Laser Applications in Pediatric Dentistry

Abstract

In recent years, laser technology has emerged as a significant innovation in dentistry, offering more comfortable treatment options, particularly for pediatric patients. Initially used solely for soft tissue procedures, lasers have now become effective in hard tissue applications, expanding their range of clinical uses. Laser systems with different wavelengths, including Nd:YAG, Er:YAG, Er,Cr:YSGG, diode, and CO₂ lasers, are successfully utilized in various fields such as Restorative Dentistry, Endodontics, Periodontology, and Maxillofacial Surgery. This review examines the advantages of laser applications in Pediatric Dentistry, their clinical applications, and the efficacy of different laser types. The role of lasers in the diagnosis and treatment of dental caries, soft tissue surgery, and pulp therapy is highlighted, emphasizing their minimally invasive approach. Additionally, patient-friendly features such as reduced pain, minimal bleeding, and decreased need for anesthesia are discussed. Furthermore, the psychological and clinical benefits of laser technology, including improved patient compliance and reduced anxiety and fear in children, are explored. However, issues such as the high cost of laser devices, the need for standardized treatment protocols, and the long-term effectiveness of laser applications remain subjects of ongoing research. With continued scientific studies and technological advancements, lasers are expected to become more widely used in pediatric dentistry and play a significant role in routine dental treatments in the future.

Keywords

• Dentistry
• Laser therapy
• Pedodontics

Çocuk Diş Hekimliğinde Lazer Uygulamaları

Öz

Lazer teknolojisi, son yıllarda diş hekimliğinde önemli bir yenilik olarak öne çıkmış ve özellikle çocuk hastalar için daha konforlu tedavi seçenekleri sunmaya başlamıştır. Başlangıçta sadece yumuşak doku işlemlerinde kullanılan lazerler, günümüzde sert doku uygulamalarında da etkili hale gelerek geniş bir kullanım alanına yayılmıştır. Nd:YAG, Er:YAG, Er,Cr:YSGG, diyot ve CO₂ gibi farklı dalga boylarına sahip lazer sistemleri; Restoratif Diş Hekimliği, Endodonti, Periodontoloji ve Ağız Diş ve Çene Cerrahi gibi çeşitli alanlarda etkin bir şekilde uygulanmakta ve başarılı sonuçlar elde edilmektedir. Bu derlemede, Çocuk Diş Hekimliği’nde lazer kullanımının sunduğu avantajlar, klinik uygulama alanları ve farklı lazer türlerinin etkinliği ele alınmıştır. Lazerlerin diş çürüklerinin tanı ve tedavisinde, yumuşak doku cerrahisinde ve pulpa tedavilerinde sağladığı minimal invaziv yaklaşımlar vurgulanmış; ağrı, kanama ve anestezi ihtiyacını azaltma gibi hasta dostu özellikleri incelenmiştir. Ayrıca, çocuk hastaların diş tedavisine uyumunu artırması, anksiyete ve korkuyu azaltması gibi psikolojik ve klinik faydalar üzerinde durulmuştur. Bununla birlikte, lazer teknolojisinin maliyeti, tedavi protokollerinin standardizasyonu ve uzun vadeli etkinliği gibi konular hâlâ araştırılmaya devam etmektedir. Gelecekte yapılacak bilimsel çalışmalar ve teknolojik gelişmeler ile lazerlerin çocuk diş hekimliğinde daha yaygın bir kullanım alanı bulması ve rutin tedavilerde önemli bir yer edinmesi beklenmektedir.

Anahtar Kelimeler

• Diş hekimliği
• Lazer tedavisi
• Pedodonti

References

1. 1. Gross AJ, Herrmann TRW. History of lasers. World J Urol. 2007; 25: 217-20. doi: 10.1007/s00345-007-0173-8
2. 2. Coluzzi D, Convissar R. Atlas of laser applications in dentistry. Br Dent J. 2007; 203: 164.
3. 3. Olivi G, Olivi M. Lasers in Restorative Dentistry: A Practical Guide. 1st ed, Springer, Heidelberg, 2015.
4. 4. Sulieman M. An overview of the use of lasers in general dental practice: 2. laser wavelengths, soft and hard tissue clinical applications. Dent Update. 2005; 32: 286-96. doi: 10.12968/denu.2005.32.5.286
5. 5. Coluzzi DJ. Fundamentals of dental lasers: science and instruments. Dent Clin North Am. 2004; 48: 751-70. doi: 10.1016/j.cden.2004.05.003
6. 6. Frame JW. Carbon dioxide laser surgery for benign oral lesions. Br Dent J. 1985; 158: 125-8.
7. 7. Myers TD. Lasers in dentistry. J Am Dent Assoc. 1991; 122: 46-50. doi: 10.14219/jada.archive.1991.0018
8. 8. Fornaini C, Arany P, Rocca JP, et al. Photobiomodulation in pediatric dentistry: a current state-of-the-art. Photobiomodul Photomed Laser Surg. 2019; 37: 798-813. doi: 10.1089/photob.2019.4722

