by Dr.Aijaz Malik (Fellow AALT, Singapore ) ,Fellowship in Implantology
A 35-year-old patient presented with a history of persistent discomfort and radiographic evidence of periapical pathology involving the maxillary central incisors (#11 and #21). Clinical and radiological findings confirmed the presence of a periapical granuloma, indicating chronic inflammation and failed prior endodontic intervention. The treatment plan was focused on preserving the natural dentition while eliminating the infection and regenerating lost periapical bone.
The case was managed using a minimally invasive, laser-assisted approach. Root canal retreatment was initiated, followed by surgical periapical debridement and apicoectomy. To achieve deep-level disinfection beyond conventional methods, a soft tissue diode laser (Novolase) was used during the procedure. The laser settings were meticulously chosen—2 watts power output, 400-micron fiber tip, in pulsed mode—optimizing both cutting efficiency and microbial elimination. A dual-wavelength protocol was employed using combo coherence at 980 nm for bacterial reduction and 660 nm for bio-stimulatory effects.
Following debridement, the periapical defect was managed with bone graft placement to restore the structural integrity of the site. Osteeon 3 collagen was used in this case, allowing the graft to integrate naturally within the osseous walls. Laser-assisted disinfection was followed by the implementation of photobiomodulation therapy (PBM) using a 660 nm wavelength. PBM was performed daily for five consecutive days post-operatively. This low-level laser therapy supported soft tissue regeneration, minimized post-operative discomfort, and accelerated healing at both cellular and vascular levels.
The patient was followed up at three weeks post-surgery. Clinical examination revealed excellent soft tissue healing, with no signs of inflammation, swelling, or discomfort. Radiographic imaging demonstrated early signs of bone fill in the previously radiolucent periapical area, indicating positive graft response and ongoing regeneration. The patient reported high satisfaction with the pain-free recovery process, further validating the use of laser-supported techniques in surgical endodontics.
This case highlights the integration of diode laser technology into endodontic microsurgery for enhanced outcomes. The dual role of high-power laser disinfection and low-level PBM offers a comprehensive solution in cases with chronic periapical pathology. Novolase’s dual-wavelength capability allowed for targeted decontamination as well as tissue modulation, reducing the biological load while promoting healing at a cellular level. When combined with modern regenerative strategies such as bone grafting, laser-assisted techniques are proving to be a game-changer in managing persistent apical lesions with greater predictability and patient comfort.