Vol.:(0123456789) 1 3 European Archives of Paediatric Dentistry https://doi.org/10.1007/s40368-018-0358-4 SYSTEMATIC REVIEW Clinical and radiographic outcomes of laser pulpotomy in vital primary teeth: a systematic review and meta-analysis H. Nematollahi 1,2  · A. Sarraf Shirazi 2,3  · M. Mehrabkhani 1,2  · S. Sabbagh 2,4 Received: 29 September 2017 / Accepted: 16 May 2018 © European Academy of Paediatric Dentistry 2018 Abstract Aim This was to compare clinical and radiographic success rates of laser pulpotomy with those of other pulpotomy tech- niques in primary teeth. Methods PubMed, SCOPUS, EMBASE, Cochrane and ISI Web of Knowledge databases were searched electronically with- out time or language limitations. Clinical trials in which laser pulpotomy was compared with at least one other pulpotomy modality in primary teeth were selected. The bibliographic reference lists of eligible articles were also hand-searched. Odds ratios, risk diferences and 95% confdence intervals were calculated with the aid of Comprehensive Meta-Analysis software (Version 2.2.050, Biostat, Englewood, NJ, USA). The methodological quality of articles included in the meta-analysis was determined using the Jadad scale. Results Twelve pulpotomy studies were selected for systematic review and underwent data extraction. Of these studies, statistical analysis was conducted on 11. All clinical trials had low to moderate risks of methodological bias. The meta- analysis showed no signifcant diferences in clinical and radiographic pulpotomy outcomes with laser compared with other techniques (p > 0.05). Likewise, no diferences were found in the outcomes at 1, 3, 6, 9, 12 or ≥ 18 months (all p > 0.05). Conclusions For primary molar pulpotomy, the laser technique showed comparable clinical and radiographic results to other conventional pulpotomy medicaments, including formocresol and mineral trioxide aggregate. Keywords Lasers · Meta-analysis · Pulpotomy · Systematic review · Primary teeth · Treatment outcome Introduction Pulpotomy is viewed as the most common pulp treatment in primary dentition, and it aims primarily at preserving oral tissue integrity and health (Fuks 2002; Nematollahi et al. 2011). It is mainly indicated when pulp is mechani- cally or cariously exposed during the treatment of a vital primary tooth with infammation confned to the coronal pulp (Fuks 2002; American Academy of Paediatric Dentistry 2016). Formocresol (FC), composed of formaldehyde and cresol, has been the “gold standard” medicament for vital pulpotomy in primary molars since 1930 (Nematollahi et al. 2011; Niranjani et al. 2015). The ease of application, low cost, and high rate of clinical success (55–98%), as well as its fxative and bacteriostatic properties, led FC to be used widely (Simancas-Pallares et al. 2010; Nematollahi et al. 2011). Nonetheless, its chemical composition has aroused concern over its safety as a pulp therapy agent. Formalde- hyde, a cytotoxic, carcinogenic and mutagenic component, systemically distributes following pulpotomy, and cresol exerts locally deleterious efects on vital tissue. Thus, alter- native modalities have been sought for more than 2 decades (Waterhouse 1995; Peng et al. 2007). Various materials and techniques have been proposed for primary tooth pulpotomy, including glutaraldehyde, ferric sulphate (FS), calcium hydroxide (CH), sodium hypochlo- rite, mineral trioxide aggregate (MTA), electrosurgery, calcium-enriched mixture cement, Biodentine ™ (Septo- dont, Saint Maur des Faussés, France), and laser (Rivera * S. Sabbagh sedigheh.sabbagh@gmail.com 1 Dental Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2 Department of Pediatric Dentistry, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran 3 Dental Materials Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 4 Students Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran