ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Laser-Assisted Endodontic Debridement Does Not Improve Healing Compared to Conventional Endodontic Disinfection for Patients With Pulpal Necrosis and Apical Periodontitis
Clinical Question For patients with pulpal necrosis and apical periodontitis does laser-assisted endodontic disinfection result in better healing than conventional disinfection alone?
Clinical Bottom Line When compared to conventional disinfection, laser-assisted endodontic disinfection does not result in statistically different healing rates for patients with pulpal necrosis and apical periodontitis.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24328607Martins/201443 patients with radiographic evidence of apical periodontitis and necrotic pulps.Randomized Controlled Trial
Key results43 patients with teeth meeting inclusion criteria were randomized to two groups: standard two-visit non-surgical root canal therapy (NSRCT) with conventional disinfection or a two-visit NSRCT with laser-assisted disinfection (2780 nm Er,Cr:YSGG) with sterile saline used as the irrigant throughout the procedure. At the 12-month follow-up appointment, all control teeth were considered healed, and 88.9% of the laser-assisted treated teeth were considered healed; however, this difference was not statistically significant (p=0.11).
#2) 22869158Martins/201336 patients with necrotic pulps and radiographic evidence of apical periodontitis. Randomized Controlled Trial
Key results36 patients with teeth meeting inclusion criteria (anterior or premolars with necrotic pulps and radiographic evidence of apical periodontitis at least 1 mm in size) were randomly assigned to a conventional disinfection two-day endodontic treatment or a laser-assisted protocol (sterile saline used as irrigant during instrumentation and a 2780 nm Er,Cr:YSGG laser used for irradiation at both the first appointment and the second appointment). In the control group 66.67% of the teeth were considered healed at 6 months, whereas 58.82% of the laser-treated group were considered healed at the same time; however, there was no statistically significant difference between the two groups (p=0.69).
Evidence Search PubMed Search: ("lasers"[MeSH Terms] OR "lasers"[All Fields] OR "laser"[All Fields]) AND ("endodontics"[MeSH Terms] OR "endodontics"[All Fields]) AND ("periapical periodontitis"[MeSH Terms] OR ("periapical"[All Fields] AND "periodontitis"[All Fields]) OR "periapical periodontitis"[All Fields] OR ("apical"[All Fields] AND "periodontitis"[All Fields]) OR "apical periodontitis"[All Fields])
Comments on
The Evidence
These two studies each represented randomized controlled trials in which blinded endodontists independently reviewed radiographs for determination of periapical healing. The methods were well described; however, this does not overcome the small sample sizes found in both studies after considering patients lost for various reasons following randomization (30 patients included in final analysis in Martins/2014 and 29 patients included in Martins/2013). While the authors did not claim any competing interests, a limitation is still that both studies were conducted by the same group of investigators, meaning that ideally a similar trial should be conducted by others to confirm the results. Conventional endodontic disinfection is a predictable and effective treatment for patients presenting with necrotic pulps and apical periodontitis. Laser-assisted disinfection has not been as thoroughly tested, and even initial studies such as these do not demonstrate a healing advantage by the use of lasers for endodontic therapy.
Applicability The findings of this review apply to any dentist performing endodontic procedures. The evidence suggests that there is no advantage for the use of lasers in endodontic procedures for patients with necrotic pulps and evidence of apical periodontitis and that clinicians should feel confidant in continuing conventional disinfection protocols that are less costly.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Laser, endodontic, debridement
ID# 3200
Date of submission: 03/31/2017spacer
E-mail hargreavesnd@livemail.uthscsa.edu
Author Nicholas Dybdal-Hargreaves
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, MS, PhD
Faculty mentor/Co-author e-mail DIOGENES@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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