REVIEW ARTICLE Role of laser irradiation in direct pulp capping procedures: a systematic review and meta-analysis Fawad Javed 1 & Sergio Varela Kellesarian 1 & Tariq Abduljabbar 2 & Elham Gholamiazizi 3 & Changyong Feng 4 & Khaled Aldosary 5 & Fahim Vohra 2 & Georgios E. Romanos 6,7 Received: 14 May 2016 /Accepted: 12 September 2016 # Springer-Verlag London 2016 Abstract A variety of materials are available to treat exposed dental pulp by direct pulp capping. The healing response of the pulp is crucial to form a dentin bridge and seal off the exposed pulp. Studies have used lasers to stimulate the exposed pulp to form tertiary dentin. The aim of the present systematic review and meta-analysis was to evaluate the evidence on the effects of laser irradiation as an adjunctive therapy to stimulate healing after pulp exposure. A systematic literature search was conduct- ed up to April 2016. A structured search using the keywords BDirect pulp capping,^ BLasers,^ BCalcium hydroxide pulp cap- ping,^ and BResin pulp capping^ was performed. Initially, 34 potentially relevant articles were identified. After removal of duplicates and screening by title, abstract, and full text when necessary, nine studies were included. Studies were assessed for bias and data were synthetized using a random-effects me- ta-analysis model. Six studies were clinical, and three were pre- clinical animal trials; the follow-up period ranged from 2 weeks to 54 months. More than two thirds of the included studies showed that laser therapy used as an adjunct for direct pulp capping was more effective in maintaining pulp vitality than conventional therapy alone. Meta-analysis showed that the suc- cess rate in the laser treatment group was significantly higher than the control group (log odds ratio = 1.737; 95 % confidence interval, 1.304–2.171). Lasers treatment of exposed pulps can improve the outcome of direct pulp capping procedures; a num- ber of confounding factors may have influenced the outcomes of the included studies. Keywords Calcium hydroxide . Direct pulp capping . Lasers . Resin pulp capping Introduction Pulpal exposure is often encountered during routine restorative procedures such as caries excavation and cavity and crown preparations [1–3]. Depending on the size and the extent of hemorrhage, the exposure can be treated using pulp capping techniques, pulpotomy or pulpectomy [4, 5]. Of these methods, pulp capping has been shown to have a predictable outcome in the management of pulpal exposures [6, 7]. Pulp capping is an attempt to maintain the vitality of the exposed pulp by inducing a healing response. This response is mediated by the stimula- tion of the pulp tissue to form a reparative dentin bridge which seals the pulp from bacterial contamination [8]. A variety of materials have been used in an attempt to stimulate odonto- blasts in the exposed pulp to secrete reparative dentine [9]. Calcium hydroxide (Ca[OH] 2 ), resins, glass ionomer cement (GIC), mineral trioxide aggregate (MTA), formocresol, and * Fawad Javed fawad_javed@urmc.rochester.edu 1 Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA 2 Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia 3 Department of Mechanical Engineering, Pennsylvania State University, Capital College, PA, USA 4 Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA 5 Dental Department, King Khaled University Hospital, King Saud University, Riyadh, Saudi Arabia 6 Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe, University of Frankfurt, Frankfurt, Germany 7 Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA Lasers Med Sci DOI 10.1007/s10103-016-2077-6