9. 9. Suresh S, Navit S, Khan SA, et al. Effect of diode laser office bleaching on mineral content and surface topography of enamel surface: an SEM study. Int J Clin Pediatr Dent. 2020; 13: 481-5. doi: 10.5005/jp-journals-10005-1823
10. 10. Olivi G, Renovesi MD, Caprioglio C. Evidence-based dentistry on laser Paediatric Dentistry: review and outlook. Eur J Paediatr Dent. 2009; 10: 29-40.
11. 11. Coluzzi DJ, Convissar RA, Roshkind DM. Principles and Practice of Laser Dentistry. 2nd ed., Elsevier Mosby, St. Louis, 2016.
12. 12. Hadley J, Young DA, Eversole LR, et al. A laser-powered hydrokinetic system for caries removal and cavity preparation. J Am Dent Assoc. 2000; 131: 777-85. doi: 10.14219/jada.archive.2000.0277
13. 13. Usumez A, Aykent F. Bond strengths of porcelain laminate veneers to tooth surfaces prepared with acid and Er,Cr:YSGG laser etching. J Prosthet Dent. 2003; 90: 24-30. doi: 10.1016/s0022-3913(03)00235-x
14. 14. Boj J. The future of laser pediatric dentistry. J Oral Laser Appl. 2005; 5: 173-7.
15. 15. Öznurhan F, Ölmez A. Çocuk dişhekimliğinde lazerler. Cumhuriyet Dent J. 2012; 15: 175-85. doi: 10.7126/cdj.2012.787
16. 16. Marwah N. Lasers in Pediatric Dentistry. In: Textbook of Pediatric Dentistry. 3rd ed., Jaypee Brothers Medical Pub., New Delhi, p. 947-83. 2014.
17. 17. Coluzzi DJ. An overview of lasers in dentistry. Dent Clin North Am. 2000; 44: 753-65.
18. 18. Moritz A, Schoop U, Goharkhay K, et al. The CO2 laser as an aid in direct pulp capping. J Endod. 1998; 24: 248-51. doi: 10.1016/S0099-2399(98)80106-4
19. 19. Moritz A, Schoop U, Goharkhay K, et al. Advantages of a pulsed CO2 laser in direct pulp capping: a long-term in vivo study. Lasers Surg Med. 1998; 22: 288-93. doi: 10.1002/(sici)1096-9101(1998)22:5<288::aid-lsm5>3.0.co;2-l
20. 20. Dederich DN. Laser/tissue interaction: what happens to laser light when it strikes tissue? J Am Dent Assoc. 1993; 124: 57-61. doi: 10.14219/jada.archive.1993.0036
21. 21. Welch AJ, Torres JH, Cheong WF. Overview of laser physics laser physics and laser-tissue interaction. Tex Heart Inst J. 1989; 16: 141-9.
22. 22. Vogel A, Venugopalan V. Mechanisms of pulsed laser ablation of biological tissues. Chem Rev. 2003; 103: 577-644. doi: 10.1021/cr010379n
23. 23. Green J, Weiss A, Stern A. Lasers and radiofrequency devices in dentistry. Dent Clin North Am. 2011; 55: 585-97. doi: 10.1016/j.cden.2011.02.017
24. 24. Martens LC. Laser physics and a review of laser applications in dentistry for children. Eur Arch Paediatr Dent. 2011; 12: 61-7. doi: 10.1007/BF03262781
25. 25. Convissar RA. The biologic rationale for the use of lasers in dentistry. Dent Clin North Am. 2004; 48: 771-94. doi: 10.1016/j.cden.2004.06.004
26. 26. Piccione PJ. Dental laser safety. Dent Clin North Am. 2004; 48: 795-807. doi: 10.1016/j.cden.2004.05.009
27. 27. American Academy of Pediatric Dentistry. Policy on patient safety. The Reference Manual of Pediatric Dentistry. Chicago,Ill.: American Academy of Pediatric Dentistry; 2024.
28. 28. Parker S. Laser regulation and safety in general dental practice. Br Dent J. 2007; 202: 523-32. doi: 10.1038/bdj.2007.370
29. 29. Verma S, Maheshwari S, Singh R, et al. Laser in dentistry: an innovative tool in modern dental practice. Natl J Maxillofac Surg. 2012; 3: 124. doi: 10.4103/0975-5950.111342
30. 30. Garden JM, O’banion MK, Bakus AD, et al. Viral disease transmitted by laser-generated plume (aerosol). Arch Dermatol. 2002; 138: 1303-7. doi: 10.1001/archderm.138.10.1303
