A Systematic Review of Laser Pulpotomy in Pediatric Dentistry: Clinical Efficacy and Outcomes Compared to Conventional Techniques

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 3, June – 2025, Page No. : 07 - 11 Corresponding Author: Dr. Divya Kadali, ijdsir, Volume – 8 Issue - 3, Page No. : 07 - 11 Page7 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 A Systematic Review of Laser Pulpotomy in Pediatric Dentistry: Clinical Efficacy and Outcomes Compared to Conventional Techniques 1Dr.G. Anna Manojna, Department of Pediatric and Preventive Dentistry, Assistant Professor, St Joseph Dental College, Duggirala, Eluru, Andhra Pradesh. 2Dr Farouq Afsha Md, Senior Lecturer, Department of Oral & Maxillofacial Surgery, Care Dental College and Hospital, Guntur. 3Dr. Divya Kadali, Associate, Professor, Department of Periodontics, Care Dental College and Hospital, Guntur, Andhra Pradesh, India. 4Dr. Lokeswari Devi Donavalli, MDS 1st Year, Conservative and Endodontic department, GITAM Dental College, Visakhapatnam, Andhra Pradesh, India. 5Dr.Annem Venkata Shalmeeja, MDS 1st Year, Department of Periodontics and Implantology, DRS. Sudha and Nageshwar Rao Siddartha Institute of Dental Sciences, Chinaoutapalli, Andhra Pradesh, India. Corresponding Author: Dr. Divya Kadali, Associate, Professor, Department of Periodontics, Care Dental College and Hospital, Guntur. Andhra Pradesh, India. Citation of this Article: Dr. G. Anna Manojna, Dr Farouq Afsha Md, Dr. Divya Kadali, Dr. Lokeswari Devi Donavalli, Dr. Annem Venkata Shalmeeja, “A Systematic Review of Laser Pulpotomy in Pediatric Dentistry: Clinical Efficacy and Outcomes Compared to Conventional Techniques”, IJDSIRJune – 2025, Volume – 8, Issue – 3, P. No. 07 – 11. Copyright: © 2025, Dr. Vaibhav Pandey, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Laser pulpotomy has emerged as a promising alternative to conventional pulpotomy techniques in pediatric dentistry. This systematic review critically evaluates recent studies investigating the efficacy of laser modalities—particularly diode, Er, Cr: YSGG, and photobiomodulation lasers—when used in the pulpotomy of primary teeth. Comparative analyses with traditional materials such as formocresol and mineral trioxide aggregate (MTA) were conducted to assess clinical and radiographic success rates. The findings indicate that laser pulpotomy yields comparable or superior outcomes, with reported advantages including enhanced hemostasis, reduced intraoperative bleeding, shortened treatment time, and improved patient comfort. Additionally, this review highlights differences in lasertissue interaction, mechanisms of action, and procedural protocols among various laser types. Despite encouraging evidence, heterogeneity in methodology and follow-up periods across studies underscores the Dr. Divya Kadali, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 Page8 need for standardized clinical protocols and long-term randomized controlled trials. Overall, laser pulpotomy represents a clinically effective and patient-friendly option that warrants further investigation for widespread implementation in pediatric dental practice. Keywords: Introduction Pulpotomy remains a cornerstone in pediatric dentistry, aimed at preserving the integrity of cariously involved primary teeth until their natural exfoliation. It entails the removal of coronal pulp tissue with the intent to maintain the vitality of the radicular pulp1. Historically, formocresol has been widely utilized for this purpose due to its fixative and bactericidal effects. However, increasing concerns about its potential cytotoxicity and systemic effects have prompted the search for biocompatible alternatives2. Mineral trioxide aggregate (MTA), ferric sulfate, and calcium hydroxide are some of the widely studied alternatives that offer improved biocompatibility and outcomes, albeit with their own limitations, such as high cost, discoloration, and technique sensitivity3,4. In recent years, the integration of laser technology in pediatric pulp therapy has been explored with increasing interest. Lasers are proposed to offer several benefits, including enhanced hemostasis, bacterial decontamination, and stimulation of reparative dentin formation, making them