Minimally Invasive Approach to Periapical Granuloma

Authors

  • Wisam Rasool Jalaawi Collage of Dentistry, Al-Ayen Iraqi University, Thi-Qar, Iraq.

DOI:

https://doi.org/10.5195/d3000.2026.1114

Keywords:

Oral Pathology, Diode Laser Therapy, Bone Regeneration

Abstract

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.

Downloads

Published

2026-02-10

Issue

Vol. 14 No. 1 (2026)

Section

Adults & the Elderly

License

Copyright (c) 2026 Wisam Rasool Jalaawi

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Revised 7/16/2018. Revision Description: Removed outdated link.