Low-level laser therapy in oral surgery: how strong is the evidence for improved postoperative outcomes?

A Commentary on: Chaple Gil A, Díaz L, Von Marttens A, Sotomayor C, Basualdo J, Beltrán V, Jorquera G, Caviedes R, Fernández E. The efficacy of low-level laser therapy in oral surgery: a systematic review of randomized controlled trials. Photodiagnosis Photodyn Ther 2025; https://doi.org/10.1016/j.pdpdt.2025.104594. Design: This systematic review followed PRISMA 2020 guidelines and evaluated randomised controlled trials investigating the effect of low-level laser therapy on postoperative healing and comfort following oral surgery. The protocol was registered in PROSPERO. The Cochrane RoB 2 tool was used for quality assessment, and the PROPS framework was applied to interpret the clinical relevance of outcomes such as pain and wound healing. Case selection: Eighteen randomised controlled trials involving 771 participants were included. The surgical procedures comprised third molar extraction, implant placement and a range of periodontal and mucogingival procedures. Most participants were healthy adults. Laser parameters ranged from 660 to 1064 nm in wavelength and from 3 to 35 J/cm² in fluence. Data analysis: Because of variability in laser parameters, timing of therapy and outcome measures, meta-analysis was not feasible. The authors therefore synthesised the findings narratively, focusing on postoperative pain, inflammation and tissue healing. Results: Low-level laser therapy significantly improved early epithelialisation and soft tissue healing in the included trials, particularly when wavelengths between 660 and 810 nm and fluences between 3 and 12 J/cm² were used. Several studies reported reductions in inflammatory cytokines such as tumour necrosis factor alpha and interleukin-6, together with increased vascular endothelial growth factor expression. Pain scores decreased by ~30–55% within the first postoperative week, and several trials reported fewer postoperative complications, including delayed healing and local infection, in laser-treated groups. Twelve studies were judged to be at low risk of bias, five had some concerns and one was at high risk. Follow-up was predominantly short term (7–14 days) for soft-tissue outcomes, although a minority of implant-related studies extended observation to several months to assess bone and peri-implant parameters. Conclusions: Low-level laser therapy appears to accelerate early healing and reduce postoperative pain after oral surgery, with no significant adverse effects reported and some evidence of reduced postoperative complication rates. However, heterogeneity in dosimetry, protocols and outcome assessment, together with generally small sample sizes and limited long-term follow-up, reduces confidence in the precision and durability of these effects, and the overall certainty of evidence remains low.