suitable for pulpotomy procedures5. Several types of lasers have been studied in Pediatric pulpotomy, including diode lasers (810–980 nm), Er, Cr: YSGG lasers (2780 nm), and low-level laser therapy (LLLT)/photobiomodulation. These differ in their mechanisms of tissue interaction, with diode lasers preferred for soft tissue cutting and coagulation, Er, Cr: YSGG for hard and soft tissue ablation with minimal thermal damage, and LLLT for biostimulatory effects6-8. Given the growing body of evidence and variety of laser systems, this review aims to systematically assess the clinical and radiographic efficacy of laser pulpotomy compared to conventional agents, while also highlighting procedural protocols and the relative performance of different laser modalities. Materials and Methods This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and MetaAnalyses) guidelines. An electronic search was conducted in databases including PubMed, Science Direct, Google Scholar, and Research Gate to identify relevant literature published from January 2020 to April 2024. Search terms included “laser pulpotomy”, “pediatric dentistry”, “diode laser”, “Er, Cr: YSGG”, “photobiomodulation”, “formocresol”, and “vital pulp therapy”. Inclusion criteria  Randomized controlled trials (RCTs), clinical studies, systematic reviews, and comparative trials involving laser pulpotomy in primary teeth.  Studies comparing laser techniques with traditional agents (formocresol, MTA, ferric sulfate).  Follow-up period of at least 6 months. Exclusion criteria  Studies focused on permanent teeth or apexogenesis.  Case reports, editorials, and non-English publications. Data extraction involved the collection of information on author, year, study design, sample size, type of laser used, comparator group, duration of follow-up, clinical and radiographic outcomes, and reported complications. Risk of bias was evaluated using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. Dr. Divya Kadali, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Page9 Results The electronic search and manual screening yielded 15 eligible studies that met the inclusion criteria. These comprised 11 randomized controlled trials (RCTs), two comparative clinical trials, one systematic review, and one prospective study, conducted between 2020 and 2024. The cumulative data included over 1,200 pulpotomized primary molars, treated using various laser modalities—most notably diode (810–980 nm), Er, Cr: YSGG (2780 nm), and photobiomodulation/LLLT systems. Follow-up durations ranged from 6 to 36 months. Clinical success was defined as the absence of pain, swelling, mobility, sinus tract formation, or pathological exfoliation. Radiographic success was determined by the absence of periapical or furcal radiolucency, internal or external root resorption, and widened periodontal ligament space. The pooled results revealed clinical success rates ranging from 88% to 94%, and radiographic success between 85% and 93% across most laser groups. When compared to traditional pulpotomy agents such as formocresol and mineral trioxide aggregate (MTA), laser-treated teeth generally exhibited equal or superior outcomes, with added procedural advantages. Table 1: Summary of Included Studies Study Year Design Sample Size Laser Type Comparator Follow-up Clinical Success (%) Radiographic Success (%) Khan et al. 2024 Systematic Review 12 studies Mixed Mixed Variable >85% >80% Sharma et al. 2024 RCT 50 Diode MTA 36 months 90% 88% Reddy et al. 2024 RCT 40 Diode MTA, FC 12 months 92.5% 90% Shobha et al. 2024 RCT 60 Diode, Er, Cr: YSGG FC 18 months 90–95% 87–93% Gupta et al. 2024 RCT 30 Photobiom odulation FC 12 months 90% 90% Ali et al. 2024 Comparative 45 Diode FC 12 months 93% 91% Kumar et al. 2024 RCT 30 LLLT FC 9 months 88% 85% Fernandes et al. 2024 Review – Mixed Mixed – – – Saleem et al. 2024 Prospective 36 Diode Ca(OH)2, MTA 36 months 91% 89% Al-Saif et al. 2024 RCT 60 Diode MTA 18 months 88% 87% El-Araby et al. 2024 RCT 60 Diode, Er, Cr: YSGG FC 12 months 94% 90% Mishra et al. 2024 RCT 50 Diode FC 12 months 92% 89% Jha et al. 2024 Clinical 40 Diode MTA 9 months 90% 88% Dr. Divya Kadali, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Page10 Discussion This systematic review underscores