Selective Caries Removal in Deciduous Teeth Using the Er:YAG Laser

Objectives: The concept of minimally invasive dentistry implies the removal of infected dentin or irreversibly denatured, preserving as much as possible of the remaining healthy tooth structure. The Er:YAG laser provide greater comfort to the infant patients due to the absence of pressure, vibration and noise produced by bur preparation.
The aim of the present clinical randomized study (split mouth) was evaluate effectiveness and efficiency of Er:YAG laser for selective caries removal in primary molars, microbiological dentine analysis and clinical restorations after 1 year.
Methods: The children’s teeth were randomized into two groups: (I) Er:YAG laser (II) bur preparation (n=42). The efficiency of selective caries removal was evaluated by the time spend on the procedure. To assess the effectiveness, the teeth were visual and tactile evaluated. Microbiological analysis was performed through the evaluation of Streptococcus mutans and Lactobacillus sp in remaining dentine. Clinical analysis of restorations was performed using USPHS method, along with photographs of restored teeth, 7 days after the restorative procedure and after 1 year. All cavities were restored employing the restorative system Adper Single Bond 2/ Filtek Z350 (3M). The obtained data were analyzed by t-test, Mann-Whitney and Kruskal-Wallis test with a significant level of 5%.
Results: The Er:YAG laser was less effective and presents the same efficacy of the bur preparation during the selective caries removal at the pulpal wall of deciduous molars. At the surrounding walls, the bur preparation was more effective. Regardless of the method employed, the affected dentine of the pulpal wall presented similar amount of Streptococcus mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method at the one-year period.
Conclusions: The selective caries removal with the Er:YAG laser had no influence on the clinical behavior of restorations.