Efficacy of erbium laser as monotherapy or adjunctive therapy in access flap periodontal surgery: a meta-analysis

Abstract Purpose This systematic review aimed to evaluate the clinical effectiveness of erbium laser therapy, either as monotherapy or as an adjunct to access flap surgery, on managing residual periodontal pockets in patients with periodontitis. Methods This systematic review adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024620788). A comprehensive literature search was conducted across PubMed, Cochrane, Scopus, and trial registries. Data synthesis was performed using random-effects meta-analysis, and the quality of evidence was assessed using GRADE. Finally, five RCTs involving 124 patients and 310 sites met the inclusion criteria. Results Both erbium laser and conventional flap surgery groups demonstrated improvements in periodontal parameters. Differences favoring erbium lasers were observed in clinical attachment level (CAL) at 6 and 12 months (mean difference − 0.36 mm; p < 0.05). Other parameters, including probing pocket depth (PPD), gingival recession (GR), gingival inflammation (GI), and plaque index (PI) showed no significant differences. Results for bleeding on probing (BoP) and radiographic changes were inconsistent. Patient-reported outcomes were better in the erbium laser group. Conclusions Erbium laser therapy may represent a promising minimally invasive approach with outcomes broadly comparable to conventional access flap surgery, with modest improvements in CAL and favorable patient-reported outcomes. However, the limited evidence base warrants cautious interpretation. Long-term RCTs are necessary to validate these findings and inform clinical practice.