31. 31. Caprioglio C, Olivi G, Genovese MD. Paediatric laser dentistry. Part 1: General introduction. Eur J Paediatr Dent. 2017; 18: 80-2. doi: 10.23804/ejpd.2017.18.01.17
32. 32. Boj JR, Poirier C, Espasa E, et al. Lower lip mucocele treated with an erbium laser. Pediatr Dent. 2009; 331: 249-52.
33. 33. Rai S, Kaur M, Bhatnagar P. Laser: a powerful tool for treatment of pyogenic granuloma. J Cutan Aesthet Surg. 2011; 4: 144. doi: 10.4103/0974-2077.85044
34. 34. American Academy of Pediatric Dentistry. Policy on the Use of Lasers for Pediatric Dental Patients.The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry. 2024.
35. 35. Boj JR, Poirier C, Hernandez M, et al. Review: laser soft tissue treatments for paediatric dental patients. Eur Arch Paediatr Dent. 2011; 12: 100-5. doi: 10.1007/BF03262788
36. 36. Verco PJW. Case report and clinical technique: argon beam electrosurgery for tongue ties and maxillary frenectomies in infants and children. Eur Arch Paediatr Dent. 2012; 8: 15-9. doi: 10.1007/BF03262604
37. 37. Tamarit-Borràs M, Delgado-Molina E, Berini-Aytés L, et al. Removal of hyperplastic lesions of the oral cavity. A retrospective study of 128 cases. Med Oral Patol Oral Cir Bucal. 2005; 10: 151-62.
38. 38. Vesnaver A, Dovšak DA. Treatment of vascular lesions in the head and neck using Nd:YAG laser. J Craniomaxillofac Surg. 2006; 34: 17-24. doi: 10.1016/j.jcms.2005.07.009
39. 39. Fornaini C, Rocca JP, Bertrand MF, et al. Nd:YAG and diode laser in the surgical management of soft tissues related to orthodontic treatment. Photomed Laser Surg. 2007; 25: 381-92. doi: 10.1089/pho.2006.2068
40. 40. Cauwels RGEC, Martens LC. Low level laser therapy in oral mucositis: a pilot study. Eur Arch Paediatr Dent. 2011; 12: 118-23. doi: 10.1007/BF03262791
41. 41. Cruz LB, Ribeiro AS, Rech A, et al. Influence of low-energy laser in the prevention of oral mucositis in children with cancer receiving chemotherapy. Pediatr Blood Cancer. 2007; 48: 435-40. doi: 10.1002/pbc.20943
42. 42. Liu CM, Hou LT, Wong MY, et al. Comparison of Nd:YAG laser versus scaling and root planing in periodontal therapy. J Periodontol. 1999; 70: 1276-82. doi: 10.1902/jop.1999.70.11.1276
43. 43. Mogedas-Vegara A, Hueto-Madrid JA, Chimenos-Küstner E, et al. Oral leukoplakia treatment with the carbon dioxide laser: a systematic review of the literature. J Cranio-Maxillofac Surg. 2016; 44: 331-6. doi: 10.1016/j.jcms.2016.01.026
44. 44. White JM, Chaudhry SI, Kudler JJ, et al. Nd:YAG and CO2 laser therapy of oral mucosal lesions. J Clin Laser Med Surg. 1998; 16: 299-304. doi: 10.1089/clm.1998.16.299
45. 45. Akyol A, Anadolu R, Anadolu Y, et al. Multifocal papillomavirus epithelial hyperplasia: successful treatment with CO2 laser therapy combined with interferon alpha-2b. Int J Dermatol. 2003; 42: 733-5. doi: 10.1046/j.1365-4362.2003.01777.x
46. 46. Summersgill KF, Smith EM, Levy BT, et al. Human papillomavirus in the oral cavities of children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 91: 62-9. doi: 10.1067/moe.2001.108797
47. 47. Prathima GS, Bhadrashetty D, Babu SBU, et al. Microdentistry with Lasers. J Int Oral Health. 2015; 7: 134-7.
48. 48. Ando M, Van Der Veen MH, Schemehorn BR, et al. Comparative study to quantify demineralized enamel in deciduous and permanent teeth using laser- and light-induced fluorescence techniques. Caries Res. 2001; 35: 464-70. doi: 10.1159/000047491