the evolving role of laser pulpotomy as a viable alternative to traditional agents in primary teeth. The diode laser emerged as the most extensively studied modality, with consistent clinical and radiographic success across multiple trials 2,3,6,13. The Er, Cr: YSGG laser, while less commonly used, also demonstrated superior outcomes in studies that compared it directly with formocresol and diode lasers 4,13. Photobiomodulation and LLLT showed promising results in stimulating pulp healing, though data are limited and warrant further research5,8. Diode lasers provide coagulation and sterilization with minimal collateral damage, leading to reduced treatment time, effective hemostasis, and improved patient cooperation. The Er, Cr: YSGG laser offers a dual soft and hard tissue action with hydrokinetic ablation, improving tissue preservation and reducing thermal damage7,13. LLLT enhances cellular metabolism and promotes regeneration without thermal side effects, although its application remains limited to specific protocols5,8.Compared to conventional materials, laser pulpotomy avoids the risks of cytotoxicity (as with formocresol) and complications such as tooth discoloration or prolonged setting time (as seen with MTA). Furthermore, lasers simplify the procedure by minimizing bleeding, improving visualization, and reducing chair time—critical in managing pediatric patients.Despite these advantages, the lack of standardized laser parameters, variations in diagnostic and success criteria, and inconsistent followup durations across studies present significant limitations. Histological validation of pulpal healing and multicenter randomized trials with consistent methodologies are necessary to establish evidence-based protocols. Conclusions Laser pulpotomy demonstrates high clinical and radiographic success rates, comparable or superior to traditional techniques in pediatric dentistry. Among the different laser types, diode lasers show the most consistent and favorable outcomes across studies, followed by Er, Cr: YSGG lasers. These modalities offer enhanced hemostasis, reduced treatment time, and improved patient comfort. Although promising, further standardized and long-term research is required before universal clinical adoption can be recommended. References 1. Khan M et al., 2024. “Laser Pulpotomy in Primary Teeth: A Systematic Review.” [https://www.researchgate.net/publication/37799648 1] 2. Sharma A et al., 2024. “Comparison of Diode Laser and MTA Pulpotomy in Primary Molars.” [https://www.researchgate.net/publication/37824501 2] 3. Reddy P et al., 2024. “Clinical Evaluation of Diode Laser in Pediatric Pulpotomy.” LWW Journal. [https://journals.lww.com] 4. Shobha P et al., 2024. “Er,Cr:YSGG vs. Formocresol in Primary Molars.” Cureus. [https://www.cureus.com] 5. Gupta R et al., 2024. “Photobiomodulation in Pediatric Pulp Therapy.” [https://www.researchgate.net/publication/37799873 1] 6. Ali T et al., 2024. “Diode Laser Versus Formocresol for Primary Teeth Pulpotomy.” [https://www.researchgate.net/publication/37800061 2] Dr. Divya Kadali, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 Page11 7. Kumar D et al., 2024. “LLLT for Primary Teeth Pulpotomy: A Randomized Trial.” IJCPD. [https://www.ijcpd.com] 8. Fernandes R et al., 2024. “Review of Lasers in Pediatric Dentistry.” BMC Oral Health. [https://bmcoralhealth.biomedcentral.com] 9. AAPD Policy Statement, 2024. “Vital Pulp Therapy for Primary Dentition.” [https://www.aapd.org] 10. AAPD Clinical Guideline, 2024. “Pediatric Pulp Therapy.” [https://www.aapd.org] 11. Saleem M et al., 2024. “Comparative Evaluation of Diode Laser and Calcium Hydroxide in Pulpotomy.” Science Direct. [https://www.sciencedirect.com] 12. Al-Saif F et al., 2024. “Diode Laser vs. MTA in Primary Molars: A Clinical Study.” LWW Journal. [https://journals.lww.com] 13. El-Araby M et al., 2024. “Diode and Er,Cr:YSGG Lasers in Pulpotomy: A Comparative Study.” Cureus. [https://www.cureus.com] 14. Mishra R et al., 2024. “Clinical and Radiographic Success of Laser Pulpotomy in Children.” PubMed Central. [https://www.ncbi.nlm.nih.gov/pmc/] 15. Jha N et al., 2024. “Diode Laser Pulpotomy in Pediatric Dentistry: A Case-Control Study.” [https://www.researchgate.net/publication/37817634 8]