Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis
Avani R Doiphode, Ritesh Kalaskar, Ashita Kalaskar, Nilam V Honaje, Urvi P Gala
Citation Information :
Doiphode AR, Kalaskar R, Kalaskar A, Honaje NV, Gala UP. Clinical and Radiographic Efficacy of Low-level Laser Therapy and Formocresol as Pulpotomy Agents in Primary Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2024; 17 (9):1075-1085.
Research question: To evaluate the effectiveness of low-level laser therapy (LLLT) as a pulpotomy agent in primary molars.
Research protocol: This systematic review followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline 2020.
Literature search: An electronic search of the databases was performed to find the effectiveness of LLLT over formocresol as a pulpotomy agent in primary molars in children aged between 3 and 10 years.
Data extraction: Authors independently extracted the data from the 14 included studies based on the inclusion criteria. The inclusion criteria comprised studies that compared the clinical and radiographical effectiveness of LLLT pulpotomy with formocresol pulpotomy in primary molars using randomized clinical trials (RCTs).
Quality appraisal: The risk of bias was assessed using a tool developed by the Cochrane Collaboration for RCT studies.
Data analysis: The meta-analyses were performed using the fixed-effects model. Heterogeneity was assessed by a Q test and quantified with I2 statistics. Radiological and clinical success among the teeth treated with either formocresol or LLLT was considered the main outcome.
Results and interpretation of results: The search resulted in 390 published studies. After the removal of duplicate studies and analysis of full-text articles, 14 studies were selected for systematic review. Overall, the results demonstrated a high risk of selection and performance bias. No statistically significant difference was found between LLLT and formocresol as pulpotomy agents when compared clinically and radiographically at 6–9 and 12-month follow-up periods. LLLT is a good alternative method to be used as a pulpotomy agent in cases of reversible pulpitis.
Key message: Low-level laser therapy is an emerging and trending branch in dentistry because of its beneficial effects in various treatment approaches. It can be effectively used in the pulpotomy procedure due to its properties to reduce pulp inflammation, improve healing, and preserve dental pulp vitality.
Kazeminia M, Abdi A, Shohaimi S, et al. Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis. Head Face Med 2020;16:22. DOI: 10.1186/s13005-020-00237-z
American Academy of Pediatric Dentistry. Pulp therapy for primary and immature permanent teeth. The Reference Manual of Pediatric Dentistry. Chicago: American Academy of Pediatric Dentistry; 2020. pp. 384–392.
El Meligy OAES, Alamoudi NM, Allazzam SM, et al. Biodentine™ versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial. BMC Oral Health 2019;19:3. DOI: 10.1186/s12903-018-0702-4
Ghajari MF, Mirkarimi M, Vatanpour M, et al. Comparison of pulpotomy with formocresol and MTA in primary molars: a systematic review and meta-analysis. Iran Endod J 2008;3:45–49.
Pulikkotil SJ, Veettil SK, Vineet Dhar BD. Effectiveness of formocresol and ferric sulfate as pulpotomy material in primary molars: a systematic review and meta-analysis with trial sequential analysis of randomized clinical trials. Quintessence Int 2019;50:2–15.
Lewis B. The obsolescence of formocresol. Br Dent J 2009;207:525–528. DOI: 10.1038/sj.bdj.2009.1103
Carroll JD, Milward MR, Cooper PR, et al. Developments in low level light therapy (LLLT) for dentistry. Dent Mater 2014;30:465–475. DOI: 10.1016/j.dental.2014.02.006
Huth KC, Hajek-Al-Khatar N, Wolf P, et al. Long-term effectiveness of four pulpotomy techniques: 3-year randomised controlled trial. Clin Oral Investig 2012;16:1243–1250. DOI: 10.1007/s00784-011-0602-3
Liu J. Effects of Nd:YAG laser pulpotomy on human primary molars. J Endod 2006;32:404–407. DOI: 10.1016/j.joen.2006.01.005
Pescheck A, Pescheck B, Moritz A. Pulpotomy of primary molars with the use of a carbon dioxide laser: results of a long-term in vivo study. J Oral Laser Appl 2002;2:61–67.
Golpayegani MV, Ansari G, Tadayon N, et al. Low-level laser therapy for pulpotomy treatment of primary molars. Tehran Univ Med J 2009;6:168–174.
Joshi P, Baliga S, Rathi N, et al. A comparative evaluation between formocresol and diode laser assisted pulpotomy in primary molars–an in vivo study. Eur J Pharm Med Res 2017;4:569–575.