49. 49. Lussi A, Megert B, Longbottom C, et al. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci. 2001; 109: 14-9. doi: 10.1034/j.1600-0722.2001.109001014.x
50. 50. Olivi G, Genovese MD. Laser restorative dentistry in children and adolescents. Eur Arch Paediatr Dent. 2011; 12: 68-78. doi: 10.1007/BF03262782
51. 51. Bengtson AL, Gomes AC, Mendes FM, et al. Influence of examiner’s clinical experience in detecting occlusal caries lesions in primary teeth. Pediatr Dent. 2005; 27: 238-43.
52. 52. Chen J, Qin M, Ma W, et al. A clinical study of a laser fluorescence device for the detection of approximal caries in primary molars. Int J Paediatr Dent. 2012; 22: 132-8. doi: 10.1111/j.1365-263X.2011.01180.x
53. 53. Nair BG, Reddy KA, Reddy MG, et al. A review of laser Doppler flowmetry and pulse oximetry in dental pulp vitality. J Clin Diagn Res. 2011; 5: 903-5.
54. 54. Roeykens H, De Moor R. The use of laser Doppler flowmetry in Paediatric dentistry. Eur Arch Paediatr Dent. 2011; 12: 85-9. doi: 10.1007/BF03262784
55. 55. Stern RH, Sognnaes RF. Laser inhibition of dental caries suggested by first tests in vivo. J Am Dent Assoc. 1972; 85: 1087-90. doi: 10.14219/jada.archive.1972.0491
56. 56. Ana PA, Bachmann L, Zezell DM. Lasers effects on enamel for caries prevention. Laser Phys. 2006; 16: 865-75. doi: 10.1134/S1054660X06050197
57. 57. Fried D, Ragadio J, Akrivou M, et al. Dental hard tissue modification and removal using sealed transverse excited atmospheric-pressure lasers operating at lambda=9.6 and 10.6 microm. J Biomed Opt. 2001; 6: 231-8. doi: 10.1117/1.1344192
58. 58. Pagano S, Lombardo G, Orso M, et al. Lasers to prevent dental caries: a systematic review. BMJ Open. 2020; 10: E038638. doi: 10.1136/bmjopen-2020-038638
59. 59. Zancopé B, Rodrigues LP, Lopes LM, et al. CO2 laser irradiation combined with fluoridated dentifrice improved its protective effect on caries lesion progression regardless of the acidulated phosphate fluoride gel application: an in situ study. Clin Oral Investig. 2023; 27: 7753-63. doi: 10.1007/s00784-023-05365-9
60. 60. Stabholz A, Sahar-Helft S, Moshonov J. Lasers in endodontics. Dent Clin North Am. 2004; 48: 809-32. doi: 10.1016/j.cden.2004.05.012
61. 61. Yavagal C, Patil V, Yavagal P, et al. Efficacy of laser photoacoustic streaming in paediatric root canal disinfection- an ex-vivo study. Contemp Clin Dent. 2021; 12: 44-8. doi: 10.4103/ccd.ccd_498_19
62. 62. Botu RK, Rachuri P, Martha S, et al. Comparative evaluation of the efficacy of chlorhexidine, diode laser, and saline in reducing the microbial count in primary teeth root canals: an in vivo study. Int J Clin Pediatr Dent. 2023; 16: 459-63. doi: 10.5005/jp-journals-10005-2596
63. 63. Odabaş ME. Vital pulpa tedavilerinde lazer uygulaması. GÜ Diş Hek Fak Derg. 2011; 28: 51-9.
64. 64. Kimura Y, Yonaga K, Yokoyama K, et al. Histopathological changes in dental pulp irradiated by Er:YAG laser: a preliminary report on laser pulpotomy. J Clin Laser Med Surg. 2023; 21: 345-50. doi: 10.1089/104454703322650149
65. 65. Toomarian L, Fekrazad R, Sharifi D, et al. Histopathological evaluation of pulpotomy with Er,Cr:YSGG laser vs formocresol. Lasers Med Sci. 2008; 23: 443-50. doi: 10.1007/s10103-007-0505-3
66. 66. Pei S-L, Shih W-Y, Liu J-F. Outcome comparison between diode laser pulpotomy and formocresol pulpotomy on human primary molars. J Dent Sci. 2020; 15: 163-7. doi: 10.1016/j.jds.2020.03.005
