Non-Cochrane · intervention · PM38383278
Effect of Er:YAG Laser Irradiation on Preventing Enamel Caries: A Systematic Review and Meta-Analysis.
Feng Zhiyuan, Yuan Rui, Cheng Lin, et al. · International dental journal · 2024 · PubMed · doi:10.1016/j.identj.2024.01.022
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
5
current version
GRADE rated
0
No studies
0
Included studies
16
linked below
No studies 0 · 0%Ungraded 5 · 100%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 | Human teeth with intact enamel and no defects, microcracks, caries, restorations, or developmental lesions (in vitro) | 16 in vitro studies on human enamel specimens (mostly permanent teeth; 2 deciduous); sound enamel in most, demineralised enamel in 2 studies |
| Intervention | Er:YAG laser irradiation | Er:YAG laser irradiation (2.94 um wavelength) at varying fluences/energies (n=16 studies) |
| Comparison | Control group receiving no anticaries intervention | Untreated enamel, no anticaries intervention (n=16 studies) |
| Outcomes | Solubility of calcium ions in solution; enamel surface microhardness; mineral loss; demineralised lesion depth | Surface microhardness (5 studies: 3 sound, 2 demineralised); mineral loss (4 studies); lesion depth (3 studies); calcium ions released (6 studies) |
| Study designs | In vitro studies | 16 in vitro studies (published 2003-2022) |
| Timing | Not specified | In vitro acid challenge / pH cycling (8 h to 12 d) or acid immersion |
Search date: Up to June 2023. Databases: PubMed, Web of Science, EMBASE; grey literature (Google Scholar, OpenGrey); hand-search of reference lists and selected journals
Questions and results
Er:YAG laser irradiation of sound enamel before acid challenge vs No anticaries intervention (untreated enamel)
Population: Human tooth enamel specimens, sound/intact (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Demineralised lesion depth After cariogenic acid challenge / pH cycling Er:YAG laser irradiation significantly reduced demineralised lesion depth versus untreated control (SMD -0.55, 95% CI -0.97 to -0.12; 3 in vitro studies, I2=62%; ungraded). Source: Results 'Lesion depth'; Figure 3A (forest plot) · same question in other reviews | SMD -0.55 [-0.97, -0.12] | 3 studies · 252 participants | Ungraded |
Enamel surface microhardness After cariogenic acid challenge / pH cycling · sound enamel In sound enamel, Er:YAG laser irradiation significantly increased surface microhardness after acid challenge versus untreated control (SMD 2.41, 95% CI 0.70 to 4.12; 3 in vitro studies; ungraded). Source: Results 'Surface microhardness'; Figure 2A · same question in other reviews | SMD 2.41 [0.70, 4.12] | 3 studies | Ungraded |
Enamel mineral loss After cariogenic acid challenge / pH cycling Er:YAG laser irradiation significantly reduced enamel mineral loss versus untreated control (SMD -2.09, 95% CI -3.29 to -0.88; 4 in vitro studies; ungraded). Source: Results 'Mineral loss'; Figure 2B · same question in other reviews | SMD -2.09 [-3.29, -0.88] | 4 studies | Ungraded |
Calcium ions released in acidic solution After acid immersion (acid dissolution) Er:YAG laser irradiation did not significantly change calcium ions released into acidic solution versus untreated control (SMD -0.40, 95% CI -0.96 to 0.15; 6 in vitro studies, I2=80%; ungraded). Source: Results 'Calcium ions released'; Figure 3B (forest plot) · same question in other reviews | SMD -0.40 [-0.96, 0.15] | 6 studies · 292 participants | Ungraded |
Er:YAG laser irradiation of enamel after demineralisation vs No anticaries intervention (untreated enamel)
Population: Human tooth enamel specimens with early demineralised lesions (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel surface microhardness Laser applied after demineralisation (no further acid challenge) · demineralised enamel In demineralised enamel, Er:YAG laser irradiation did not significantly change surface microhardness versus untreated control (SMD 0.66, 95% CI -1.12 to 2.44; 2 in vitro studies; ungraded). Source: Results 'Surface microhardness' (subgroup on demineralised enamel); Figure 2A; Discussion · same question in other reviews | SMD 0.66 [-1.12, 2.44] | 2 studies | Ungraded |
