Title Dental Lasers for Caries Removal in Children Is a Good Alternative to Conventional Mechanical Methods
Clinical Question For children with caries, is Er:YAG laser application an effective treatment for caries removal and cavity preparation compared to conventional methods?
Clinical Bottom Line Caries removal via Er:YAG laser is similarly effective as traditional methods, with the added benefit of decreased perceived pain and decreased anesthetic use. This is supported by multiple studies including a Cochrane systematic review and meta-analysis that showed decreased perceived pain and decreased anesthetic use with laser removal. However, cavity preparation using the Er:YAG laser takes significantly longer than traditional methods.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
30003427Li/2019326 participants (aged 3-16 yrs.) in 7 RCTs Meta-Analysis
Key resultsThe procedure time was significantly increased (SMD 1.945, 95% CI 0.942 to 2.948) and pain score significantly decreased (SMD - 1.013, 95%CI - 1.892 to - 0.196) with laser application as compared to traditional caries removal technique. On the contrary, no significant difference was found when using lasers for caries removal when comparing restoration retention, marginal discoloration and marginal adaptation.
27666123Montedori/2016662 participants in 9 trials (age range 3.5 to 84 years old)Systematic review of randomized trials
Key resultsFour trials included children/adolescents; four trials included adults only; and one trial included children/adolescents and adults. Due to the available studies having small sample sizes and high risk of bias, “evidence was insufficient to support the use of laser as an alternative to traditional drill therapy for caries removal.” For the included studies, there was no difference in marginal integrity or pulpal inflammation. However, in the drill group, pain (RR 0.40, 95% CI 0.28 to 0.57) and need for anesthesia (RR 0.25, 95% CI 0.10 to 0.65) were significantly higher.
25877234Valerio/201629 childrenRandomized Controlled Trial
Key resultsBur preparation was more effective than the Er:YAG laser in regard to the time of the procedure (p=0.019) and caries removal on the surrounding walls (p=0.0001). However, no statistical significance was found when comparing caries removal near the pulpal wall (p=0.5) and restoration survival after 1 year (p=0.05).
Evidence Search ("dental health services"[MeSH Terms] OR ("dental"[All Fields] AND "health"[All Fields] AND "services"[All Fields]) OR "dental health services"[All Fields] OR "dental"[All Fields]) AND ("lasers"[MeSH Terms] OR "lasers"[All Fields] OR "laser"[All Fields]) AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) AND removal[All Fields] AND ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields])
Comments on
The Evidence
Validity: In both Montedori’s systemic review and Li’s meta analysis there “were a limited number of studies that met the inclusion criteria." In Valerio/2016 originally 42 subjects were used with a total of 84 primary molars, but only 29 children were evaluated 1 year after the procedure was completed. All teeth were prepared and restored by the same operator, and another examiner was blinded and evaluated caries removal with visual and tactile methods. Caries depth differed between the 29 subjects, and either IPC and GI cement were used, just GI cement, or neither. The study was unclear on how many teeth received each treatment. Perspective: The increase in time to complete cavity preparation with laser as compared to traditional drill is most likely associated with operators having less experience with laser use as compared to traditional drill use. It is possible that more training early on with dental lasers will decrease the time difference for cavity preparations.
Applicability Children often feel anxious when coming to the dentist for a cavity preparation. A multitude of factors, including the “shot,” the noise of the drill, the vibrations and the perceived pain, contribute to this anxiety. This evidence shows that the Er:YAG laser is a good option for cavity preparation when the goal is to reduce pain levels and anesthesia use.
Specialty (Pediatric Dentistry) (Restorative Dentistry)
Keywords Laser, Caries Removal, Children, Pain
ID# 3398
Date of submission 11/22/2019
E-mail KohlerD@livemail.uthscsa.edu
Author Dorothy Kohler
Co-author(s) e-mail
Faculty mentor Dr. Liu
Faculty mentor e-mail LiuJA@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?)
None available
Comments and Evidence-Based Updates on the CAT
None available