67. 67. Tozar KN, Erkmen Almaz M. Evaluation of the efficacy of erbium, chromium-doped yttrium, scandium, gallium, and garnet laser in partial pulpotomy in permanent immature molars: a randomized controlled trial. J Endod. 2020; 46: 575-83. doi: 10.1016/j.joen.2020.02.003
68. 68. Fadhil WA, Noori AJ. Clinical and radiographic evaluation of diode and Er,Cr:YSGG lasers as an alternative to formocresol and sodium hypochlorite for pulpotomy techniques in primary molars: a randomized controlled clinical trial. Cureus. 2024; 16: E65902. doi: 10.7759/cureus.65902
69. 69. Priya MS, Dakshindas DM, Warhadpande MM, et al. Effectiveness of lasers in direct pulp capping among permanent teeth - a systematic review and meta-analysis. J Conser Dent Endod. 2023; 26: 494-501. doi: 10.4103/jcd.jcd_344_23
70. 70. Wang M, Ma L, Li Q, et al. Efficacy of Er:YAG laser-assisted direct pulp capping in permanent teeth with cariously exposed pulp: a pilot study. Aust Endod J. 2020; 46: 351-7. doi: 10.1111/aej.12404
71. 71. Kermanshah H, Omrani LR, Ghabraei S, et al. Direct pulp capping With ProRoot MTA alone and in combination with Er:YAG laser irradiation: a clinical trial. J Lasers Med Sci. 2020; 11: 60-6. doi: 10.34172/jlms.2020.S10
72. 72. Marraccini TM, Bachmann L, Wigdor HA, et al. Enamel and dentin irradiation with 9.6 µm CO2 and 2.94 µm Er:YAG lasers: bond strength evaluation. Laser Phys Lett. 2006; 3: 96-101. doi: 10.1002/lapl.200510058
73. 73. Cavalcanti BN, Lage-Marques JL, Rode SM. Pulpal temperature increases with Er:YAG laser and high-speed handpieces. J Prosthet Dent. 2003; 90: 447-51. doi: 10.1016/j.prosdent.2003.08.022
74. 74. Jacboson B, Berger J, Kravitz R, et al. Laser pediatric Class II composites utilizing no anesthesia. J Clin Pediatr Dent. 2004; 28: 99-101. doi: 10.17796/jcpd.28.2.h483456897052472
75. 75. Jacboson B, Berger J, Kravitz R, et al. Laser pediatric crowns performed without anesthesia: a contemporary technique. J Clin Pediatr Dent. 2003; 28: 11-2. doi: 10.17796/jcpd.28.1.t4v16x7757245q64
76. 76. Dommisch H, Peus K, Kneist S, et al. Fluorescence-controlled Er:YAG laser for caries removal in permanent teeth: a randomized clinical trial. Eur J Oral Sci. 2008; 116: 170-6. doi: 10.1111/j.1600-0722.2008.00521.x
77. 77. Abdrabuh R, El Meligy O, Farsi N, et al. Restoration integrity in primary teeth prepared using erbium/yttrium-aluminum-garnet laser: a randomized split-mouth clinical study. Children (Basel). 2023; 10: 1215. doi: 10.3390/children10071215
78. 78. Xu P, Ren C, Jiang Y, et al. Clinical application of Er:YAG laser and traditional dental turbine in caries removal in children. J Clin Pediatr Dent. 2024; 48: 183-8. doi: 10.22514/jocpd.2024.118
79. 79. Moshonov J, Stabholz A, Zyskind D, et al. Acid-etched and Erbium:Yttrium Aluminium Garnet laser-treated enamel for fissure sealants: a comparison of microleakage. Int J Paediatr Dent. 2005; 15: 205-9. doi: 10.1111/j.1365-263X.2005.00624.x
80. 80. Albertini R, Villaverde AB, Aimbire F, et al. Anti-inflammatory effects of low-level laser therapy (LLLT) with two different red wavelengths (660 nm and 684 nm) in carrageenan-induced rat paw edema. J Photochem Photobiol B. 2007; 89: 50-5. doi: 10.1016/j.jphotobiol.2007.08.005
81. 81. Bjordal JM, Johnson MI, Iversen V, et al. Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg. 2006; 24: 158-68. doi: 10.1089/pho.2006.24.158
