Clinical and radiographic outcomes of laser pulpotomy in vital primary teeth: a systematic review and meta-analysis
Abstract
Aim
This was to compare clinical and radiographic success rates of laser pulpotomy with those of other pulpotomy techniques in primary teeth.
Methods
PubMed, SCOPUS, EMBASE, Cochrane and ISI Web of Knowledge databases were searched electronically without time or language limitations. Clinical trials in which laser pulpotomy was compared with at least one other pulpotomy modality in primary teeth were selected. The bibliographic reference lists of eligible articles were also hand-searched. Odds ratios, risk differences and 95% confidence intervals were calculated with the aid of Comprehensive Meta-Analysis software (Version 2.2.050, Biostat, Englewood, NJ, USA). The methodological quality of articles included in the meta-analysis was determined using the Jadad scale.
Results
Twelve pulpotomy studies were selected for systematic review and underwent data extraction. Of these studies, statistical analysis was conducted on 11. All clinical trials had low to moderate risks of methodological bias. The meta-analysis showed no significant differences in clinical and radiographic pulpotomy outcomes with laser compared with other techniques (p > 0.05). Likewise, no differences were found in the outcomes at 1, 3, 6, 9, 12 or ≥ 18 months (all p > 0.05).
Conclusions
For primary molar pulpotomy, the laser technique showed comparable clinical and radiographic results to other conventional pulpotomy medicaments, including formocresol and mineral trioxide aggregate.
Keywords
Lasers Meta-analysis Pulpotomy Systematic review Primary teeth Treatment outcomeNotes
Funding
No funding was received.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
References
- American Academy of Paediatric Dentistry. Guideline on pulp therapy for primary and immature permanent teeth. Pediatr Dent. 2016;38(6):280–8.Google Scholar
- Bagherian A, Sarraf Shirazi A. Preparation before acid etching in fissure sealant therapy: yes or no? A systematic review and meta-analysis. J Am Dent Assoc. 2016;147(12):943–51. https://doi.org/10.1016/j.adaj.2016.08.003.CrossRefPubMedGoogle Scholar
- Celik B, Atac AS, Cehreli ZC, Uysal S. A randomized trial of mineral trioxide aggregate cements in primary tooth pulpotomies. J Dent Child (Chic). 2013;80(3):126–32.Google Scholar
- De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent. 2013;23(6):389–99. https://doi.org/10.1111/ipd.12014.PubMedGoogle Scholar
- DerSimonian R, Laird N. Meta-analysis in clinical trials revisited. Contemp Clin Trials. 2015;45(Pt A):139–45. https://doi.org/10.1016/j.cct.2015.09.002.CrossRefPubMedPubMedCentralGoogle Scholar
- Durmus B, Tanboga I. In vivo evaluation of the treatment outcome of pulpotomy in primary molars using diode laser, formocresol, and ferric sulphate. Photomed Laser Surg. 2014;32(5):289–95. https://doi.org/10.1089/pho.2013.3628.CrossRefPubMedPubMedCentralGoogle Scholar
- Elliott RD, Roberts MW, Burkes J, Phillips C. Evaluation of the carbon dioxide laser on vital human primary pulp tissue. Pediatr Dent. 1999;21(6):327–31.PubMedGoogle Scholar
- Fernandes AP, Lourenco Neto N, Teixeira Marques NC, et al. Clinical and radiographic outcomes of the use of low-level laser therapy in vital pulp of primary teeth. Int J Paediatr Dent. 2015;25(2):144–50. https://doi.org/10.1111/ipd.12115.CrossRefPubMedGoogle Scholar
- Fuks AB. Current concepts in vital primary pulp therapy. Eur J Paediatr Dent. 2002;3(3):115–20.PubMedGoogle Scholar
- Fuks AB, Papagiannoulis L. Pulpotomy in primary teeth: review of the literature according to standardized criteria. Eur Arch Paediatr Dent. 2006;7(2):64–71.CrossRefPubMedGoogle Scholar
- Furze HA, Furze ME. Pulpotomy with laser in primary and young permanent teeth. J Oral Laser Appl. 2006;6(1):53–8.Google Scholar
- Golpayegani MV, Ansari G, Tadayon N, Shams S, Mir M. Low-level laser therapy for pulpotomy treatment of primary molars. J Dent Tehran Univ Med Sci. 2009;6(4):168–74.Google Scholar
