Non-Cochrane · intervention · PM38635085
Clinical and ex-vivo effect of LASERs on prevention of early-enamel caries: systematic review & meta-analyses.
Abd El-Aal Nermin H, Hussein Ahmad Mostafa Hussein Mohamad Mostafa, Banerjee Avijit, et al. · Lasers in medical science · 2024 · PubMed · doi:10.1007/s10103-024-04049-4
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
6
current version
GRADE rated
0
No studies
0
Included studies
8
linked below
No studies 0 · 0%Ungraded 6 · 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 | Healthy patients with permanent teeth who have, or are susceptible to, initial carious lesions, including fixed-orthodontic-appliance patients (any age, gender, ethnicity); plus ex vivo / in situ studies using human enamel | 8 studies: 4 clinical RCTs (202 patients; two trials evaluated 1074 teeth) and 4 ex-vivo / in situ studies (62 volunteers) (n=8) |
| Intervention | Application of a laser beam on enamel for remineralization of initial carious lesions or prevention of demineralization | CO2 laser (6/8 studies); Er:YAG (2/8); Nd:YAG (1/8); output power 0.16 to 5 W, mostly pulsed non-contact (n=8) |
| Comparison | Laser-irradiated versus non-manipulated enamel, or versus other preventive procedures | Placebo / no laser or untreated enamel; some vs fluoride or combined laser+fluoride (n=8) |
| Outcomes | Primary: preventive effect of laser on enamel demineralization (visual follow-up, light-induced fluorescence, degree of decalcification via wet chemical analysis, surface microhardness, polarized light microscopy). Secondary: optimum laser parameters; synergy between fluoride and lasers | Incidence of new WSLs (clinical); enamel microhardness, mineral loss, lesion depth and acid resistance (ex vivo) (n=8) |
| Study designs | RCTs / CCTs (with a laser arm) and ex vivo / in situ studies; English-language; last 10 years | 4 clinical RCTs + 4 ex-vivo / in situ studies (n=8) |
| Timing | Not specified | Clinical follow-up 3 to 18 months (4 RCTs) |
Search date: 2023-01-30. Databases: PubMed (primary); Scopus; EBSCO; Google Scholar (additional databases checked, only duplicates found)
Questions and results
Low-power CO2 laser irradiation (LLLT, 0.5 to 2 W) vs Placebo / no laser (control)
Population: High caries-risk patients: fixed-orthodontic-appliance patients and children with partially erupted permanent molars
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of new white spot lesions (WSLs) 3 to 18 months follow-up Low-power CO2 laser (LLLT) is associated with a lower incidence of new white spot lesions than placebo (OR 0.21, CI 0.15 to 0.30; ungraded, 3 RCTs, considerable heterogeneity I2=71%). Source: Abstract; Meta-analysis outcome (para); Fig 2 (forest plot) · same question in other reviews | OR 0.21 [0.15, 0.30] | 3 studies · 182 participants | Ungraded |
CO2 laser irradiation (0.4 to 5 W) vs Untreated control enamel
Population: Human / bovine enamel specimens under cariogenic challenge (in situ / ex vivo)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel surface / cross-sectional microhardness CO2 laser irradiation changes enamel microhardness versus untreated enamel (MD 49.55, CI 37.74 to 61.37; ungraded, 3 ex-vivo studies, I2=48%); the forest plot shows higher microhardness in laser-treated enamel, although the review text states the opposite. Source: Abstract; Meta-analysis outcome (para); Fig 4 (forest plot) · same question in other reviews | MD 49.55 [37.74, 61.37] | 3 studies · 64 participants | Ungraded |
Er:YAG laser irradiation vs Untreated / high-speed-handpiece control enamel
Population: Human enamel adjacent to restorations or in pits and fissures (in situ / ex vivo)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel resistance to demineralization (microhardness / lesion depth) Er:YAG laser showed a mixed and limited effect on enamel resistance to demineralization: feasible for controlling progression around restorations but not preventing caries formation, and ineffective in pits and fissures (ungraded, 2 ex-vivo studies, no pooled estimate). Source: Evaluation of the studies outcomes (para); Discussion; Table 2 (Colucci [21], Afonso [23]) · same question in other reviews | Narrative only (not meta-analyzed). Colucci: Er:YAG laser feasible for controlling caries progression adjacent to restorations but not able to prevent caries formation (optimum 2 Hz). Correa-Afonso: Er:YAG did not… | 2 studies | Ungraded |
