Erbium:YAG laser application in caries therapy. Evaluation of patient perception and acceptance

Objectives: In previous studies it has been demonstrated that the Er:YAG laser can be used to prepare cavities efficiently and without thermal damage to the adjacent dental hard and soft tissues. To investigate the patientsʹ response to Er:YAG laser preparation of teeth, a prospective clinical study was performed in five dental hospitals. Methods: To evaluate patientsʹ perception and response to cavity preparation a direct comparison was made between conventional mechanical preparation and Er:YAG laser preparation of caries in dental hard tissues. Half of the preparations were completed by the laser alone with standardized parameters, with the other half being mechanically prepared. The sequential order of treatment was randomized, and clinical parameters such as depth and location of the cavities were carefully balanced. A three-score evaluation scheme of patient responses was used: comfortable, uncomfortable, very uncomfortable. In addition the patients were asked to decide which was the more uncomfortable form of treatment and the preferred treatment for future caries therapy. Results: The study included 103 patients with 206 preparations distributed amongst 194 teeth. All teeth gave vital responses (ice test) before and after both types of treatment. The laser treatment was found to be more comfortable than the mechanical treatment, with high statistical significance. During treatment, the need for local anaesthesia was 11% for mechanical preparation compared to 6% during laser application. It was found that 80% of the patients rated the conventional preparation as more uncomfortable than the laser treatment and 82% of the patients indicated that they would prefer the Er:YAG laser preparation for further caries treatment. Conclusions: The application of the Er:YAG laser system is a more comfortable alternative or adjunctive method to conventional mechanical cavity preparation.