Background: The quest for minimally invasive disinfection in endodontics has led to using Erbium:Yttrium-Aluminum-Garnet (Er:YAG) lasers. Conventional approaches may leave bacterial reservoirs in complex canal anatomies. Er:YAG’s strong water absorption generates photoacoustic streaming, improving smear layer removal with lower thermal risk than other laser systems. Methods: This systematic review followed PRISMA 2020 guidelines. Database searches (PubMed/MEDLINE, Embase, Scopus, Cochrane Library) identified studies (2015–2025) on Er:YAG laser-assisted root canal disinfection. Fifteen articles met the inclusion criteria: antibacterial efficacy, biofilm disruption, or smear layer removal. Data on laser settings, irrigants, and outcomes were extracted. The risk of bias was assessed using a ten-item checklist, based on guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Results: All studies found Er:YAG laser activation significantly improved root canal disinfection over conventional or ultrasonic methods. Photon-induced photoacoustic streaming (PIPS) and shock wave–enhanced emission photoacoustic streaming (SWEEPS) yielded superior bacterial reduction, especially apically, and enabled lower sodium hypochlorite concentrations without sacrificing efficacy. Some research indicated reduced post-operative discomfort. However, protocols, laser parameters, and outcome measures varied, limiting direct comparisons and emphasizing the need for more standardized, long-term clinical trials. Conclusions: Er:YAG laser-assisted irrigation appears highly effective in biofilm disruption and smear layer removal, supporting deeper irrigant penetration. While findings are promising, further standardized research is needed to solidify guidelines and confirm Er:YAG lasers’ long-term clinical benefits.

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm²; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.

Background/Objectives: Oral candidiasis is an opportunistic infection caused by Candida species. Recently, antifungal drugs have become less effective due to yeast resistance, emphasizing the need for new treatment strategies. This study aimed to assess the effect of the Er:YAG laser on the inhibition of growth and elimination of mature single-species Candida biofilms. Methods: The study utilized reference strains of C. albicans, C. glabrata, C. parapsilosis, and C. krusei organized in single-species biofilms on Sabouraud dextrose agar (SDA). First part: Candida suspensions (0.5 McFarland standard) were spread on SDA plates—two for each strain. Er:YAG laser irradiation was applied in a single pulse mode, 30 to 400 mJ, to 32 predetermined points. The growth inhibition zones (GIZs) were measured at 24–96 h of incubation. Second part: biofilms were prepared similarly and, after 96 h of incubation, exposed to Er:YAG laser irradiation at different energies (50, 100, 150, 200 mJ) for 180 s, per 1.44 cm area. Post-irradiation, impressions were taken using Rodac Agar to determine yeast counts. The count of colony-forming units (CFU) after irradiation was measured and results were analysed statistically. Results: First part: GIZ was found in all irradiated sites, with various Candida strains. The results showed a significant increase in the width of GIZ in the energy range of 30–280 mJ and a non-significant increase in the energy range of 300–400 mJ. Second part: the number of CFU remaining after the irradiation of biofilms with 150 mJ energy differed statistically significantly from other results obtained after using 50, 100, or 200 mJ energy, regardless of the Candida strain tested. Conclusions: The Er:YAG is shown to have good disinfecting properties (inhibiting biofilm growth, even at low-energy doses (50 mJ), and eliminating maturity, Candida spp. biofilms most effective on the 150 mJ energy dose).

