Laser and remineralising agents in dental erosion: a systematic review and meta-analysis

Aim This systematic review aimed to evaluate, by means of statistical comparison between selected studies, the effectiveness of laser irradiation on dental erosion applied alone or in combination with anti-erosive agents (fluoride, Acidulated phosphate fluoride APF and CPP-amorphous calcium fluoride phosphate CPP-ACFP), through optical proflometry and microhardness measurement. Methods The searching strategy was conducted according to the International PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to answer research questions regarding the effectiveness of lasers used in the context of dental erosion (such as Nd:YAG, CO2, Er:YAG, Er,Cr:YSGG, Diode, and Argon Ion lasers). A comprehensive and unrestricted sys-tematic searching was performed using the electronic databases of PubMed and Cochrane Library, for all articles published up to the end of January 2023. The review record was registered by the International prospective register of systematic reviews (PROSPERO) under the identification number CRD408639. Results Of the 16 studies included, only 7 were selected for data of interest, enabling a comparison between the experimental and control groups for metanalysis. A comparison between laser and the control group (no agent or fluoride agent) showed improved enamel microhardness (standardised mean deviation, SMD 1.47, p=0.05, I2 =88%) and tissue loss assessed for optical proflometry (SMD 2.53, p=0.0002, I2 =87%). Regarding active ingredients compared to the control group, the overall SMD was 1.44 (p=0.0003, I2=81%). For the other groups, outcomes concerning microhardness were as follows: SMD -0.26 (p=0.5, I2=0%) for APF gel + Laser versus control group; SMD -0.85 (p=0.005, I2=81%) for APF gel + Laser versus APF gel; SMD -0.65 (p=0.09, I2=64%) for APF gel + laser versus Laser; SMD -1.13 (p=0.00001, I2=91%) for Laser + APF gel versus APF gel. Conclusions Change in microhardness for the lasers group, irrespective of the type of laser used in the sample, was significantly greater compared with the one in the control group. Regards microhardness, the combination of Laser and APF gel showed promising results compared to APF gel agent.