Jasrasaria Neha, Yadav Rakesh Kumar, Tiwari Rini
King George's Medical University, Lucknow, India.
Lasers Med Sci. 2025 May 23;40(1):242. doi: 10.1007/s10103-025-04496-7.
The study aimed to evaluate the clinical and radiographic outcomes of three treatment modalities: Biodentine alone, Er: YAG laser followed by Biodentine, and Er: YAG laser alone. The primary objective was to determine whether the use of Er: YAG laser enhances the success rate of direct pulp capping (DPC) in cariously exposed permanent teeth.
This study included 42 participants with mature permanent teeth requiring DPC, randomly assigned to three groups of 14 patients each. Group 1 received Biodentine alone, Group 2 underwent Er: YAG laser irradiation followed by Biodentine application, and Group 3 was treated with Er: YAG laser. The laser parameters used for enamel cutting and cavity preparation were: output power 8.0 W, energy 400 mJ, fluence 10 J/cm², spot size 0.8 mm, frequency 20 Hz, air 80%, and water 60%, in contact mode. For carious dentin removal, parameters were adjusted to 4.0 W power, 200 mJ energy, fluence 3 J/cm², frequency 20 Hz, air 90%, and water 30%, maintaining the same spot size. Pulp irradiation was performed using a 0.6 mm spot size, 0.5 W output power, 30 mJ energy and frequency 15 Hz in non-contact mode with no water spray, at a distance of 1.5 mm from the pulp. Laser was applied in a sweeping motion for 15 s per application, repeated 5-20 times until hemostasis was achieved. Clinical and radiographic evaluations were conducted at baseline, 3 months, 6 months and 12 months. Success was defined as the absence of pain, sensitivity, or pathology and evidence of dentin bridge formation on radiographs. Statistical analysis was performed to compare outcomes across groups.
All three groups demonstrated favourable clinical and radiographic success rates. Group 2 (Er: YAG laser + Biodentine) showed a statistically significant higher success rate compared to the other groups, particularly in terms of dentin bridge formation (p = 0.01) and reduced postoperative sensitivity (p = 0.03). Group 1 and Group 3 also performed well, but the outcomes in Group 3 were slightly inferior due to limited dentin bridge formation (p = 0.04).
The inclusion of Er: YAG laser in DPC procedures enhances treatment outcomes, particularly when combined with Biodentine. This approach offers a promising alternative for vital pulp therapy in mature permanent teeth, ensuring better dentin bridge formation and clinical success.
Clinical trial registration details (Registry-Clinical Trials Registry - India, Trial registration number-CTRI/2022/04/041678, and date of registration-06/04/2022).
本研究旨在评估三种治疗方式的临床和影像学结果：单纯使用BioDentine、铒激光（Er:YAG）照射后使用BioDentine以及单纯使用铒激光。主要目的是确定使用铒激光是否能提高龋源性暴露恒牙直接盖髓术（DPC）的成功率。
本研究纳入42例需要进行DPC的成熟恒牙患者，随机分为三组，每组14例。第一组单纯使用BioDentine，第二组先进行铒激光照射，然后应用BioDentine，第三组仅接受铒激光治疗。用于牙釉质切割和窝洞制备的激光参数为：输出功率8.0W，能量400mJ，能量密度10J/cm²，光斑尺寸0.8mm，频率20Hz，空气80%，水60%，接触模式。对于龋坏牙本质的去除，参数调整为功率4.0W，能量200mJ，能量密度3J/cm²，频率20Hz，空气90%，水30%，保持光斑尺寸不变。牙髓照射采用光斑尺寸0.6mm、输出功率0.5W、能量30mJ、频率15Hz的非接触模式，不喷水，距牙髓1.5mm。每次照射以扫动方式进行15秒，重复5 - 20次直至止血。在基线、3个月、6个月和12个月进行临床和影像学评估。成功定义为无疼痛、敏感或病变，且X线片上有牙本质桥形成的证据。进行统计分析以比较各组结果。
所有三组均显示出良好的临床和影像学成功率。第二组（铒激光 + BioDentine）与其他组相比，成功率在统计学上显著更高，特别是在牙本质桥形成方面（p = 0.01）和术后敏感性降低方面（p = 0.03）。第一组和第三组也表现良好，但第三组由于牙本质桥形成有限，结果略逊一筹（p =
