Cochrane · intervention · CD010229
Lasers for caries removal in deciduous and permanent teeth
Montedori, A, Abraha, I, Orso, M, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
19
current version
GRADE rated
7
No studies
1
Included studies
9
as reported
No studies 1 · 5.3%Ungraded 11 · 57.9%Very low 4 · 21.1%Low 3 · 15.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adults with caries, any age; deciduous and permanent teeth, restored or unrestored, vital or non-vital/root-filled; excluding participants selected for special (general or oral) health conditions | 662 participants (children, adolescents and adults), 27 to 123 per study; age 3.5 to 84 years; 4 trials children/adolescents only; 4 trials adults only; 1 trial mixed (3.5 to 68 years); 1498 teeth treated |
| Intervention | Any laser specific to the removal of carious lesions (e.g. erbium lasers), with different radiation parameters | Er:YAG laser (n=6 studies); Er,Cr:YSGG laser (n=2 studies); Nd:YAG laser (n=1 study) |
| Comparison | Conventional mechanical caries removal (handpiece with a bur); or other systems (chemo-mechanical, sono-abrasion, air-abrasion) | Conventional mechanical drill with handpiece and bur (n=9 studies) |
| Outcomes | Caries removal (primary); Episodes of pain (primary); Marginal integrity of restoration; Durability of restoration; Recurrent caries; Pulpal inflammation or necrosis; Participant discomfort; Need for anaesthesia; Operator preference/fatigue; Participant preference; Duration of treatment | Caries removal (n=4 studies; 2 with quantitative data); Episodes of pain (n=5 studies); Marginal integrity of restorations (n=3 studies); Durability of restorations (n=4 studies); Recurrent caries (n=2 studies); Pulpal inflammation or necrosis (n=4 studies); Participant discomfort (n=5 studies); Need for anaesthesia (n=4 studies); Operator preference/fatigue (n=1 study); Participant preference (n=3 studies); Duration of treatment (n=4 studies) |
| Study designs | Randomised controlled trials, split-mouth trials and cluster-randomised trials (any language or publication status) | Split-mouth RCT (n=6 studies); parallel-group RCT (n=3 studies) |
| Timing | Not specified | Follow-up 1 week to 2 years |
Search date: 2016-06. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ProQuest Dissertations and Theses; Zetoc; ISI Web of Knowledge; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Current version onlyLaser (Er:YAG, Er,Cr:YSGG, or Nd:YAG) vs Conventional mechanical caries removal (standard drill; handpiece with a bur)
Population: Children, adolescents and adults with caries in deciduous and permanent teeth (age 3.5 to 84 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pulpal inflammation or necrosis 1 week follow-up | RR 1.51 [0.26, 8.75] 2 [-4, 31] more per 1000 | 3 studies · 317 participants | Very low Downgraded: risk of bias, imprecision |
Duration of treatment | MD 0.90 [0.59, 1.21] | 4 studies | Ungraded |
Marginal integrity of restorations 6 months follow-up | RR 1.00 [0.21, 4.78] 0 [-6, 24] per 1000 | 3 studies · 146 participants | Very low Downgraded: risk of bias, imprecision |
Participant preference | Three studies (Evans 2000; Liu 2006; Zhang 2013) reported participants' preference for future treatment. Zhang 2013: 37/53 children (72%) preferred laser, 10 (22%) drill. Liu 2006: 36/40 (90%) preferred laser, 4 (5%)… | 3 studies | Ungraded |
Marginal integrity of restorations 2 years follow-up | RR 1.00 [0.21, 4.74] | 1 study | Ungraded |
Participant discomfort (vibration, smell, noise) during treatment | Five studies reported participant discomfort (Belcheva 2014; Evans 2000; Hadley 2000; Keller 1998; Liu 2006). Keller 1998 (90 adults): discomfort significantly lower with laser (Analysis 1.6). Hadley 2000 (66 adults):… | 5 studies | Ungraded |
Pulpal inflammation or necrosis 6 months follow-up | RR 0.99 [0.10, 9.41] 0 [-4, 33] per 1000 | 2 studies · 156 participants | Very low Downgraded: risk of bias, imprecision |
Pulpal inflammation or necrosis overall (1 week to 6 months) | RR 1.29 [0.32, 5.14] | 4 studies | Ungraded |
