Efficacy of adjunct Nd-YAG laser (1064 nm) to non-surgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The Neodymium-doped Yttrium Aluminum Garnet (Nd: YAG) laser is proposed as an adjunct to scaling and root planing (SRP) to enhance bacterial reduction and healing in periodontitis. This study aims to evaluate the efficacy of Nd: YAG laser therapy (1064 nm) compared with SRP alone in improving clinical periodontal outcomes.

Methods: This systematic review adhered to PRISMA 2020 guidelines and was prospectively registered with PROSPERO. We included only randomized controlled trials (RCTs) comparing SRP with adjunctive Nd: YAG laser therapy to SRP alone in patients with periodontitis. The primary outcomes were pocket depth (PD), plaque index (PI), bleeding on probing (BOP), and clinical attachment loss (CAL) assessments at baseline and after three months. Secondary outcomes included gingival cervical fluid (GCF) at baseline and after three months. Risk-of-bias assessment (using ROB-2) was performed independently by multiple reviewers. All statistical analyses were performed using R (version 4.4.3). The certainty of evidence for all outcomes was evaluated using the GRADE approach.

Results: The systematic review and meta-analysis included 22 randomized controlled trials published between 2010 and 2025, totaling 776 patients. Meta-analysis demonstrated that adjunctive ND: YAG laser with SRP significantly improved PD reduction compared with SRP alone (MD = − 0.46 mm; 95% CI −0.82 to − 0.10; p = 0.0117), Subgroup analysis showed that split-mouth RCTs had a larger effect (MD = − 0.66 mm) than parallel-group RCTs (MD = − 0.20 mm), but the difference between subgroups was not significant. No statistically significant benefits were observed for PI (MD = − 0.03; 95% CI −0.19 to 0.13; p = 0.63), CAL (MD = − 0.04; 95% CI −0.21 to 0.13; p = 0.61), GCF volume (MD = − 0.20; 95% CI −0.45 to 0.06; p = 0.097), or BOP (MD = − 7.88; 95% CI −19.23 to 3.46; p = 0.17).

Conclusion: Adjunctive Nd: YAG laser therapy provides a modest, statistically significant benefit in reducing periodontal pocket depth beyond conventional therapy alone. However, it does not demonstrate superior efficacy in improving clinical attachment levels or plaque control. Consequently, while beneficial for pocket reduction, current evidence does not support its routine universal use as a substitute for standard mechanical debridement.