Abstract
Endodontic infections are characterized by complex polymicrobial communities residing within the intricate root canal system. Traditional chemomechanical methods frequently fail to achieve complete microbial eradication, especially in cases involving biofilm-forming and resistant species. This systematic review synthesizes current evidence on the molecular basis and antimicrobial efficacy of the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in root canal disinfection, particularly against polymicrobial infections. A comprehensive literature search was conducted in the PubMed, Embase, Scopus, and Cochrane databases in accordance with PRISMA 2020 guidelines. Experimental and preclinical studies evaluating the bactericidal properties of Nd:YAG laser therapy were included. The Nd:YAG laser demonstrated significant reductions in total microbial load through photothermal effects, including denaturation of proteins, disruption of cell membranes, and degradation of mixed-species biofilms. Although complete sterilization was not consistently achieved, its ability to penetrate dentinal tubules and target microbial consortia offers substantial adjunctive value. Standardization of laser parameters and further clinical studies are needed to validate these findings and establish Nd:YAG laser use in routine endodontic disinfection protocols.