospective Clinical Comparison of 1-Year Periapical Healing with Sonic, Ultrasonic, Manual Dynamic and Conventional Techniques
DIAGNOSTICS, cilt.16, sa.7, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 16 Sayı: 7
- Basım Tarihi: 2026
- Doi Numarası: 10.3390/diagnostics16071003
- Dergi Adı: DIAGNOSTICS
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, Directory of Open Access Journals, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO)
- Recep Tayyip Erdoğan Üniversitesi Adresli: Evet
Özet
Background: Successful healing of chronic apical periodontitis after endodontic treatment requires a reduction in the size of the radiolucent area and the healing of the bone. This study aimed to compare the effects of different irrigation activation techniques on healing in single-rooted mandibular premolar teeth with periapical lesions of endodontic origin. Methods: A total of 132 systemically healthy patients with mandibular single-rooted premolar teeth and a periapical index (PAI) score >= 3 were assigned to five experimental groups (Sonic activation, Passive ultrasonic irrigation, Photon-Induced Photoacoustic Streaming, Shock Wave Enhanced Emission Photoacoustic Streaming and Manual dynamic activation) and a control group (Conventional Syringe Irrigation). After access cavity preparation, the canals were prepared up to three sizes larger than the initial apical diameter with 5 mL of 2.5% NaOCl used between each file. Final irrigation was performed via the assigned activation system. The root canals were obturated with gutta-percha in a single visit. The effects of the activation systems on healing were compared at 1-year follow-up. The primary outcome measure was the change in lesion diameter. PAI score and fractal dimension (FD) were evaluated as secondary outcomes. Results: At the 1-year follow-up, FD values significantly increased, PAI scores and lesion size decreased in all groups compared with baseline (p < 0.001). However, the increase in FD was comparable among the irrigation groups (p > 0.05). In contrast, lesion size reduction and PAI-based healing rates favored the laser-activated groups. The PAI scores and lesion size in the control group were significantly greater than that in the laser groups (p < 0.05). Conclusions: At the 1-year follow-up, all the groups presented similar FD increases, while the laser irrigation groups presented significantly greater reductions in lesion size than did the control group.