Minimally invasive treatment of dental caries in primary teeth using an Er:YAG Laser

Maintaining deciduous teeth as long as possible represents a goal in pediatric dentistry and avoids a plethora of health problems. Er:YAG carious decay treatment may help for prevention as well as during the curative processes.

An Er:YAG laser was used to ablate 30 carious lesions on primary teeth. Diagnosis being conventionally dressed, treatment was conducted in respect of the following parameters: Er:YAG laser (Lite Touch, Syneron): output power from 300 mJ (enamel) to 200 mJ (dentine), frequency 20 Hz, sapphire tip (diameter 1.3 mm), air water spray ratio 8 (39 ml/min), pulse duration 50 µsec., theoretical fluence ranging from 15.08 J/cm(2) for dentin to 22.61 J/cm(2) for enamel. Then cavity depth was controlled (observation + probe). Glass-ionomer cement (GC Fuji Triage capsule) or flowable composite resin or compomer were used to fill the cavities. Children's acceptance to Er-YAG laser treatment was evaluated. According to predefined criteria, each case was followed up for one month after treatment and then with further monthly follow-ups for one year.

Clinical cases illustrate the validity of this clinical approach. The benefit of laser dental treatment has been shown to be the greatest in children. However, the lack of studies evaluating laser ablation capability in primary teeth restrains the adoption of this technology. The interaction between the Er:YAG laser and primary enamel and dentin depends on the composition of the tissues - a higher presence of water and lower presence of minerals- comparative to the permanent enamel and dentin. Thus, photoablation of primary enamel and dentin requires lower energy. This study shows that the laser parameters used (300 mJ/20 Hz for enamel and 200 mJ/20 Hz for dentin) are efficient enough for the ablation of tissues of deciduous teeth and moreover demonstrates to be well accepted by young patients.