Yavagal CM, Lal A, Chavan Patil VV, et al. Efficacy of laser photobiomodulation pulpotomy in human primary teeth: a randomized controlled trial. J Indian Soc Pedod Prev Dent 2021;39:436–441. DOI: 10.4103/jisppd.jisppd_150_21
Ansari G, Chitsazan A, Fekrazad R, et al. Clinical and radiographic evaluation of diode laser pulpotomy on human primary teeth Diod Laser pulpotomy of primary teeth. Laser Therapy 2018;27:187–192. DOI: 10.5978/islsm.27_18-OR-17
Saltzman B, Sigal M, Clokie C, et al. Assessment of a novel alternative to conventional formocresol-zinc oxide eugenol pulpotomy for the treatment of pulpally involved human primary teeth: diode laser-mineral trioxide aggregate pulpotomy. Int J Paediatr Dent 2005;15:437–447. DOI: 10.1111/j.1365-263X.2005.00670.x
Fernandes AP, Lourenço Neto N, Teixeira Marques NC, et al. Clinical and radiographic outcomes of the use of low-level laser therapy in vital pulp of primary teeth. Int J Paediatr Dent 2015;25:144–150. DOI: 10.1111/ipd.12115
Durmus B, Tanboga I. In vivo evaluation of the treatment outcome of pulpotomy in primary molars using diode laser, formocresol, and ferric sulphate. Photomed Laser Surg 2014;32:289–295. DOI: 10.1089/pho.2013.3628
Ansari G, Morovati SP, Asgary S. Evaluation of four pulpotomy techniques in primary molars: a randomized controlled trial. Iran Endod J 2018;13:7. DOI: 10.22037/iej.v13i1.18407
Shaikh MN, Jha MN, Undre MI, et al. Outcome of pulpotomy in primary teeth using diode laser. J Contemp Dent 2019;9:72–77.
Alamoudi N, Nadhreen A, Sabbagh H, et al. Clinical and radiographic success of low-level laser therapy compared with formocresol pulpotomy treatment in primary molars. Pediatr Dent 2020;42:359–366.
Pei SL, Shih WY, Liu JF. Outcome comparison between diode laser pulpotomy and formocresol pulpotomy on human primary molars. J Dent Sci 2020;15:163–167. DOI: 10.1016/j.jds.2020.03.005
Kharbotly BM, Fawzy MI, Mostafa MH, et al. Clinical and radiographic assessment of an innovative pulpotomy technique compared to conventional in primary molars (randomized clinical trial). Al-Azhar Dent J Girls 2020;7:635–641.
Nadhreen A, Sabbagh H, Alamoudi N, et al. Photobiomodulation 810 nm diode laser and formocresol for primary molar pulpotomy: a randomized clinical trial. Egypt Dent J 2021;67:19–30.
Kaya C, Elbay ÜŞ, Elbay M, et al. The comparison of calcium hydroxide + biostimulation, calcium hydroxide, formocresol, and MTA pulpotomies without biostimulation in primary teeth: 12-months clinical and radiographic follow-up. Lasers Med Sci 2022;37:2545–2554. DOI: 10.1007/s10103-022-03536-w
Marques NC, Neto NL, Rodini Cde O, et al. Low-level laser therapy as an alternative for pulpotomy in human primary teeth. Lasers Med Sci 2015;30:1815–1822. DOI: 10.1007/s10103-014-1656-7
Uloopi KS, Vinay C, Ratnaditya A, et al. Clinical evaluation of low level diode laser application for primary teeth pulpotomy. J Clin Diagn Res 2016;10:ZC67–ZC70.
Golpayegani MV, Ansari G, Tadayon N. Clinical and radiographic success of low level laser therapy (LLLT) on primary molars pulpotomy. Res J Biol Sci 2010;5:51–55.
Šimunović L, Špiljak B, Vranić L, et al. Should the application of diode laser completely replace conventional pulpotomy of primary teeth? Appl Sci 2022;12:11667. DOI: 10.3390/app122211667
Saltzman BE. Diode LASER-MTA pulpotomy for the treatment of pulpally involved human primary teeth. 2004. Available from: tspace.library.utoronto.ca
Seby T. Clinical and radiographic success of three pulpotomy procedures in primary teeth: a randomized controlled clinical trial. 2016. Available from: repository-tnmgrmu.ac.in
Jha S, Goel N, Dash BP, et al. An update on newer pulpotomy agents in primary teeth: a literature review. J Pharm Bioallied Sci 2021;13:S57–S61. DOI: 10.4103/jpbs.JPBS_799_20
Jamali S, Nasrabadi N, Darvish M, et al. Clinical and radiographic outcomes comparison between various types of laser pulpotomy and formocresol pulpotomy on primary molars: a systematic review and meta-analysis. J Oral Maxillofac Surg Med Pathol 2021;33:75–82.
Moskovitz M, Tickotsky N, Dassa M, et al. Zinc oxide zinc sulfate versus zinc oxide eugenol as pulp chamber filling materials in primary molar pulpotomies. Children (Basel) 2021;8:776. DOI: 10.3390/children8090776
Subay RK, Ilhan B, Ulukapi H. Mineral trioxide aggregate as a pulpotomy agent in immature teeth: long-term case report. Eur J Dent 2013;7:133–138.