{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:02:52Z","timestamp":1791298972705,"version":"4.1.0"},"reference-count":58,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: The quest for minimally invasive disinfection in endodontics has led to using Erbium:Yttrium-Aluminum-Garnet (Er:YAG) lasers. Conventional approaches may leave bacterial reservoirs in complex canal anatomies. Er:YAG\u2019s strong water absorption generates photoacoustic streaming, improving smear layer removal with lower thermal risk than other laser systems. Methods: This systematic review followed PRISMA 2020 guidelines. Database searches (PubMed\/MEDLINE, Embase, Scopus, Cochrane Library) identified studies (2015\u20132025) on Er:YAG laser-assisted root canal disinfection. Fifteen articles met the inclusion criteria: antibacterial efficacy, biofilm disruption, or smear layer removal. Data on laser settings, irrigants, and outcomes were extracted. The risk of bias was assessed using a ten-item checklist, based on guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Results: All studies found Er:YAG laser activation significantly improved root canal disinfection over conventional or ultrasonic methods. Photon-induced photoacoustic streaming (PIPS) and shock wave\u2013enhanced emission photoacoustic streaming (SWEEPS) yielded superior bacterial reduction, especially apically, and enabled lower sodium hypochlorite concentrations without sacrificing efficacy. Some research indicated reduced post-operative discomfort. However, protocols, laser parameters, and outcome measures varied, limiting direct comparisons and emphasizing the need for more standardized, long-term clinical trials. Conclusions: Er:YAG laser-assisted irrigation appears highly effective in biofilm disruption and smear layer removal, supporting deeper irrigant penetration. While findings are promising, further standardized research is needed to solidify guidelines and confirm Er:YAG lasers\u2019 long-term clinical benefits.<\/jats:p>","DOI":"10.3390\/dj13030101","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T06:15:33Z","timestamp":1740550533000},"page":"101","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Enhancing Root Canal Disinfection with Er:YAG Laser: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3173-9389","authenticated-orcid":false,"given":"Jakub","family":"Fiegler-Rudol","sequence":"first","affiliation":[{"name":"Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6109-6809","authenticated-orcid":false,"given":"Zuzanna","family":"Grzech-Le\u015bniak","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Wroclaw Medical University, 50-425 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Tkaczyk","sequence":"additional","affiliation":[{"name":"Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5700-4577","authenticated-orcid":false,"given":"Kinga","family":"Grzech-Le\u015bniak","sequence":"additional","affiliation":[{"name":"Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland"},{"name":"Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23284, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Zawilska","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5673-7413","authenticated-orcid":false,"given":"Rafa\u0142","family":"Wiench","sequence":"additional","affiliation":[{"name":"Department of Periodontal and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wong, J., Manoil, D., N\u00e4sman, P., Belibasakis, G.N., and Neelakantan, P. 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