Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Payahoo, Salar; Jamali, Samira; Jabbari, Golchin; Jamee, Azad

doi:10.1590/pboci.2020.161

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Pesquisa Brasileira em Odontopediatria e Clínica Integrada

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SYSTEMATIC REVIEW • Pesqui. Bras. Odontopediatria Clín. Integr. 20 • 2020 • https://doi.org/10.1590/pboci.2020.161 copy

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The present systematic review and meta-analysis aimed at evaluating the efficacy of laser’s treatment of exposed pulps to stimulate healing.

Material and Methods:

MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I² showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata.

Results:

Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00).

Conclusion:

The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

Keywords:
Laser Therapy; Dental Pulp Exposure; Dental Pulp Diseases; Study Characteristics

PICO OR PECO Strategy	Description
P	Population/ Patient: exposed pulps treated
E	Exposure/ Intervention: laser therapy
C	Comparison: laser group versus pulp capping procedures without lasers
O	Outcome: the rate of success or failure between Intervention and control groups

Study	Study Design	Follow-Up (Months)	Sample Size	Mean of Age (Years)	Intervention Group	Control Group	Success Rate (%)
Cengiz et al. [¹⁷[17] Cengiz E, Yilmaz HG. Efficacy of erbium, chromium-doped: yttrium, scandium, gallium, and garnet laser irradiation combined with resin-based tricalcium silicate and calcium hydroxide on direct pulp capping: a randomized clinical trial. J Endod 2016; 42(3):351-5. https://doi.org/10.1016/j.joen.2015.11.015 https://doi.org/10.1016/j.joen.2015.11.0... ]	RCT	6	60 Test 1: 15 Test 2: 15 Control 1: 15 Control 2: 15	28 (18-41)	Laser+Ca(OH)₂	Ca(OH)₂	T 1: 100% T 2: 100% C 1: 73% C 2: 67%
	RCT	6	60 Test 1: 15 Test 2: 15 Control 1: 15 Control 2: 15	28 (18-41)	Laser+Resin	Resin	T 1: 100% T 2: 100% C 1: 73% C 2: 67%
Yazdanfar et al. [¹⁰[10] Yazdanfar I, Gutknecht N, Franzen R. Effects of diode laser on direct pulp capping treatment: a pilot study. Lasers Med Sci 2015; 30(4):1237-43. https://doi.org/10.1007/s10103-014-1574-8 https://doi.org/10.1007/s10103-014-1574-... ]	RCT	12	10 Test: 5 Control: 5	26 (14-40)	Laser+RM-GIC	RM-GIC	T: 100% C: 60%
Suzuki et al. [¹⁶[16] Suzuki M, Ogisu T, Kato C, Shinkai K, Katoh Y. Effect of CO2 laser irradiation on wound healing of exposed rat pulp. Odontology 2011; 99(1):34-44. https://doi.org/10.1007/s10266-010-0140-5 https://doi.org/10.1007/s10266-010-0140-... ]	Animal	1	42 Rats 75 Teeth	8-9 Weeks	Laser + Resin	Ca(OH)₂	ND
	Animal	1	42 Rats 75 Teeth	8-9 Weeks	Laser + Resin	Resin	ND
Hasheminia et al. [²⁰[20] Hasheminia SM, Feizi G, Razavi SM, Feizianfard M, Gutknecht N, Mir M. A comparative study of three treatment methods of direct pulp capping in canine teeth of cats: a histologic evaluation. Lasers Med Sci 2010; 25(1):9-15. https://doi.org/10.1007/s10103-008-0584-9 https://doi.org/10.1007/s10103-008-0584-... ]	Animal	4	9 Cats 36 Teeth	NA	Laser+MTA	MTA	ND
	Animal	4	9 Cats 36 Teeth	NA	Laser+Ca(OH)2	MTA	ND
Olivi et al. [²¹[21] Olivi G, Genovese MD, Maturo P, Docimo R. Pulp capping: advantages of using laser technology. Eur J Paediatr Dent 2007; 8(2):89-95.]	RCT	48	64 Test 1: 34 Test 2: 30	Test 1: 14.5 (11-18) Test 2: NA (19-40)	a, 2a, Laser+Ca(OH)₂	1c, 2c, Ca(OH)₂	T1a: 80% T2a: 80% T 1b: 75% T 2b: 70% C 1c: 63% C2c: 50%
	RCT	48	64 Test 1: 34 Test 2: 30	Test 1: 14.5 (11-18) Test 2: NA (19-40)	1b,2b, Laser+Ca(OH)₂	1c, 2c, Ca(OH)₂	T1a: 80% T2a: 80% T 1b: 75% T 2b: 70% C 1c: 63% C2c: 50%

