Non-Cochrane · intervention · PM31477081
The clinical effects of laser preparation of tooth surfaces for fissure sealants placement: a systematic review and meta-analysis.
Zhang Yunhan, Wang Yan, Chen Yandi, et al. · BMC oral health · 2019 · PubMed · doi:10.1186/s12903-019-0892-4
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
19
current version
GRADE rated
0
No studies
2
Included studies
5
linked below
No studies 2 · 10.5%Ungraded 17 · 89.5%Very low 0 · 0%Low 0 · 0%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 | Caries-free patients with untreated premolars and/or molars and/or primary molars suitable for pit-and-fissure sealing | Caries-free children to young adults (5 studies; ages 6-38 y; 16-64 subjects per study) |
| Intervention | Lasers as a pretreatment (enamel conditioning) method for pit-and-fissure sealing | Lasers: Er,Cr:YSGG (n=2), Er:YAG combined with acid-etching (n=2), carbon dioxide (n=1) |
| Comparison | Any other mechanical or chemical preparation (e.g., acid-etching, enameloplasty, air abrasion) | Acid-etching (phosphoric acid) in all 5 studies |
| Outcomes | Sealant retention rate; incidence of dental caries; adverse events; clinical time; patient acceptability; anxiety | Retention rate (n=4); incidence of caries (n=2); patient acceptability (n=1); dental anxiety, heart rate, oxygen saturation (n=1); adverse events (none reported, n=5) |
| Study designs | Randomized clinical trials (RCTs) | RCTs (n=5; 3 split-mouth, 2 parallel-design) |
| Timing | Not specified | Follow-up 3-36 months; meta-analysis at 3, 6, 9, 12, 18 and 24 months |
Search date: January 2019. Databases: PubMed, Scopus, Medline/EMBASE via OVID, Cochrane Library; ClinicalTrials.gov and ISRCTN trial registries; OpenGrey grey literature; reference lists of included studies (hand-search)
Questions and results
Laser enamel preparation alone (Er,Cr:YSGG or CO2 laser) vs Acid-etching (phosphoric acid)
Population: Caries-free children to young adults with premolars/molars requiring pit-and-fissure sealants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sealant retention rate (completely retained) 18 months At 18 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 0.82, 95% CI 0.23 to 2.85; ungraded, single study, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 0.82 [0.23, 2.85] | 1 study · 16 participants | Ungraded |
Sealant retention rate (completely retained) 12 months At 12 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 1.05, 95% CI 0.61 to 1.80; ungraded, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 1.05 [0.61, 1.80] | 3 studies · 73 participants | Ungraded |
Patient acceptability (VAS discomfort) Both laser and acid-etching preparation were well accepted by patients (VAS, P = 1.000; ungraded, single study). Source: Results 'Patient satisfaction'; Table 1 · same question in other reviews | Kumar 2016 (Er,Cr:YSGG laser vs acid-etching): patient acceptance scored on a visual analogue scale; both preparations well accepted, P = 1.000; no significant difference. | 1 study · 50 participants | Ungraded |
Sealant retention rate (completely retained) 6 months At 6 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 1.22, 95% CI 0.69 to 2.16; ungraded, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 1.22 [0.69, 2.16] | 3 studies · 80 participants | Ungraded |
Clinical (chair-side) time Laser conditioning was reported to take less chair-side time than acid-etching in the studies that measured it, but times were not pooled (ungraded, narrative). Source: Results 'Clinical time' · same question in other reviews | Walsh 1996 reported laser conditioning time of 7 s vs 70 s for acid preparation; Kumar 2016 reported Er,Cr:YSGG exposure ~10 s vs >35 s for acid etching; laser conditioning was shorter but times were not pooled, and… | 2 studies | Ungraded |
Incidence of dental caries 24 months In the single study reporting it, caries incidence was 0% in both the laser-alone and acid-etching groups (ungraded, single study). Source: Results 'Incidence of caries' · same question in other reviews | Karaman 2013 (Er,Cr:YSGG laser vs acid-etching): incidence of caries was 0% in both groups; not meta-analyzed. | 1 study · 16 participants | Ungraded |
Sealant retention rate (completely retained) 3 months At 3 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 2.78, 95% CI 0.87 to 8.91; ungraded, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 2.78 [0.87, 8.91] | 2 studies · 65 participants | Ungraded |
Adverse events No adverse events were reported in any included study (ungraded, narrative). Source: Results 'Adverse events' · same question in other reviews | No adverse events (pulpal sensation, post-lasing thermal sensitivity, pulpitis, or other laser-induced pathology) were reported in any of the included studies. | 5 studies | Ungraded |
Sealant retention rate (completely retained) 9 months At 9 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 1.15, 95% CI 0.63 to 2.10; ungraded, single study, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 1.15 [0.63, 2.10] | 1 study · 43 participants | Ungraded |
Sealant retention rate (completely retained) 24 months At 24 months, laser preparation alone did not differ significantly from acid-etching for sealant retention (OR 0.87, 95% CI 0.31 to 2.45; ungraded, single study, high risk of bias). Source: Results 'Retention rate'; Fig. 4 · same question in other reviews | OR 0.87 [0.31, 2.45] | 1 study · 16 participants | Ungraded |
Er:YAG laser preparation combined with acid-etching vs Acid-etching (phosphoric acid) alone
Population: Children with permanent molars requiring pit-and-fissure sealants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sealant retention rate (completely retained) 6 months At 6 months, adding Er:YAG laser to acid-etching did not significantly change sealant retention versus acid-etching alone (OR 0.55, 95% CI 0.23 to 1.34; ungraded, single study). Source: Results 'Retention rate'; Discussion 'Laser combined with acid preparation'; Fig. 5 · same question in other reviews | OR 0.55 [0.23, 1.34] | 1 study · 42 participants | Ungraded |
