Selective Removal of Necrotic Dentin in Primary Teeth Using Laser Irradiation: One-Year Clinical Evaluation of Composite Restorations

Abstract Introduction: This study aimed to evaluate the child’s salivary cortisol levels, clinical performance and marginal adaptation of restorations after selective removal of necrotic dentin in primary teeth using Er: YAG laser irradiation.Methods: A double-blind clinical study was performed in children at ۷-۱۰ years. Children who had at least ۲ teeth with carious lesions involving the occlusal and proximal surfaces of primary molars counterparts were selected. Removal of necrotic dentin was performed by ۲ methods: Er: YAG laser irradiation and bur-preparation. Cortisol levels (n = ۲۴) was evaluated by ELISA. Clinical analysis (n = ۲۰) was performed after the restorations polish, ۶ and ۱۲ months after restorative procedure using United States Public Health Service (USPHS) method and photographs. Scanning electron microscopy (SEM) was used to analyz the marginal gap formation (n = ۲۰). The analysis of the data was performed by ۹۵% confidence interval, Shapiro-Wilk test, Friedman and Wilcoxon post hoc tests (α = ۵%).Results: Cortisol levels were higher during selective removal of necrotic dentin, regardless of the method used (P > ۰.۰۵). After ۱۲ months, there was no evidence of the difference in the restorations performed on cavities prepared by both methods. SEM analysis revealed that the laser-irradiated teeth showed ۱۰% of gaps in the full extent of restoration. For bur-prepared teeth, ۲۰% of gaps were found at the cavosurface margin.Conclusion: The salivary cortisol levels on children that received Er: YAG laser irradiation for removal the necrotic dentin was similar to the control group. Class II restorations evaluated after ۱ year period did not suffer interference by the use of Er: YAG laser irradiation. Keywords: Lasers Dental restoration Dental caries Stress Primary teeth