Non-Cochrane · intervention · PM42513311
Prognosis of Periapical Lesions Treated by Activated Disinfection (PUI, Laser) Without the Use of Systemic Antibiotics: Systematic Review and Meta-Analysis.
Fernández-Moreno Paula, Areal-Quecuty Victoria, Segura-Raya Carlos, et al. · Journal of clinical medicine · 2026 · PubMed · doi:10.3390/jcm15145397
Findings
Population Adults (18 years or older) with permanent teeth with radiographically diagnosed apical periodontitis needing root canal treatment
3 findings
| Activated irrigation (passive ultrasonic irrigation and/or laser-assisted irrigation) | Conventional syringe and needle irrigation (same irrigant, no systemic antibiotics) | Periapical healing (clinical and/or radiographic treatment success) Longest available follow-up (6 to 19 months) · Dental clinics (adult teeth with apical periodontitis) · Overall (all activation methods) | OR 2.25 [1.29, 3.93] Moderate Downgraded: risk of bias 5 studies · 451 participants |
| Passive ultrasonic irrigation (PUI) | Conventional syringe and needle irrigation (same irrigant, no systemic antibiotics) | Periapical healing (clinical and/or radiographic treatment success) Longest available follow-up (6 to 19 months) · Dental clinics (adult teeth with apical periodontitis) · PUI subgroup | OR 1.95 [1.08, 3.54] GRADE not reported 4 studies · 388 participants |
| Laser-assisted irrigation (LAI) | Conventional syringe and needle irrigation (same irrigant, no systemic antibiotics) | Periapical healing (clinical and/or radiographic treatment success) Longest available follow-up (6 to 19 months) · Dental clinics (adult teeth with apical periodontitis) · LAI subgroup Unresolved: the two extractors disagree on this row. | OR 6.77 [1.63, 28.12] GRADE not reported 3 studies · 124 participants |
Included primary studies 5
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Dogan 2024 Association between the irrigation-agitation techniques and Periapical Healing of large periapical lesions: a Randomized Controlled Trial. PMID:38878107 | 2024 | 1 other review | Periapical healing (clinical and/or radiographic treatment success) | not extracted yet |
| Liang 2013 Radiographic healing after a root canal treatment performed in single-rooted teeth with and without ultrasonic activation of the irrigant:… PMID:24041381 | 2013 | 1 other review | Periapical healing (clinical and/or radiographic treatment success) | not extracted yet |
| Martins 2014 Outcome of Er,Cr:YSGG laser-assisted treatment of teeth with apical periodontitis: a blind randomized clinical trial. PMID:24328607 | 2014 | this review only | Periapical healing (clinical and/or radiographic treatment success) | not extracted yet |
| Tang 2015 Clinical study of single-visit root canal treatment with a nickel-titanium (Ni-Ti) rotary instrument combined with different ultrasonic… PMID:26406018 | 2015 | this review only | Periapical healing (clinical and/or radiographic treatment success) | not extracted yet |
| Verma 2020 A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in… PMID:32994870 | 2020 | this review only | Periapical healing (clinical and/or radiographic treatment success) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| Effect of root canal filling techniques and materials on endodontic treatment outcomes: a systematic review and meta-analysis. (2026) | 2 | 0.01 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (18 years or older) with permanent teeth and radiographically diagnosed periapical lesions requiring endodontic treatment | Adults with chronic apical periodontitis (n=451 teeth in 5 RCTs) |
| Intervention | Intracanal irrigant activation with PUI and/or laser systems, without adjunctive systemic antibiotics | PUI (4 trials) and laser-assisted irrigation (Er:YAG SWEEPS, Er,Cr:YSGG; 3 trials) |
| Comparison | Conventional non-activated syringe-and-needle irrigation with the same irrigant, without systemic antibiotics | Conventional syringe-and-needle NaOCl irrigation |
| Outcomes | Clinical healing and/or radiographic healing of periapical lesion | Treatment success (clinical and/or radiographic healing) (n=5 studies) |
| Study designs | RCTs | RCTs (n=5) |
| Timing | Medium-term (6 months or longer) and long-term (12 months or longer) follow-up | 6 to 19 months follow-up |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes · NRSI: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |