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Literature Review June 2023

Laser Literature Review

Compiled by Dr Igor Cernavin, Prosthodontist, Honorary Senior Fellow University of Melbourne School of Medicine, Dentistry and Health Sciences.

Zang et al1 compared the clinical effect of Er:YAG laser and turbine handpiece in the removal of lower horizontally impacted wisdom teeth and concluded that operation time of extraction with Er:YAG laser is similar to that with turbine handpiece, but laser can reduce postoperative reaction and the incidence of complications.

Habshi and coworkers2 published an article on the efficacy of smear layer removal at the apical one-third of the root using different protocols of the Er:YAG lser. The abstract is reproduced in full.

Background and Objectives: Smear layer forms during cleaning and shaping can obstruct the entry of both irrigant and sealant into the dentinal tubules, resulting in the accumulation of the bacteria and their byproducts. To ensure effective adhesion and better periapical healing, it is strongly advised to remove the smear layer before proceeding with root canal obturation. This study was designed to compare the efficiency of laser-activated irrigation (LAI) in removing the smear layer and debriding the most apical third of the root canal. Materials and Methods: Sixty-five extracted human teeth with straight single roots were randomly and equally divided into four laser and one control groups. Root canals in all samples were shaped using prime size TruNatomy rotary files. During preparation, each canal was irrigated with 3 mL of 3% NaOCl and 3 mL of 17% EDTA alternately, followed by the irrigation with 10 mL of distilled water to avoid the prolonged effect of EDTA and NaOCl solutions. Final irrigation of 5 mL of 17% EDTA of the root canal was done to eliminate the smear layer and was subsequently activated by an endodontic ultrasonic tip for 20 s three times (control group), a flat-end laser tip (test groups 1 and 3) or a taper-end laser tip (test groups 2 and 4) for two cycles. The time of each cycle activation was 10 s (groups 1 and 2) or 20 s (groups 3 and 4) in which the Er:YAG laser of 2940 nm was used. The laser operating parameters were 15 Hz and 50 mus pulse duration. The samples were then split longitudinally and subjected to scanning electron microscopy (SEM). Results: The remaining smear layer at the apical part of the root canals was statistically significant between the control group and the laser groups 1 (p = 0.040) and 2 (p = 0.000). Within the laser groups, the exposed tubules count was greater in the laser with the flat tip as compared with the tapered tip (Laser 1 > Laser 2 and Laser 3 > Laser 4). Finally, no significant differences in the count of debris between the laser groups and control group were observed, except for laser 4 (p < 0.05), which had the highest count of debris. Conclusion: LAI to remove debris and smear layer at the apical third of the root canal is inferior to the current ultrasonic technique. However, when using the Er:YAG LAI, it is recommended to use a flat tip design for 10 s for two cycles to ensure maximum debridement of the apical dentin surface.

Manente et al3 published the results of a systematic review on the use of laser acupuncture in the treatment of neuropathies in dentistry and found that it presented itself as a viable alternative in dentistry for the treatment of paresthesia and facial paralysis due to its therapeutic potential in neuropathic treatment.

Abdulhussein and coworkers4 examined the preventive effect of combined Er, Cr:YSGG and fluoride on acid resistance of permanent tooth enamel and concluded that it provided a more significant benefit.

Pion et al5 carried out a systematic review and meta-analysis on the use of lasers for dentine hypersensitivity and concluded that regardless of the type of laser used in the treatment of DH, this treatment is an effective option.

Attia and coworkers6 evaluated the effect of low-level laser therapy (LLLT) on bone density (BD) and osteoprotegerin levels in peri-implant crevicular fluid (PICF) in type II diabetic patients and found that LLLT significantly improved bone quality during osseointegration on dental implants in type 2 diabetic patients. LLLT is considered potentially important for T2DM patients during implant placement.

Al-Karadaghi et al7 in an in vitro research study aimed to examine the effectiveness of the 2790nm Er,Cr:YSGG laser utilizing a fractional technique to debond lithium disilicate veneers. They found that the Er,Cr:YSGG laser with a fractional technique can be used successfully for veneer removal. Besides safe temperature rising, veneers can be reused because there was neither a fractured specimen during the whole study nor major irregularities or cracks shown in SEM pictures analysis for the veneer surfaces; thus, they can be removed quickly, safely, and comfortably using Er,Cr:YSGG.