Background/Objectives: The development of pharmacotherapy, particularly in antiangiogenic drugs, has led to the emergence of MRONJ as a significant side effect. With the increasing incidence of cancer, the management of MRONJ poses a growing challenge for clinicians. The aim of the study is to evaluate the effectiveness of photobiomodulation (PBM) in treating patients with stage I, II, and III medication-related osteonecrosis of the jaw (MRONJ). Methods: A total of 31 patients were divided into two groups: Group 1 (n = 14 patients), with Stage 1 MRONJ; and Group 2 (n = 17 patients), with Stage II and III MRONJ. In total, 10 patients had osteoporosis and 21 underwent cancer treatment. The sole variable under investigation was the stage of MRONJ, as all patients underwent the same photobiomodulation (PBM) procedure. For treatment protocol, PBM with a diode laser was used (Lasotronix Smart M Pro, Piaseczno, Poland) with the following parameters: 100 mW; continuous wave; 635 nm; 4 J/cm² for 20 s; irradiance for one point: 0.398 W/cm²; fluency for one point: 7.96 J/cm², and for four points, which was one appointment: 31.83 J/cm²; and tip diameter 8 mm (three points from buccal surface, perpendicular for the lesion and one point on the floor of the mouth) during each session. The protocol assumed 10 sessions at 3 days intervals. Antibiotic therapy (amoxicillin with clavulanic acid 875 mg + 125 mg or clindamycin 600 mg every 12 h) was started 3 days before PBM and continued for 14 days. Antibiotics were taken for 14 days in total. Pain was measured with VAS scale. Follow-up was after 3 and 6 months. Results: Among the 14 patients in Group 1, none exhibited any clinical signs or symptoms of MRONJ during the 3 months follow-up, and complete cure was achieved. While PBM resolved inflammation and pain in stage II MRONJ, further surgical intervention was necessary to fully address the condition. Conclusions: PBM is an effective treatment for achieving complete recovery in patients with Stage 1 MRONJ. However, in Stages II and III MRONJ, PBM significantly alleviates symptoms but requires complementary surgical intervention to achieve full resolution. A beneficial aspect is the reduction in pain symptoms and the extent of surgical intervention.

In contemporary dentistry, laser-based interventions have become one of the mainstays of care for patients with oral biofilm diseases, such as candidiasis, periodontal disease and peri-implantitis. The purpose of this study was to evaluate the effectiveness of Er:YAG laser (LightWalker, Ljubljana, Fotona, Slovenia) irradiation at varying irradiance levels (T1: 11.3 W/cm² and T2: 120.54 W/cm²) on microbial viability in single- and dual-species biofilm models, focusing on Candida albicans, Candida glabrata and Streptococcus mutans, to address challenges in managing complex oral biofilms in clinically relevant settings. The results showed substantial microbial reduction, with C. albicans being the most susceptible microorganism (93–99.9%), while C. glabrata exhibited marked resistance at higher irradiance levels. Interestingly, S. mutans demonstrated varying reductions based on the biofilm composition, highlighting the influence of microbial interactions. This study concluded that the Er:YAG laser effectively reduced biofilm viability, with its efficacy depending on the microbial composition and irradiance settings. These findings highlight the need for tailored erbium laser parameters to optimize clinical outcomes, underscoring the need for individualized polymicrobial biofilm management, particularly in periodontal and peri-implant therapies.

Erbium family lasers have been used as an alternative method for the treatment of dental caries in deciduous teeth, in comparison to traditional methods. The study aimed to determine the most optimal erbium-doped yttrium-aluminum-garnet (Er:YAG) laser settings for carious lesions in deciduous teeth on different surfaces with the evaluation of treatment time and pain level on a visual analog scale (VAS). The randomized clinical trial involved 66 teeth with deep caries in 33 children aged 3-8 years, divided into 2 study groups: Er:YAG laser (test group); and conventional treatment with a dental turbine (control group). The time required for caries removal and cavity preparation using both methods was recorded. The inclusion criteria encompassed generally healthy pediatric patients, pain-free subjects, first-time dental appointment, and unicuspid primary teeth with caries. Dental caries treatment was performed without the administration of local anesthesia. The cavity preparation time was on average 2.5 times longer when the Er:YAG laser was used compared to the conventional method. The study demonstrated the effectiveness of the Er:YAG laser in hard tissue preparation of deciduous teeth with a pulse energy of 230 mJ for enamel preparation, mainly on occlusal and proximal surfaces, and with a pulse energy of 120 mJ and 150 mJ for dentin preparation. Optimum operating frequencies were 10 Hz and 20 Hz with corresponding water consumption. The level of discomfort among the laser-treated patients indicated 0 based on VAS, meaning no pain. Among patients treated with the traditional method, the pain level averaged 5.27. The use of the Er:YAG laser offers substantial advancements in comparison to traditional treatment with dental turbines by enhancing the overall comfort during caries therapy in children. It fosters better patient cooperation and reduces the need for intraoperative anesthetics due to its minimally invasive nature and the fact that it is a relatively quiet operation. This approach minimizes anxiety and discomfort often associated with dental procedures, making them more amenable to children.