Clinical and radiographic evaluation of diode laser pulpotomy on human primary teeth

Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis

Research question

To evaluate the effectiveness of low-level laser therapy (LLLT) as a pulpotomy agent in primary molars.

Research protocol

This systematic review followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020.

Literature search

An electronic search of the databases was performed to find the effectiveness of LLLT over formocresol as a pulpotomy agent in primary molars in children aged between 3 and 10 years.

Data extraction

Authors independently extracted the data from the 14 included studies based on the inclusion criteria. The inclusion criteria comprised studies that compared the clinical and radiographical effectiveness of LLLT pulpotomy with formocresol pulpotomy in primary molars using randomized clinical trials (RCTs).

Quality appraisal

The risk of bias was assessed using a tool developed by the Cochrane Collaboration for RCT studies.

Data analysis

The meta-analyses were performed using the fixed-effects model. Heterogeneity was assessed by a Q test and quantified with I2 statistics. Radiological and clinical success among the teeth treated with either formocresol or LLLT was considered the main outcome.

Results and interpretation of results

The search resulted in 390 published studies. After the removal of duplicate studies and analysis of full-text articles, 14 studies were selected for systematic review. Overall, the results demonstrated a high risk of selection and performance bias. No statistically significant difference was found between LLLT and formocresol as pulpotomy agents when compared clinically and radiographically at 6-9 and 12-month follow-up periods. LLLT is a good alternative method to be used as a pulpotomy agent in cases of reversible pulpitis.

Key message

Low-level laser therapy is an emerging and trending branch in dentistry because of its beneficial effects in various treatment approaches. It can be effectively used in the pulpotomy procedure due to its properties to reduce pulp inflammation, improve healing, and preserve dental pulp vitality.

How to cite this article

Doiphode AR, Kalaskar R, Kalaskar A, et al. Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024;17(9):1075-1085.

Assessing the efficacy of Laser pulpotomy versus conventional pulpotomy in primary teeth: A systematic review and meta-analysis of clinical trials

PURPOSE

This study systematically reviewed the clinical and radiographic outcomes of laser versus conventional pulpotomy in primary teeth. It also compared the success and effectiveness of different lasers to enhance the understanding and use of laser pulpotomy as an alternative treatment.

METHODOLOGY

An electronic search was carried out in PubMed and Cochrane from 1st January 1999 to 31st December 2023. The published articles in the English language were searched using MeSH terms and text words. Only randomized controlled trials with a sample size of more than 10 and follow-ups over 6 months were included. Meta-analysis and forest plots were evaluated by utilizing Review Manager 5.4 software. Two reviewers assessed the risk of bias using the RoB 2 tool and discrepancies were resolved by the third reviewer. The success rates were combined using a random effects model to determine clinical and radiographic outcomes. We used risk ratios with 95% confidence intervals (CI) as the primary effect measures and set the significance level at 0.05.

RESULTS

Only 18 studies met the inclusion criteria after an electronic search. Among them, 13 studies evaluated the clinical and radiographic outcomes of laser with formocresol pulpotomy, 2 studies compared with ferric sulfate pulpotomy, and the remaining studies with Mineral trioxide aggregate (MTA) pulpotomy. The various studies showed different levels of bias. There was no significant difference in the clinical success rate (p = 0.47; RR: 1.01; 95% CI 0.98-1.04; I2 = 0%; p = 0.70) and radiographic success rate (p = 0.94; RR: 1.00; 95% CI 0.91-1.09; I2 = 64%; p = 0.001) between laser pulpotomy and formocresol. Similarly, there was no significant difference between laser pulpotomy and ferric sulfate or MTA pulpotomy.

CONCLUSION

Diode laser and LLLT can be considered as alternative pulpotomy agents to formocresol in primary teeth. However, high-quality trials are needed to confirm the accuracy and reliability of these findings.

The application of lasers in vital pulp therapy: clinical and radiographic outcomes

The main purpose of vital pulp therapy (VPT) is to preserve the integrity and function of the pulp. A wide variety of materials and techniques have been proposed to improve treatment outcomes, and among them, the utilization of lasers has gained significant attention. The application of lasers in different stages of VPT has witnessed remarkable growth in recent years, surpassing previous approaches.This study aimed to review the applications of lasers in different steps of VPT and evaluate associated clinical and radiographic outcomes. An electronic search using Scopus, MEDLINE, Web of Science and Google Scholar databases from 2000 to 2023 was carried out by two independent researchers. The focus was on human studies that examined the clinical and/or radiographic effects of different laser types in VPT. A total of 4243 studies were included in this narrative review article. Based on the compiled data, it can be concluded that although current literature suggests laser may be proposed as an adjunct modality for some procedural steps in VPT, more research with standardized methodologies and criteria is needed to obtain more reliable and conclusive results.