Four-year clinical prospective follow-up of resin composite restoration after selective caries removal using Er:YAG laser



The aim of this study was to longitudinally evaluate, after a 4-year period, the clinical longevity of composite resin restoration compared to the baseline, after selective caries removal in permanent molars using Er:YAG laser or bur preparation with biomodification of dentin with the use of chlorhexidine.


Selective caries removal was performed on 80 teeth of 20 individuals who each had at least four active carious lesions. These lesions, located on occlusal surfaces of permanent molar counterparts, were removed using (i) Er:YAG laser biomodified with chlorhexidine, (ii) Er:YAG laser and application of deionized water, (iii) bur preparation biomodified with chlorhexidine, and (iv) bur preparation and application of deionized water. At the end of 4 years, 64 of the 80 restorations were evaluated in 16 individuals (n = 16). The restorations were evaluated, both clinically and photographically, using scanning electron microscopy (SEM) and pulp vitality analysis. The experimental data were statistically evaluated by kappa, Fisher’s, and chi-square tests, with a significance level of 5%. The Kaplan–Meier test and the Cox regression analysis were used to evaluate the survival of the restorations.


After 4 years of follow-up, there was a statistically significant difference in marginal discoloration criteria for all of the groups evaluated. For marginal adaptation criteria, there was a statistically significant difference for the Er:YAG laser group biomodified with chlorhexine (p = 0.050). For clinical and radiographic evaluation of pulp vitality, there were no statistically significant differences among the groups (p = 0.806).


Er:YAG laser can be used for selective caries removal, regardless of dentin biomodification with chlorhexidine or application of deionized water, once it produced promising results in composite resin restorations after 4 years of follow-up, according to the criteria evaluated. The selective caries removal using Er:YAG laser or bur and the biomodification of dentin with the use of chlorhexidine did not influence the survival of composite resin restorations after the 4-year follow-up period.

Clinical relevance

Composite resin restorations applied after selective caries removal using Er:YAG laser or burs, regardless of dentin biomodification with the use of chlorhexidine or application of deionized water, showed adequate clinical behavior after 4 years of follow-up.

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The author thanks the Ribeirão Preto, School of Dentistry / University of São Paulo (FORP/USP), for giving all the necessary support for accomplishing this research and the São Paulo Research Foundation (FAPESP) for its financial support (2012/06910-6).


São Paulo Research Foundation (FAPESP) process number (2012/06910-6).

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Correspondence to Maria Cristina Borsatto.

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This study was approved by the Research Ethics Committee of the Ribeirao Preto School of Dentistry, University of São Paulo (FORP/USP—Case No. 2016.1.586.58.4). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Valério, R.A., Galo, R., Galafassi, D. et al. Four-year clinical prospective follow-up of resin composite restoration after selective caries removal using Er:YAG laser. Clin Oral Invest 24, 2271–2283 (2020).

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  • Lasers
  • Clinical trial
  • Permanent restorative dentistry
  • Composite resins
  • Dental marginal adaptation