Seghaver and coworkers8 published an article on the effect of passive Ultrasonic Irrigation, Er,Cr:YSGG Laser, and Photon-Induced Photoacoustic Streaming against Enterococcus faecalis Biofilms in the Apical Third of Root Canals. Their findings were that PUI and PIPS showed a significantly greater reduction in bacterial content within the main root canal compared with the WTL. There was no difference among all experimental groups in the apical third of the root.

Amadoriet et al9 carried out a randomized, double blind, controlled study examining the effects of photobiomodulation on pemphigus vulgaris oral lesions. They found that it was a validated therapeutic option.

Sourvanos and coworkers10 published a scoping review and analysis designed to assess the amount of time spent delivering photobiomodulation (PBM) light therapy after dental extraction to improve postoperative pain and wound healing. They concluded that there is future potential to integrate PBM after dental extraction therapy to improve postoperative pain and clinical wound healing. The amount of time spent delivering PBM will vary by wavelength and the type of device.


1. Comparative study on extraction of impacted mandibular wisdom teeth by Er:YAG laser and turbine handpiece. Zhang, Ying-Hao; Zhao, Ning; (...); Zhu, Chao. Shanghai kou qiang yi xue = Shanghai journal of stomatology 32 (1), 2023-feb, pp.75-79.

2. Efficacy of Smear Layer Removal at the Apical One-Third of the Root Using Different Protocols of Erbium-Doped Yttrium Aluminium Garnet (Er:YAG) Laser. Habshi, Amel Yousif; Aga, Nausheen; (...); Jouhar, Rizwan. Medicina (Kaunas, Lithuania) 59 (3) 2023-02-22.

3. Laser acupuncture in the treatment of neuropathies in dentistry: a systematic review. Manente, Rafaela; Pedroso, Gabriela Leite; (...); Corona, Silmara Aparecida Milori. Lasers in medical science 38 (1) , 2023-03-25 pp.92.

4. Preventive effect of combined Er, Cr: YSGG and fluoride gel on acid resistance of the permanent tooth enamel: An in vitro study. Abdulhussein, Dhuha-Najm and Al Haidar, Aseel-Haidar M J. Journal of clinical and experimental dentistry 15 (3) , 2023-03-01 pp.e225-e232.

5. Treatment outcome for dentin hypersensitivity with laser therapy: Systematic review and meta-analysis. Pion, Luciana Antonio; Matos, Lais Lopes Machado De; (...); Faraoni, Juliana Jendiroba 2023 Jan-mar | Dental and medical problems 60 (1) , pp.153-166.

6. The Influence of Low-Level Laser Therapy on CBCT Radiographic and Biochemical Profiles of Type II Controlled Diabetic Patients After Dental Implant Insertion: A Randomized Case-Control Study. Attia, Mai S; Elewa, Gasser M; (...); Ghoneim, Mohamed M. 2023-03-23 | Cureus 15 (3) , pp.e36559.

7. Debonding of LDSVs utilising Er,Cr:YSGG laser irradiation with fractional technique: an in vitro study. Al-Karadaghi, S S and Jawad, Hussein A. Australian Dental Journal. 2023-apr-25.

8. Effect of Passive Ultrasonic Irrigation, Er,Cr:YSGG Laser, and Photon-Induced Photoacoustic Streaming against Enterococcus faecalis Biofilms in the Apical Third of Root Canals. Seghayer, Ibrahim; Lee, Angeline H C; (...); Zhang, Chengfei. Bioengineering (Basel, Switzerland) 10 (4)> 2023-04-20.

9. Photobiomodulation laser therapy in pemphigus vulgaris oral lesions: A randomized, double-blind, controlled study. Amadori, Francesca; Bardellini, Elena; (...); Majorana, Alessandra. Stomatologija 24 (3) , pp.80-84. 2022

10. Photobiomodulation in dental extraction therapy: Postsurgical pain reduction and wound healing. Sourvanos, Dennis; Lander, Bradley; (...); Fiorellini, Joseph P. Journal of the American Dental Association (1939) 2023-may-18.

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