Only weak evidence that laser-assisted pulpotomy improves outcomes in primary teeth

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Pulpotomy procedure are used to maintain a carious tooth by removing the infected pulp and lasers have been shown to reduce bacterial levels in human tissue.  The aim of this review was to identify studies comparing laser with conventional techniques for pulpotomy procedures in primary teeth and to evaluate their methodological quality, to assess whether laser treatment may represent an appreciable benefit over conventional approaches.

The Medline, Web of Science and Cochrane’s CENTRAL databases were searched for prospective studies, Randomized controlled trials (RCT), case– control studies, or case series (CS) with at least 6 months follow-up. Initial selection and quality assessment of the articles was carried out by two reviewers.

  • Seven studies were included, five RCTs and 2 CS. One study also included data on permanent teeth – so only primary tooth data was considered.
  • Studies involved Nd:YAG, Er:YAG, CO2 and 632/980 nm diode lasers.
  • A qualitative summary of the studies is presented as no meta-analysis was conducted as there was significant heterogeneity between the studies.
  • The available data suggest that lasers are less successful than conventional pulpotomy techniques.

The authors concluded

To date, there is only weak evidence that laser application may enhance treatment outcomes of pulpotomy procedures. Consequently general recommendations for the clinical use of laser in pulpotomy in primary teeth can yet not be formulated.

Comment

Earlier this month  (6th Dec 2012) we looked at another review by Fransson et al  that looked at the efficacy of laser as an adjunct to root canal treatment. That review found only 5 low quality studies that also suggest no positive effect with laser use.  The review focuses on primary teeth and included a detailed discussion of the included studies no quality assessment of the individual studies is presented.

Links

De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent. 2012 Nov 22. doi: 10.1111/ipd.12014. [Epub ahead of print] PubMed PMID: 23171469.

The Dental Elf 6th December 2012

 

 

 

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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