Nd:YAG laser irradiation vs Untreated control enamel
Population: Human enamel in pits and fissures (in situ / ex vivo)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel acid resistance (cross-sectional microhardness) Nd:YAG laser increased enamel acid resistance versus untreated enamel in pits and fissures (ungraded, 1 ex-vivo study, no pooled estimate). Source: Evaluation of LASER type (para); Evaluation of the studies outcomes; Table 2 (Afonso [23]) · same question in other reviews | Narrative only (not meta-analyzed). Correa-Afonso: Nd:YAG (and CO2) laser increased enamel acid resistance in pits and fissures; microhardness of the Nd:YAG group was higher than the control group. | 1 study | Ungraded |
CO2 laser combined with fluoride vs Fluoride alone
Population: Human enamel specimens under cariogenic challenge (in situ / ex vivo)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel demineralization / mineral loss Evidence on a synergistic effect of combining CO2 laser with fluoride versus fluoride alone is mixed: one ex-vivo study found combined treatment superior while another found no synergy (ungraded, 2 ex-vivo studies, no pooled estimate). Source: Evaluation of the studies outcomes (para); Discussion; Table 2 (Takate [20], Gabriel [22]) · same question in other reviews | Narrative only (secondary question: laser-fluoride synergy). Takate: combined low-power CO2 laser plus 1.23% APF gave greater inhibition of mineral loss than either alone (APF after laser gave maximum inhibition).… | 2 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pit-and-fissure caries progression (ICDAS), CO2 laser vs fluoride varnish alone Rechmann 2013 (single RCT, n=20, 12-month follow-up) | no estimate extracted | 1 study | 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 | No | No | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: No | 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 8
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Mahmoudzadeh, 2019 Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial. PMID:31565692 | 1 other review | Incidence of new white spot lesions (WSLs) | not extracted yet | not extracted yet |
| Brandao, 2020 Efficacy of CO lasers in preventing dental caries in partially erupted first permanent molars: a randomized 18-month clinical trial. PMID:31970563 | this review only | Incidence of new white spot lesions (WSLs) | not extracted yet | not extracted yet |
| Colucci, 2015 Effect of Er:YAG laser on enamel demineralization around restorations. PMID:24522657 | this review only | Enamel resistance to demineralization (microhardness / lesion depth) | not extracted yet | not extracted yet |
| Correa-Afonso, 2013 Influence of laser irradiation on pits and fissures: an in situ study. PMID:23336742 | this review only | not stated | not extracted yet | not extracted yet |
| Raghis, 2018 Enamel resistance to demineralisation around orthodontic brackets after CO2 laser irradiation: a randomised clinical trial. PMID:30071781 | this review only | Incidence of new white spot lesions (WSLs) | not extracted yet | not extracted yet |
| Rechmann, 2013 In-vivo occlusal caries prevention by pulsed CO2 -laser and fluoride varnish treatment--a clinical pilot study. PMID:23737079 | this review only | not stated | not extracted yet | not extracted yet |
| Souza-Gabriel, 2015 In situ study of the anticariogenic potential of fluoride varnish combined with CO2 laser on enamel. PMID:25791325 | this review only | Enamel surface / cross-sectional microhardness | not extracted yet | not extracted yet |
| Takate, 2019 Assessment of Inhibition of Mineral Loss from Human Tooth Enamel by Carbon Dioxide Laser and 1.23% Acidulated Phosphate Fluoride. PMID:30923693 | this review only | Enamel surface / cross-sectional microhardness | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| Distribution of initial caries lesions in relation to fixed orthodontic therapy. A systematic review and meta-analysis. (2024) | 1 | 0.03 |