82. 82. Pretel H, Lizarelli RFZ, Ramalho LTO. Effect of low-level laser therapy on bone repair: histological study in rats. Lasers Surg Med. 2007; 39: 788-96. doi: 10.1002/lsm.20585
83. 83. Rochkind S. Phototherapy in peripheral nerve regeneration: from basic science to clinical study. Neurosurg Focus. 2009; 26: E8. doi: 10.3171/FOC.2009.26.2.E8
84. 84. Farivar S, Malekshahabi T, Shiari R. Biological effects of low-level laser therapy. J Lasers Med Sci. 2014; 5: 58-62.
85. 85. De Coster P, Rajasekharan S, Martens L. Laser-assisted pulpotomy in primary teeth: a systematic review. Int J Paediatr Dent. 2013; 23: 389-99. doi: 10.1111/ipd.12014
86. 86. Annu A, Paranna S, Patil AT, et al. Comparative evaluation of photobiomodulation therapy at 660 and 810 nm wavelengths on the soft tissue local anesthesia reversal in pediatric dentistry: an in-vivo study. J Dent Anesth Pain Med. 2023; 23: 229-36. doi: 10.17245/jdapm.2023.23.4.229
87. 87. Doiphode AR, Kalaskar R, Kalaskar A, et al. Clinical and radiographic efficacy of low-level laser therapy and formocresol as pulpotomy agents in primary molars: a systematic review and meta-analysis. Int J Clin Pediatr Dent. 2024; 17: 1075-85. doi: 10.5005/jp-journals-10005-2947
88. 88. Calarga CC, Cotomácio CC, Simões A. Photobiomodulation for oral mucositis management in pediatric patients: a systematic review. Lasers Med Sci. 2024; 39: 272. doi: 10.1007/s10103-024-04221-w
89. 89. Kimura Y, Wilder-Smith P, Yonaga K, et al. Treatment of dentine hypersensitivity by lasers: a review. J Clin Periodontol. 2000; 27: 715-21. doi: 10.1034/j.1600-051x.2000.027010715.x
90. 90. Muniz RSC, Carvalho CN, Aranha ACC, et al. Efficacy of low-level laser therapy associated with fluoride therapy for the desensitisation of molar-incisor hypomineralisation: randomised clinical trial. Int J Paediatr Dent. 2020; 30: 323-33. doi: 10.1111/ipd.12602
91. 91. Cerqueira NM, Altube LG, Gambarini L, et al. Laser therapy in molar-incisor hypomineralization (MIH) teeth treatment of hypersensitivity: a systematic review. Lasers Med Sci. 2025; 40: 11. doi: 10.1007/s10103-024-04280-z
92. 92. Takamori K, Furukawa H, Morikawa Y, et al. Basic study on vibrations during tooth preparations caused by high-speed drilling and Er:YAG laser irradiation. Lasers Surg Med. 2003; 32: 25-31. doi: 10.1002/lsm.10140
93. 93. Eren F, Altinok B, Ertugrul F, et al. The effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser therapy on pain during cavity preparation in Paediatric dental patients: a pilot study. Oral Health Dent Manag. 2013; 12: 80-4. 94. Matsumoto K, Wang X, Zhang C, et al. Effect of a novel Er:YAG laser in caries removal and cavity preparation: a clinical observation. Photomed Laser Surg. 2007; 25: 8-13. doi: 10.1089/pho.2006.202
94. 95. Belcheva A, Shindova M. Efficiency of ER:YAG laser therapy in combination with behavior management technique in reducing anxiety among Paediatric dental patients - a study protocol for a randomized clinical trial. BMJ Open. 2022;12 E054523. doi: 10.1136/bmjopen-2021-054523
95. 96. Abdrabuh RE, El Meligy OAES, Felemban OM, et al. Evaluation of the Erbium-doped Yttrium Aluminum Garnet laser and the conventional method on pain perception and anxiety level in children during caries removal: a randomized split-mouth study. Int J Clin Pediatr Dent. 2023; 16: 39-44. doi: 10.5005/jp-journals-10005-2634