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Endodontics – Irrigant activation and postoperative pain

Can lasers help reduce post–root-canal pain more than ultrasonics?

Evidence-Based Dentistry (2026)Cite this article

Subjects

Abstract

A Commentary on

Sabeti M, Harouni A, Gabbay J.

Comparing Ultrasonically Activated Irrigation and Laser-Activated Irrigation for Postoperative Pain Reduction in Endodontics: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Endodontics 20251.

Objective

A recent systematic review and meta-analysis evaluated whether laser-activated irrigation offers a measurable benefit over ultrasonic activation in reducing postoperative endodontic pain. Seven randomized controlled trials involving 490 teeth were included. Across multiple time points (6 h to 7 days), LAI demonstrated a consistently greater reduction in patient-reported pain than UAI, with the effect most pronounced at 24–48 h post-treatment. Pulsed Er:YAG laser modalities—particularly PIPS and SWEEPS—showed the highest analgesic effect, while diode lasers showed little to no added benefit. Despite moderate to high heterogeneity and some concerns regarding allocation concealment in several trials, the overall certainty of evidence was rated low-to-moderate. The findings suggest that LAI, especially advanced Er:YAG-based protocols, may provide short-term pain.

Clinical Significance

While LAI—particularly Er:YAG systems—may enhance short-term patient comfort, UAI remains an effective and pragmatic standard in typical dental practice.

Design

Systematic review and meta-analysis (PRISMA-compliant), prospectively registered on PROSPERO.

Case selection

Adult patients undergoing primary non-surgical root canal treatment for irreversible pulpitis, necrotic pulp, or apical periodontitis. Only RCTs comparing LAI vs UAI with postoperative VAS pain measurements were included.

Data analysis

Random-effects modeling, subgroup analyses by laser type and timepoint, sensitivity analyses excluding imputed data, and GRADE certainty assessment.

Results

LAI demonstrated superior postoperative pain reduction compared to UAI. Er:YAG-based systems (PIPS, SWEEPS) showed the strongest effects. Diode lasers showed minimal benefit. Heterogeneity remained high.

Conclusions

LAI provides measurable short-term postoperative pain benefits but should not be recommended as a replacement for UAI in routine practice due to cost and accessibility challenges.

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Authors and Affiliations

  1. Department of Conservative Dentistry & Endodontics, Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, India

    Lora Mishra

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  1. Lora Mishra
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Correspondence to Lora Mishra.

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Mishra, L. Can lasers help reduce post–root-canal pain more than ultrasonics?. Evid Based Dent (2026). https://doi.org/10.1038/s41432-026-01203-5

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