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 | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | 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 | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: N/A | NRSI: Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 16
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Castellan 2007 <i>in vitro</i> Evaluation of Enamel Demineralization after Er:YAG and Nd:YAG Laser Irradiation on Primary Teeth DOI:10.1089/pho.2006.2043 | this review only | Enamel mineral loss | not extracted yet | not extracted yet |
| Ceballos-Jiménez 2018 Acid resistance of dental enamel treated with remineralizing agents, Er:YAG laser and combined treatments DOI:10.17219/dmp/93960 | this review only | Calcium ions released in acidic solution | not extracted yet | not extracted yet |
| Cecchini 2005 Effect of Er:YAG laser on enamel acid resistance: Morphlogical and atomic spectrometry analysis DOI:10.1002/lsm.20247 | this review only | Calcium ions released in acidic solution | not extracted yet | not extracted yet |
| Contreras-Bulnes 2022 The extensin signal peptide allows secretion of a heterologous protein from protoplasts. PMID:2022327 | this review only | not stated | not extracted yet | not extracted yet |
| Correa-Afonso 2010 Influence of the irradiation distance and the use of cooling to increase enamel-acid resistance with Er:YAG laser DOI:10.1016/j.jdent.2010.03.009 | this review only | Demineralised lesion depth | not extracted yet | not extracted yet |
| Delbem 2003 Effect of Er:YAG Laser on CaF <sub>2</sub> Formation and Its Anti-Cariogenic Action on Human Enamel: An <i>in Vitro</i> Study DOI:10.1089/104454703768247765 | this review only | Enamel surface microhardness | not extracted yet | not extracted yet |
| Díaz-Monroy 2014 Chemical changes associated with increased acid resistance of Er:YAG laser irradiated enamel. PMID:24600327 | this review only | Calcium ions released in acidic solution | not extracted yet | not extracted yet |
| Liu 2006 Optimal Er:YAG laser energy for preventing enamel demineralization DOI:10.1016/j.jdent.2005.03.005 | this review only | Demineralised lesion depth | not extracted yet | not extracted yet |
| Liu 2013 (Caries Res) Subablative Er:YAG Laser Effect on Enamel Demineralization DOI:10.1159/000343573 | this review only | not stated | not extracted yet | not extracted yet |
| Liu 2013 (J Dent Res) Potential Mechanism for the Laser-Fluoride Effect on Enamel Demineralization DOI:10.1177/0022034512466412 | this review only | Enamel mineral loss | not extracted yet | not extracted yet |
| Mathew 2013 Acquired acid resistance of human enamel treated with laser (Er:YAG laser and Co2 laser) and acidulated phosphate fluoride treatment: An… PMID:24015004 | this review only | Calcium ions released in acidic solution | not extracted yet | not extracted yet |
| Moura 2021 Effect of Er:YAG Laser and Association of Protocols on the Demineralized Enamel Microhardness DOI:10.1089/photob.2020.4974 | this review only | Enamel surface microhardness | not extracted yet | not extracted yet |
| Nair 2016 A Comparative Analysis of Caries Inhibitory Effect of Remineralizing Agents on Human Enamel Treated With Er:YAG Laser: An In-vitro Atomic… PMID:28208995 | this review only | Calcium ions released in acidic solution | not extracted yet | not extracted yet |
| Polat 2020 The Effects of Different Anticavity Agents and Er:YAG Laser Usage on Enamel Surface Microhardness. PMID:32176227 | this review only | Enamel surface microhardness | not extracted yet | not extracted yet |
| Yassaei 2014 matched by author and year (probable) | this review only | Enamel mineral loss | not extracted yet | not extracted yet |
| Yassaei 2020 The Effect of the Er:YAG Laser and MI Paste Plus on the Treatment of White Spot Lesions. PMID:32099627 | this review only | Enamel surface microhardness | not extracted yet | not extracted yet |