- Gupta G, Rana V, Srivastava N, Chandna P. Laser pulpotomy-an effective alternative to conventional techniques: a 12 months clinicoradiographic study. Int J Clin Pediatr Dent. 2015;8(1):18–21. https://doi.org/10.5005/jp-journals-10005-1277.CrossRefPubMedPubMedCentralGoogle Scholar
- Havale R, Anegundi RT, Indushekar K, Sudha P. Clinical and radiographic evaluation of pulpotomies in primary molars with formocresol, glutaraldehyde and ferric sulphate. Oral Health Dent Manag. 2013;12(1):24–31.PubMedGoogle Scholar
- Huth KC, Hajek-Al-Khatar N, Wolf P, et al. Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial. Clin Oral Investig. 2012;16(4):1243–50. https://doi.org/10.1007/s00784-011-0602-3.CrossRefPubMedGoogle Scholar
- Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.CrossRefPubMedGoogle Scholar
- Jukic S, Anic I, Koba K, Najzar-Fleger D, Matsumoto K. The effect of pulpotomy using CO2 and Nd:YAG lasers on dental pulp tissue. Int Endod J. 1997;30(3):175–80.CrossRefPubMedGoogle Scholar
- Khorakian F, Mazhari F, Asgary S, et al. Two-year outcomes of electrosurgery and calcium-enriched mixture pulpotomy in primary teeth: a randomised clinical trial. Eur Arch Paediatr Dent. 2014;15(4):223–8. https://doi.org/10.1007/s40368-013-0102-z.CrossRefPubMedGoogle Scholar
- Klingberg G, Ridell K, Brogardh-Roth S, Vall M, Berlin H. Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents. Eur Arch Paediatr Dent. 2017. https://doi.org/10.1007/s40368-017-0302-z.PubMedCentralGoogle Scholar
- Kuo HY, Lin JR, Huang WH, Chiang ML. Clinical outcomes for primary molars treated by different types of pulpotomy: a retrospective cohort study. J Formos Med Assoc. 2017. https://doi.org/10.1016/j.jfma.2017.02.010.Google Scholar
- Lin PY, Chen HS, Wang YH, Tu YK. Primary molar pulpotomy: a systematic review and network meta-analysis. J Dent. 2014;42(9):1060–77. https://doi.org/10.1016/j.jdent.2014.02.001.CrossRefPubMedGoogle Scholar
- Liu JF. Effects of Nd:YAG laser pulpotomy on human primary molars. J Endod. 2006;32(5):404–7. https://doi.org/10.1016/j.joen.2006.01.005.CrossRefPubMedGoogle Scholar
- Malekafzali B, Shekarchi F, Asgary S. Treatment outcomes of pulpotomy in primary molars using two endodontic biomaterials. A 2-year randomised clinical trial. Eur J Paediatr Dent. 2011;12(3):189–93.PubMedGoogle Scholar
- Mareddy A, Mallikarjun SB, Shetty PV, Rao V, Chandru T. Histological evaluation of diode laser pulpotomy in dogs. J Oral Laser Appl. 2010;10(1):7–16.Google Scholar
- Marques NC, Neto NL, Rodini Cde O, et al. Low-level laser therapy as an alternative for pulpotomy in human primary teeth. Lasers Med Sci. 2015;30(7):1815–22. https://doi.org/10.1007/s10103-014-1656-7.CrossRefPubMedGoogle Scholar
- Martens L, De Smet S, Yusof MY, Rajasekharan S. Association between overweight/obesity and periodontal disease in children and adolescents: a systematic review and meta-analysis. Eur Arch Paediatr Dent. 2017;18(2):69–82. https://doi.org/10.1007/s40368-017-0272-1.CrossRefPubMedGoogle Scholar
- Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12. https://doi.org/10.1016/j.jclinepi.2009.06.005.CrossRefPubMedGoogle Scholar
- Nazemisalman B, Farsadeghi M, Sokhansanj M. Types of lasers and their applications in pediatric dentistry. J Lasers Med Sci. 2015;6(3):96–101. https://doi.org/10.15171/jlms.2015.01.CrossRefPubMedPubMedCentralGoogle Scholar
- Nematollahi H, Sahebnasagh M, Parisay I. Comparison of electrosurgical pulpotomy with zinc oxide eugenol or zinc polycarboxylate cements sub-base. J Clin Pediatr Dent. 2011;36(2):133–7.CrossRefPubMedGoogle Scholar
- Niranjani K, Prasad MG, Vasa AA, et al. Clinical evaluation of success of primary teeth pulpotomy using mineral trioxide aggregate (R), laser and biodentine(TM)—an in vivo study. J Clin Diagn Res. 2015;9(4):ZC35–7. https://doi.org/10.7860/jcdr/2015/13153.5823.PubMedPubMedCentralGoogle Scholar
