Comparative Evaluation of Effect of Lasers and Biodentine in Dentine Regeneration: A Clinical Study

Abstract

Aim: To compare and evaluate the effect of different liners separately and in combination with lasers that is resin modified glass-ionomer cement (RMGIC), Laser+RMGIC, Biodentine, Laser+Biodentinein the treatment of deep carious lesions. Materials and methods: Forty patients with deep caries indicated for pulp capping were selected. Curative procedure including the cavity preparation with maximal removal of softened dentine using spoon excavator, slow speed handpiece with round burs was performed. Patients were divided into four groups with 10 patients in each groupIn group A RMGIC liner, group B laser biostimulation followed by RMGIC liner, group C biodentine liner, group D laser biostimulation followed by Biodentine liner were placed in the cavity after caries removal. Cavities were temporarily restored with IRM for 8 weeks.After 8 weeks, liners in each group were removed, and cavities were permanently restored lower half of the cavity with a layer of flowable Z350 XT composite, and then the remaining half of the cavity with P60 filled composites (3 M ESPE, USA) in all the groups. The observation period was 12 months. Results: All the patients showed a positive response to cold test and electric pulp test at 3 months, 6 months, 12 months follow-up. In group A (RMGIC) two patients and in group B (Laser+Biodentine) three patients did not return back for the follow-up. To standardize the samples, seven patients were selected from each group with a total of 28 samples included in the study (n = 7) and statistical analysis was done using analysis of variance (ANOVA) test.The mean for the total amount of dentine deposited after 12 months was highest in: Group D-(Laser+Biodenitne) 0.32 mm > Group C-(Biodentine) 0.25 mm > Group B-(Laser+RMGIC) 0.10 > Group A-(RMGIC) 0.07 mm Conclusion: Within the limitation of the present study the following conclusion was drawn: • Lasers and biodentine are good indirect pulp capping agents • Laser has an additional effect on the tertiary dentine formation. Clinical significance: Lasers with antibacterial effect penetrate into dentinal tubules and accelerate the rate of dentin bridge formation in deep carious lesions.

The application of lasers in vital pulp therapy: clinical and radiographic outcomes

“…This laser was used during pulpotomy treatment of primary teeth in most studies [ 29 , 31 , 33 , 34 ]. Other studies have used this laser during direct [ 12 , 31 , 43 ] and indirect pulp capping treatment [ 41 ] as well as pulpotomy for apexogenesis purposes [ 52 ]. Most studies indicate that [ 29 , 31 , 33 , 36 , 38 ], diode laser did not show any significant benefit over FC (which is considered as the gold-standard for VPT of primary teeth) [ 53 ] or ferric sulfate (FS) [ 29 , 34 ].…”

“…However, in a study by Gupta et al, [ 54 ] the clinical and radiographic success of diode laser for pulpotomy of primary teeth was reported to be 100% at 12 months, and significantly higher than that of FS and electrosurgery. In some studies, diode laser was applied on the pulp prior to pulp capping with MTA [ 27 , 28 , 30 , 55 ], Biodentine (BD) [ 41 ], resin-modified glass ionomer [ 12 , 41 ] or resin-modified calcium silicate paste (TheraCal) [ 43 ]. Studies with laser irradiation prior to the application of MTA in pulpotomy of primary teeth, did not show superior clinical and radiographic results [ 27 , 28 , 55 ].…”

“…Studies with laser irradiation prior to pulp capping with TheraCal increased the clinical success of treatment [ 43 ]. Sharma et al showed that application of diode laser prior to indirect pulp capping with resin-modified glass ionomer or Biodentine did not increase the dentinal bridge thickness significantly [ 41 ].…”

“…Absence of sensitivity to percussion and functional forces, absence of spontaneous pain, absence of sinus tract, swelling, and abscess, and absence of abnormal tooth mobility are among the clinical success criteria for permanent teeth [ 12 , 41 – 43 ]. Some other studies also used cold and heat pulp tests and electric pulp test to assess the tooth responsiveness [ 12 , 17 , 41 – 46 ].…”

“…Partially or completely closure of apex is considered a success criterion when the experiments were conducted on premature permanent teeth [ 47 , 48 ]. In a study by Sharma et al, [ 41 ] the radiographic success of indirect pulp cap was evaluated by measuring the distance between the uppermost point of the pulp horn and the cavity base.…”