Operator preference/fatigue in operator | One study (Evans 2000): 11 dental practitioners expressed a preference in 73 of 77 'dentist/patient encounters', significantly in favour of conventional drill rather than laser (P < 0.001); main difficulty with laser… | 1 study | Ungraded |
Caries removal (clinical) during treatment | RR 1.00 [0.99, 1.01] 0 [-5, 5] per 1000 | 2 studies · 190 participants | Low Downgraded: risk of bias |
Recurrent (secondary) caries 6 months to 2 years follow-up | Two trials reported data on prevalence of secondary caries (Hadley 2000 at 6 months; Yazici 2010 at 2 years). No occurrence of caries was reported in either study (no events; no estimable effect). | 2 studies | Ungraded |
Durability of restoration 1 year follow-up | RR 1.40 [0.29, 6.78] | 2 studies | Ungraded |
Durability of restoration 2 years follow-up | RR 0.50 [0.02, 14.60] | 1 study | Ungraded |
Durability of restoration 6 months follow-up | RR 2.40 [0.65, 8.77] 12 [-3, 65] more per 1000 | 4 studies · 236 participants | Very low Downgraded: risk of bias, imprecision |
Episodes of pain (moderate or high pain; six-face rating scale) during treatment | RR 0.40 [0.28, 0.57] -456 [-524, -365] fewer per 1000 | 2 studies · 143 participants | Low Downgraded: risk of bias |
Marginal integrity of restorations 1 year follow-up | RR 1.59 [0.34, 7.38] | 2 studies | Ungraded |
Need for anaesthesia during treatment · overall (children and adults) | RR 0.37 [0.19, 0.72] | 4 studies · 320 participants | Ungraded |
Need for anaesthesia during treatment · children/adolescents | RR 0.25 [0.10, 0.65] -73 [-87, -34] fewer per 1000 | 3 studies · 217 participants | Low Downgraded: risk of bias |
Laser (Er:YAG, Er,Cr:YSGG, or Nd:YAG) vs Other caries removal systems (chemo-mechanical, sono-abrasion, or air-abrasion)
Population: Children, adolescents and adults with caries in deciduous and permanent teeth (age 3.5 to 84 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | 'Types of interventions' allowed comparison of laser with other caries-removal systems (chemo-mechanical, sono-abrasion, air-abrasion); no included study used such a comparator (all nine included trials compared laser… | NR | No studies |
Laser (any laser for caries removal, e.g. erbium lasers) vs Conventional mechanical caries removal (handpiece with a bur)
Population: Children and adults with caries (any age); deciduous or permanent, restored or unrestored, vital or non-vital/root-filled teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Episodes of pain (during and after treatment) during and after treatment | no estimate extracted | NR | No studies |
Marginal integrity of restoration | no estimate extracted | NR | No studies |
Pulpal inflammation or necrosis (at 1-year follow-up) at 1-year follow-up | no estimate extracted | NR | No studies |
Costs of intervention | no estimate extracted | NR | No studies |
Need for anaesthesia | no estimate extracted | NR | No studies |
Durability of restoration (survival time of restoration, in months) | no estimate extracted | NR | No studies |
Duration of treatment | no estimate extracted | NR | No studies |
Caries removal (confirmed by clinical, radiological or other validated assessment tools) | no estimate extracted | NR | No studies |
Patient discomfort | no estimate extracted | NR | No studies |
Secondary caries | no estimate extracted | NR | No studies |
Operator preference/fatigue in operator | no estimate extracted | NR | No studies |
Patient preference | no estimate extracted | NR | No studies |
Laser (any laser for caries removal, e.g. erbium lasers) vs Other caries removal systems (chemo-mechanical, sono-abrasion, or air-abrasion)
Population: Children and adults with caries (any age); deciduous or permanent, restored or unrestored, vital or non-vital/root-filled teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Protocol 'Types of interventions' allowed laser to be compared with other caries-removal systems (chemo-mechanical, sono-abrasion, air-abrasion); this is a planned comparator (no studies at protocol stage). | NR | No studies |