Study	Type of Laser	DOF (µm)	LW (nm)	P (W)	PID (µs)	F (Hz)	EF (J/cm²)	DL
Cengiz et al. [¹⁷[17] Cengiz E, Yilmaz HG. Efficacy of erbium, chromium-doped: yttrium, scandium, gallium, and garnet laser irradiation combined with resin-based tricalcium silicate and calcium hydroxide on direct pulp capping: a randomized clinical trial. J Endod 2016; 42(3):351-5. https://doi.org/10.1016/j.joen.2015.11.015 https://doi.org/10.1016/j.joen.2015.11.0... ]	Er, Cr: YSGG	-	-	0.5	140	20	-	10
Yazdanfar et al. [¹⁰[10] Yazdanfar I, Gutknecht N, Franzen R. Effects of diode laser on direct pulp capping treatment: a pilot study. Lasers Med Sci 2015; 30(4):1237-43. https://doi.org/10.1007/s10103-014-1574-8 https://doi.org/10.1007/s10103-014-1574-... ]	Diode	400	808	1.5	-	-	-	-
Suzuki et al. [¹⁶[16] Suzuki M, Ogisu T, Kato C, Shinkai K, Katoh Y. Effect of CO2 laser irradiation on wound healing of exposed rat pulp. Odontology 2011; 99(1):34-44. https://doi.org/10.1007/s10266-010-0140-5 https://doi.org/10.1007/s10266-010-0140-... ]	CO2 laser	740	10,600	0.5	200	-	0.698	1.5
Hasheminia et al. [²⁰[20] Hasheminia SM, Feizi G, Razavi SM, Feizianfard M, Gutknecht N, Mir M. A comparative study of three treatment methods of direct pulp capping in canine teeth of cats: a histologic evaluation. Lasers Med Sci 2010; 25(1):9-15. https://doi.org/10.1007/s10103-008-0584-9 https://doi.org/10.1007/s10103-008-0584-... ]	Er: YAG	600	2940	-	700	3	71	15
Olivi et al. [²¹[21] Olivi G, Genovese MD, Maturo P, Docimo R. Pulp capping: advantages of using laser technology. Eur J Paediatr Dent 2007; 8(2):89-95.]	Er, Cr: YSGG	-	2780	3-5	20	20	-	60
Olivi et al. [²¹[21] Olivi G, Genovese MD, Maturo P, Docimo R. Pulp capping: advantages of using laser technology. Eur J Paediatr Dent 2007; 8(2):89-95.]	Er: YAG	-	2940	1.5-2	-	3	-	60

Criteria	Cengiz et al. [¹⁷[17] Cengiz E, Yilmaz HG. Efficacy of erbium, chromium-doped: yttrium, scandium, gallium, and garnet laser irradiation combined with resin-based tricalcium silicate and calcium hydroxide on direct pulp capping: a randomized clinical trial. J Endod 2016; 42(3):351-5. https://doi.org/10.1016/j.joen.2015.11.015 https://doi.org/10.1016/j.joen.2015.11.0... ]	Yazdanfar et al. ¹⁰[10] Yazdanfar I, Gutknecht N, Franzen R. Effects of diode laser on direct pulp capping treatment: a pilot study. Lasers Med Sci 2015; 30(4):1237-43. https://doi.org/10.1007/s10103-014-1574-8 https://doi.org/10.1007/s10103-014-1574-... ]	Suzuki et al. [¹⁶[16] Suzuki M, Ogisu T, Kato C, Shinkai K, Katoh Y. Effect of CO2 laser irradiation on wound healing of exposed rat pulp. Odontology 2011; 99(1):34-44. https://doi.org/10.1007/s10266-010-0140-5 https://doi.org/10.1007/s10266-010-0140-... ]	Hasheminia et al. [²⁰[20] Hasheminia SM, Feizi G, Razavi SM, Feizianfard M, Gutknecht N, Mir M. A comparative study of three treatment methods of direct pulp capping in canine teeth of cats: a histologic evaluation. Lasers Med Sci 2010; 25(1):9-15. https://doi.org/10.1007/s10103-008-0584-9 https://doi.org/10.1007/s10103-008-0584-... ]	Olivi et al. [²¹[21] Olivi G, Genovese MD, Maturo P, Docimo R. Pulp capping: advantages of using laser technology. Eur J Paediatr Dent 2007; 8(2):89-95.]
Focused	Y	Y	Y	Y	Y
The cohort has been recruited in an acceptable way	Y	Y	Y	Y	Y
Exposure has been accurately measured	Y	Y	Y	Y	Y
Outcome	Y	Y	Y	Y	Y
Confounding factors have been addressed	N	N	N	N	N
Follow-up has been extended and complete	N	Y	N	N	Y
Results have been clear	Y	Y	Y	Y	N
Results have been precise	Y	Y	Y	Y	Y
Results have been credible	Y	Y	Y	Y	Y
Results could be applied to the local population	Y	Y	N	N	Y
Results fitted with available evidence	CT	CT	CT	CT	CT
The important clinical implications	Y	Y	Y	Y	Y
Quality Score	9	10	8	8	8

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[1] Author to whom correspondence should be addressed: Samira Jamali, Department of Endodontics, Stomatological Hospital, College of Stomatology, Xi'an Jiaotong University, Shaanxi 710004, PR China. E-mail: samira.jamali90@yahoo.com