Laser Analgesia Associated with Restorative Dental Care: A Systematic Review of the Rationale, Techniques, and Energy Dose Considerations.

Riccardo Poli,Martin Grootveld,Valina Mylona,Eugenia Anagnostaki,Steven Parker,Edward Lynch

doi:10.3390/dj8040128

Riccardo Poli, Martin Grootveld + Show 4 more

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https://doi.org/10.3390/dj8040128

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Abstract

It is a common experience amongst laser dentists and patients that mid-IR wavelength application in cavity preparation may be achieved without causing any associated pain. The erbium family of lasers (Er,Cr:YSGG 2780 nm and Er:YAG 2940 nm) are frequently used without employing injectable local anesthesia as an adjunct: the phenomenon arising from the application of these devices is known as laser analgesia. This review seeks to apply a systematic approach to the examination of appropriate published studies but also to highlight the need for much more structured clinical investigations that consolidate photonic dose and methodology. A search of published data using PRISMA criteria was carried out to examine clinical trials into laser analgesia in conjunction with restorative dentistry, applying inclusion and exclusion criteria. From this, 10 published articles were selected for analysis. Suitability assessment was carried out, using a modified Cochrane risk of bias methodology. In 8/10 of the included studies, laser-induced analgesia is claimed to be better and effective, while in 2/10 of the studies, no difference was exhibited compared to the control group. Statistical analysis of three split mouth studies concluded that only one of these investigations reviewed demonstrated a significant analgesic effect for laser treatment while the other two did not support this observation. From this data, it is inconclusive to assess the predictability of laser analgesia in cavity preparation. A possible rationale and laser operating parametry has been discussed. Successful implementation of this treatment modality remains technique sensitive and subject to further investigation.

Highlights

During the development of laser applications in dentistry, several wavelengths have been used in an attempt to perform caries removal and cavity preparation
An electronic search was conducted relating to laser analgesia applications in all fields of dentistry from 17 July to 19 July 2020
The primary goal of this review was to explore the effectiveness of laser-induced analgesia in clinical dental practice

Summary

Introduction

During the development of laser applications in dentistry, several wavelengths have been used in an attempt to perform caries removal and cavity preparation. The first devices (i.e., CO2 10,600 nm and Nd:YAG 1064 nm) had insufficient ability to penetrate into dental hard tissues and produced major thermal side-effects, such as melting, carbonisation, cracks in the surrounding dental tissues, and increases in pulpal temperature [1,2,3,4]. The introduction of erbium family lasers (Er,Cr:YSGG 2780 nm and Er:YAG 2940 nm) has allowed a more effective removal of oral hard tissues (enamel, dentine, cementum, and bone) and this major benefit is coupled with a low risk of thermal damage.

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