Lasers to prevent dental caries: a systematic review

Abstract

ObjectiveTo assess the effectiveness of lasers (at sub-ablative parameters) in reducing caries incidence compared with traditional prophylactic interventions (TPIs) when used alone or together with other TPIs such as pits and fissures sealant or fluoride gels or varnishes.DesignA systematic review. Data sources include Medline (via PubMed), Embase, Web of Science and the Cochrane Library (December 2019).Eligibility criteriaOnly randomised trials (RCTs) and controlled clinical trials (CCTs) dealing with prophylactic lasers use (vs TPI or untreated teeth) were considered as eligible. We excluded in vitro and ex vivo studies.Data extractionEligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed adopting the Cochrane Risk of Bias tool. Data on caries incidence, sealant retention, fluoride uptake, adverse events, treatment duration, patients’ discomfort and cost-effectiveness ratio was extracted.Data analysisExtracted data were presented narratively due to the heterogeneity of included studies.ResultsSeven RCTs and two CCTs, all with an evident risk of bias, met inclusion criteria, pooling together 269 individuals and 1628 teeth. CO2, neodymium-doped yttrium aluminium garnet, erbium-doped yttrium aluminum garnet (Er:YAG), erbium, chromium: yttrium scandium gallium garnet (Er,Cr:YSGG) and Argon lasers were used. In the permanent dentition, lasers only when used in combination with TPIs were effective in reducing caries when compared with untreated teeth (risk ratio (RR)=0.44 (0.20–0.97); Er:YAG laser) or with TPIs used alone (RR=0.39 (0.22–0.71); CO2 laser). Moreover, Argon laser significantly improved the fluoride uptake into the enamel surfaces (ANalysis Of VAriance (ANOVA) tests: 95%, p<0.0001). Likewise, sealant retention improved when acid etching was performed on previously irradiated enamel fissures by CO2 laser (RR=0.63 (0.38–1.04)) or Er:YAG laser (RR=0.54 (95% CI: 0.34 to 0.87)). In addition, laser resulted safe and well tolerated by patients.ConclusionDespite some positive indications, an inadequate level of evidence was found in the included studies concerning the lasers’ effectiveness in preventing caries. Further studies with a higher methodological quality level are required.

Oralbiotica/Oralbiotics: The Impact of Oral Microbiota on Dental Health and Demineralization: A Systematic Review of the Literature

“…Mechanical procedures may injure the pulp due to thermal stimulation and remove much healthy tissue. Different alternative therapies have lately been presented to protect the tooth structure by eliminating only the affected tissue and being as non-invasive as possible [ 172 , 173 , 174 ]. Although ozone therapy provides many benefits in dentistry, the dangers are still too great due to upper airway difficulties and contraindications in fragile patients [ 175 ].…”

Human Enamel Fluorination Enhancement by Photodynamic Laser Treatment

“…There are significant studies in the literature about the effects of laser usage in the fluorination protocols before and after fluoride treatment, evidencing improved fluoride absorption and enamel re-mineralization stimulation [ 6 , 7 , 8 , 9 ]. The active compounds within Tiefenfluorid are sodium fluoride and dispersed calcium hydroxide, which are involved in the newly formed fluoride crystals [ 10 , 11 ].…”

Use of the Er:YAG Laser in Conservative Dentistry: Evaluation of the Microbial Population in Carious Lesions

“…In addition to the risk of removing a great deal of healthy tissue, mechanical techniques may also damage the pulp by increasing the temperature due to thermal stimulation. Different alternative treatments, such as chemo mechanical methods, ozone therapy, and laser technology, have recently been proposed to preserve the tooth structure by removing only the damaged tissue and being as conservative as possible [ 10 , 11 , 12 ]. Although there are various indications for ozone therapy use in dentistry, the risks are still too high, due to problems with the upper airways and contraindications in fragile subjects [ 13 ].…”