Clinical and radiographic evaluation of Er: YAG laser-assisted direct pulp capping in permanent teeth with carious exposure.

PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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

Clinical trial registration details (Registry-Clinical Trials Registry - India, Trial registration number-CTRI/2022/04/041678, and date of registration-06/04/2022).