Adjunctive Effects of Diode Laser in Surgical Periodontal Therapy: A Narrative Review of the Literature

The surgical procedures in the treatment of periodontitis generally aim to reduce pocket depth, improve teeth maintenance, and enhance long-term stability. Several approaches have been proposed over the years including different techniques, drugs, and medical devices, with the main purpose to minimalize the surgical procedure and improve both the outcomes and patient compliance. Among all the medical devices proposed in surgical and non-surgical periodontology, different laser wavelengths (e.g., Erbium: YAG, Erbium: CR, KTP, Diode) have been studied worldwide but generally with inconsistent results. Nowadays, the diode laser is one of the most used lasers among general dentists, also promoted as an adjunctive therapy in periodontology, mainly in non-surgical procedures. This study aims to review data emerging from the literature on the use of diode lasers and adjunctive therapy to the conventional periodontal surgery. This research was conducted using PubMed and Scopus search engines with a combination of relevant keywords, including “Surgical Periodontal Therapy”, “Periodontal Surgery”, “Periodontal Regenerative Surgery”, and “Surgical Treatment for Periodontal Disease” in combination with “Diode Laser”, “Diode-Driven Laser”, and “Diode Emission Laser”. Selected articles were carefully reviewed to identify studies reporting data on the effectiveness of diode lasers in periodontal surgery. Results of the current review suggest potential clinical benefits of diode laser-assisted periodontal surgery, as studies reported improvements in key parameters such as clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) postoperatively. Additionally, VAS scores, indicative of post-surgical discomfort, were lower for laser-treated sites, and a short-term reduction in periodontal pathogens was observed. However, the clinical outcomes significantly differ across the studies, and the evidence does not uniformly support a superior effectiveness of diode lasers as an adjunctive tool in surgical periodontology. While the data indicate that diode laser use may contribute to enhanced periodontal health and possibly accelerate healing in some cases, these findings should be interpreted cautiously, as further research, possibly multicentric and in large numbers but mandatory with well-defined protocols (stage of periodontitis, preliminary non-surgical procedures and results, laser wavelength and protocol of use, post-operative maintenance, follow-up clinical and radiological criteria) are surely needed to possibly validate the observations emerging from the current review and eventually to standardize clinical protocols in the future. Such limitations have been well addressed in this paper and are clearly discussed and essentially related to the focus on the total uncertainty of the literature and general caution