Efficacy of laser-assisted caries removal and hard tissue preparation: A meta-analysis.

INTRODUCTION/OBJECTIVES: The meta-analysis systematically explored clinical studies investigating caries excavation with a laser. DATA: Prospective controlled (non-)randomized clinical trials comparing caries excavation using a laser to using conventional burs. SOURCES: Four electronic databases (Central Cochrane, PubMed-Medline, Ovid-EMBASE, Web of science) were screened. Outcomes were e.g. restoration survival, excavation speed, pulp sensitivity/vitality, need of anesthesia, pain sensation. No time restrictions were applied. Risk of Bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler. STUDY SELECTION/RESULTS: Twenty in vivo studies with at least 2263 teeth being assessed in more than 1090 patients were included. Meta-analysis for comparing laser vs. bur revealed that restoration survival (risk ratio (RR)[95%CI]=1.51 [0.87;2.64, low level of evidence) and pulp vitality (RR[95%CI]=1.46 [0.33;6.46], low level of evidence) was not significantly influenced by the use of a laser. Furthermore, significantly fewer patients required anesthesia (RR[95%CI]=0.29 [0.11;0.75, very low level of evidence) and patients' pain sensation was significantly decreased (RR[95%CI]=0.35 [0.22;0.54], very low level of evidence) when a laser was used for excavation and preparation. In contrast, when using a laser for excavation/preparation significantly more time has to be planed compared to the use of a conventional bur (mean difference [95%CI]=2.23 [1.89;2.57], low level of evidence). CONCLUSION: Using a laser for excavation/preparation treatment does not affect restoration survival and pulp vitality compared to the use of conventional burs, while the need of anesthesia and patients' pain sensation can be reduced. However, significantly more time must be spent to achieve these benefits. CLINICAL SIGNIFICANCE: Laser-assisted caries removal reduces the need for anesthesia and minimizes patient discomfort compared to conventional rotary instruments, while restoration survival and pulp vitality are not affected. However, excavation speed remains significantly slower. Furthermore, results should be interpreted with caution considering the low level of the evidence.