- Odabas ME, Bodur H, Baris E, Demir C. Clinical, radiographic, and histopathologic evaluation of Nd:YAG laser pulpotomy on human primary teeth. J Endod. 2007;33(4):415–21. https://doi.org/10.1016/j.joen.2006.12.013.CrossRefPubMedGoogle Scholar
- Parisay I, Ghoddusi J, Forghani M. A review on vital pulp therapy in primary teeth. Iran Endod J. 2015;10(1):6–15.PubMedGoogle Scholar
- Peng L, Ye L, Tan H, Zhou X. Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(6):e40–4. https://doi.org/10.1016/j.tripleo.2006.05.017.CrossRefPubMedGoogle Scholar
- Peng L, Ye L, Guo X, et al. Evaluation of formocresol versus ferric sulphate primary molar pulpotomy: a systematic review and meta-analysis. Int Endod J. 2007;40(10):751–7. https://doi.org/10.1111/j.1365-2591.2007.01288.x.CrossRefPubMedGoogle Scholar
- Prathima GS, Bhadrashetty D, Babu SB, Disha P. Microdentistry with lasers. J Int Oral Health. 2015;7(9):134–7.PubMedPubMedCentralGoogle Scholar
- Ranly DM. Pulpotomy therapy in primary teeth: new modalities for old rationales. Pediatr Dent. 1994;16(6):403–9.PubMedGoogle Scholar
- Ren C, McGrath C, Yang Y. The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis. Lasers Med Sci. 2015;30(7):1881–93. https://doi.org/10.1007/s10103-015-1743-4.CrossRefPubMedPubMedCentralGoogle Scholar
- Rivera N, Reyes E, Mazzaoui S, Moron A. Pulpal therapy for primary teeth: formocresol vs electrosurgery: a clinical study. J Dent Child (Chic). 2003;70(1):71–3.Google Scholar
- Ruby JD, Cox CF, Mitchell SC, et al. A randomized study of sodium hypochlorite versus formocresol pulpotomy in primary molar teeth. Int J Paediatr Dent. 2013;23(2):145–52. https://doi.org/10.1111/j.1365-263X.2012.01237.x.CrossRefPubMedGoogle Scholar
- Saltzman B, Sigal M, Clokie C, et al. Assessment of a novel alternative to conventional formocresol–zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy. Int J Paediatr Dent. 2005;15(6):437–47. https://doi.org/10.1111/j.1365-263X.2005.00670.x.CrossRefPubMedGoogle Scholar
- Shabzendedar M, Mazhari F, Alami M, Talebi M. Sodium hypochlorite vs formocresol as pulpotomy medicaments in primary molars: 1-year follow-up. Pediatr Dent. 2013;35(4):329–32.PubMedGoogle Scholar
- Shoji S, Nakamura M, Horiuchi H. Histopathological changes in dental pulps irradiated by CO2 laser: a preliminary report on laser pulpotomy. J Endod. 1985;11(9):379–84. https://doi.org/10.1016/s0099-2399(85)80024-8.CrossRefPubMedGoogle Scholar
- Simancas-Pallares MA, Diaz-Caballero AJ, Luna-Ricardo LM. Mineral trioxide aggregate in primary teeth pulpotomy. A systematic literature review. Med Oral Patol Oral Cir Bucal. 2010;15(6):e942–6.CrossRefPubMedGoogle Scholar
- Togaru H, Muppa R, Srinivas N, et al. Clinical and radiographic evaluation of success of two commercially available pulpotomy agents in primary teeth: an in vivo study. J Contemp Dent Pract. 2016;17(7):557–63.PubMedGoogle Scholar
- Uloopi KS, Vinay C, Ratnaditya A, et al. Clinical evaluation of low level diode laser application for primary teeth pulpotomy. J Clin Diagn Res. 2016;10(1):ZC67–70. https://doi.org/10.7860/jcdr/2016/13218.7140.CrossRefPubMedPubMedCentralGoogle Scholar
- Utsunomiya T. A histopathological study of the effects of low-power laser irradiation on wound healing of exposed dental pulp tissues in dogs, with special reference to lectins and collagens. J Endod. 1998;24(3):187–93. https://doi.org/10.1016/s0099-2399(98)80181-7.CrossRefPubMedGoogle Scholar
- Waterhouse PJ. Formocresol and alternative primary molar pulpotomy medicaments: a review. Endod Dent Traumatol. 1995;11(4):157–62.CrossRefPubMedGoogle Scholar
- Yadav P, Indushekar K, Saraf B, Sheoran N, Sardana D. Comparative evaluation of ferric sulfate, electrosurgical and diode laser on human primary molars pulpotomy: an “in-vivo” study. Laser Ther. 2014;23(1):41–7. https://doi.org/10.5978/islsm.14-OR-05.CrossRefPubMedPubMedCentralGoogle Scholar
- Yildiz E, Tosun G. Evaluation of formocresol, calcium hydroxide, ferric sulfate, and MTA primary molar pulpotomies. Eur J Dent. 2014;8(2):234–40. https://doi.org/10.4103/1305-7456.130616.CrossRefPubMedPubMedCentralGoogle Scholar