Sealant retention rate (completely retained) 18 months At 18 months, Er:YAG laser combined with acid-etching significantly improved sealant retention versus acid-etching alone (OR 0.41, 95% CI 0.21 to 0.80, favouring laser+acid; ungraded, single study). Source: Results 'Retention rate'; Discussion 'Laser combined with acid preparation'; Fig. 5 · same question in other reviews | OR 0.41 [0.21, 0.80] | 1 study · 42 participants | Ungraded |
Sealant retention rate (completely retained) 12 months At 12 months, Er:YAG laser combined with acid-etching significantly improved sealant retention versus acid-etching alone (OR 0.39, 95% CI 0.19 to 0.80, favouring laser+acid; ungraded, single study). Source: Results 'Retention rate'; Discussion 'Laser combined with acid preparation'; Fig. 5 · same question in other reviews | OR 0.39 [0.19, 0.80] | 1 study · 42 participants | Ungraded |
Physiological stress indicators (heart rate, oxygen saturation) Population: Children (ages 6-12) receiving pit-and-fissure sealants Heart rate and oxygen saturation did not differ significantly between laser-plus-acid and acid-etching (ungraded, single study). Source: Results 'Patient satisfaction' · same question in other reviews | Shindova 2018 (Er:YAG laser+acid vs acid-etching): no significant differences in heart rate or oxygen saturation between groups. | 1 study · 64 participants | Ungraded |
Incidence of dental caries 18 months Population: Children (high caries risk) with permanent molars requiring pit-and-fissure sealants Caries incidence was 10% with laser-plus-acid versus 22% with acid-etching at 18 months, a non-significant difference (ungraded, single study). Source: Results 'Incidence of caries'; Discussion 'Laser combined with acid preparation' · same question in other reviews | Durmus 2017 (Er:YAG laser+acid vs acid-etching): caries incidence 10% (n=8) in the laser-plus-acid group vs 22% (n=18) in the acid-etching group at 18 months; difference not statistically significant (P > 0.05). | 1 study · 51 participants | Ungraded |
Dental anxiety (subjective and objective scores) Population: Children (ages 6-12) receiving pit-and-fissure sealants Er:YAG laser preparation added to acid-etching did not increase children's dental anxiety versus acid-etching alone (P > 0.05; ungraded, single study). Source: Results 'Patient satisfaction'; Table 1 · same question in other reviews | Shindova 2018 (Er:YAG laser+acid vs acid-etching): no significant difference between initial and final subjective anxiety scores for the two groups; use of the Er:YAG laser did not provoke anxiety (P > 0.05). | 1 study · 64 participants | Ungraded |
Sealant retention rate (completely retained) 3 months At 3 months, adding Er:YAG laser to acid-etching did not significantly change sealant retention versus acid-etching alone (OR 0.47, 95% CI 0.14 to 1.64; ungraded, single study). Source: Results 'Retention rate'; Discussion 'Laser combined with acid preparation'; Fig. 5 · same question in other reviews | OR 0.47 [0.14, 1.64] | 1 study · 42 participants | Ungraded |
Laser enamel preparation vs Enameloplasty
Population: Patients with premolars/molars requiring pit-and-fissure sealants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Any planned outcome (sealant retention, caries, etc.) No eligible studies compared laser preparation with enameloplasty for fissure sealant placement (evidence gap). Source: Focused question (comparators); Discussion 'Effects of study methodology on outcome' (shortcomings) · same question in other reviews | no estimate extracted | 0 studies | No studies |
Laser enamel preparation vs Air abrasion
Population: Patients with premolars/molars requiring pit-and-fissure sealants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Any planned outcome (sealant retention, caries, etc.) No eligible studies compared laser preparation with air abrasion for fissure sealant placement (evidence gap). Source: Focused question (comparators); Discussion 'Effects of study methodology on outcome' (shortcomings) · same question in other reviews | no estimate extracted | 0 studies | No studies |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: Yes | RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | NRSI: N/A · RCT: Yes | RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | N/A | no |
| 15Publication bias investigatedcritical | No | N/A | no |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 5
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Durmus 2017 DOI:10.3290/j.ohpd.a37927 | this review only | Sealant retention rate (completely retained) | not extracted yet | not extracted yet |
| Karaman 2013 Comparison of Acid Versus Laser Etching on the Clinical Performance of a Fissure Sealant: 24-Month Results DOI:10.2341/11-435-c | this review only | Sealant retention rate (completely retained) | not extracted yet | not extracted yet |
| Kumar 2016 A comparative evaluation of retention of pit and fissure sealants placed with conventional acid etching and Er,Cr:YSGG laser etching: A… PMID:28765674 | this review only | Sealant retention rate (completely retained) | not extracted yet | not extracted yet |
| Shindova 2018 Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children DOI:10.1515/folmed-2017-0086 | this review only | Dental anxiety (subjective and objective scores) | not extracted yet | not extracted yet |
| Walsh 1996 Split‐mouth study of sealant retention with carbon dioxide laser versus acid etch conditioning DOI:10.1111/j.1834-7819.1996.tb05925.x | this review only | Sealant retention rate (completely retained) | not extracted yet | not extracted yet |