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Title The Use of Laser Irradiation in Adjunct with Calcium Hydroxide Treatment of Direct Pulp Capping Procedures Leads to Higher Success Rates than Calcium Hydroxide Alone
Clinical Question In patients needing a direct pulp cap, does the use of a laser irradiation prior to calcium hydroxide application improve the prognosis of the restoration compared to the use of calcium hydroxide alone?
Clinical Bottom Line When direct pulp capping is performed, the use of laser irradiation as an adjunct to calcium hydroxide shows higher success rates for maintaining pulp vitality than the use of calcium hydroxide alone. This is supported by two meta-analyses, both reporting a significant difference in the success of direct pulp capping procedures employing laser irradiation to provide hemostasis and decontamination of the pulp exposure before placement of calcium hydroxide. The success rates were determined by the percentage of vital teeth at the final follow-up appointments. This treatment is within the capability of the average general dentistry practice and is likely to be supported by the patient to increase the likelihood of keeping the tooth vital at minimal financial cost.
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) 27659037Javed/2017687 children and adults in 6 included studies with pulp exposuresMeta-Analysis
Key resultsThe success rate for maintaining pulpal vitality was significantly higher in the treatment group compared to the control group (log odds ratio = 1.737; 95% confidence interval, 1.304 - 2.171). The meta-analysis found that 80% of the included studies showed that the use of lasers with traditional pulp capping material was more successful than control treatments.
#2) 27665108Deng/2016534 children and adults in 5 included studies with pulp exposuresMeta-Analysis
Key resultsIn the meta-analysis the success rate was significantly higher in the treatment group compared to the control group (risk ratio = 1.35; 95% confidence interval, 1.23-1.49; p<0.00001). All studies used in this meta-analysis involved the treatment of deep caries. The success rate at final follow-up was 89.9% for laser-treated teeth and 67.2% for the control group without laser irradiation.
Evidence Search direct[All Fields] AND ("dental pulp capping"[MeSH Terms] OR ("dental"[All Fields] AND "pulp"[All Fields] AND "capping"[All Fields]) OR "dental pulp capping"[All Fields] OR ("pulp"[All Fields] AND "capping"[All Fields]) OR "pulp capping"[All Fields]) AND ("lasers"[MeSH Terms] OR "lasers"[All Fields] OR "laser"[All Fields]) AND ("calcium hydroxide"[MeSH Terms] OR ("calcium"[All Fields] AND "hydroxide"[All Fields]) OR "calcium hydroxide"[All Fields])
Comments on
The Evidence
Validity: The two meta-analyses included some of the same randomized control trials, so the number of different studies analyzed is limited; however, both authors reached similar conclusions as to the applicability of laser treatment as an adjunct in direct pulp capping procedures. The time of the final follow-up appointments varied, ranging from 6 months to 4 years; there was also not a standard application of laser procedure or type of laser used in the treatment. The studies used a range of pulp exposure size from 0.1 mm to 1.2 mm, which may have played a role in the success of direct pulp capping. Perspective: When choosing the type of laser to be used, there is a wide variety available with differing laser media, wavelengths, and prices. Clinicians should adequately research the application and specifications before purchasing or utilizing a laser. It is also important to evaluate each pulp exposure on a case-by-case basis, evaluating the size of the pulp exposure, method of exposure (mechanical or caries-induced), and other variables that could influence the outcome of the procedure. I believe laser irradiation is a viable technique that can increase the success rate of direct pulp capping procedures. The topic would benefit from additional studies investigating the efficacy of specific laser systems performed on various sizes of pulp exposures to establish if there is a size limit that leads to predictable success. While this CAT only compared lasers as an adjunctive treatment with calcium hydroxide, it would be advantageous to investigate the applicability of other materials such as mineral trioxide.
Applicability Clinicians may opt for traditional methods of direct pulp capping due to moderate, well-established levels of success as well as the expense considerations of using a laser. The application of laser irradiation is likely to improve the longevity of a vital tooth and mitigate patient costs of non-surgical root canal therapy as well as trauma to the affected tooth.
Specialty/Discipline (Endodontics) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Laser, calcium hydroxide, direct pulp cap, pulp exposure
ID# 3149
Date of submission: 03/23/2017spacer
E-mail kauffman@livemail.uthscsa.edu
Author Taylor Kauffman
Co-author(s) e-mail
Faculty mentor/Co-author Jeffery L. Hicks, BS, DDS
Faculty mentor/Co-author e-mail HicksJ@uthscsa.edu
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