Minimally Invasive Approach to Periapical Granuloma

Periapical granuloma is a chronic inflammatory lesion located on the apex of the tooth, which may occur due to pulp infection or unsuccessful endodontic therapy. Apicoectomy continues to be the definitive treatment of choice, however, recurrence or incomplete healing is still problematic, especially in patients with systemic or periodontal risk factors. Adjuvant diode laser photobiomodulation (PBM) might improve wound healing, bone healing and patient satisfaction, but data are still scarce. To evaluate the relative clinical efficacy of conventional apicoectomy and apicoectomy with adjunct to improve healing, bone regeneration, patient satisfaction and complications. A prospective randomized controlled trial included 250 patients (age range: 45–66 years) referred for apicoectomy of periapical granuloma. Subjects were stratified by age, gender, socioeconomic, and residential strata, and then randomly assigned to a Laser PBM (n = 150) or Control (n = 100) group. Following surgery PBM protocol (810-980 nm, 0.3 W, 3 min every 48 h for 10 days) was applied. Outcome measurements were healing index, satisfaction, CBCT bone fill, CPITN improvement, and complications. The Laser group was associated with significantly increased HA levels of healing (4.22 ± 0.49 vs. 3.05 ± 0.50, p < 0.001), satisfaction (3.78 ± 0.40 vs. 2.59 ± 0.61, p < 0.001), and bone fill rates (94% vs. 56%, p < 0.001) compared to the conventional therapy 94%, compared with 56%, p = 0.001, as well as greater improvement in CPITN (1.7 ± 0.6 vs 1.0 ± 0.5, p = 0.003) and complications (2% vs 18%, p = 0.01). Benefits were uniform in age, sex, and socioeconomic subgroups. The use of adjunctive diode laser PBM is accompanied with the advantages of promoting healing, better patients' satisfaction, bone regeneration, and safety for the treatment of apicoectomy, regardless of patients’ profiles. Its use as part of the surgical procedure could be beneficial for outcomes in periapical surgery.