Journal of Photochemistry and Photobiology 12 (2022) 100148

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Journal of Photochemistry and Photobiology

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Laser as an innovative tool, its implications and advances in dentistry: A

systematic review
Saad Liaqat *, Haleema Qayyum, Zainab Rafaqat, Abdul Qadir, Sarmad Fayyaz, Aiman Khan,
Humaira Jabeen, Nawshad Muhammad, Muhammad Adnan Khan
Department of Dental Materials, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Since the 1960s, lasers have been used in dentistry, and their clinical uses have been evaluated.
Laser Many dental procedures involve lasers, which are noted for their simplicity, efficiency, comfort, and superiority
Soft tissue laser over older methods. Lasers have been employed in various therapy approaches, from identifying small caries to
Hard tissue laser
planning and treating more severe lesions or cancers.
Dentistry
Methodology: To conduct a comprehensive search for our systematic review, we employed three search engines:
PubMed, Cochrane, and Google Scholar. Following combinations; Lasers [general dentistry], Laser [soft tissue],
and Laser [hard tissue], published in the last five years. After applying inclusion-exclusion criteria, 46 original
articles were studied in detail.
Objective: The systematic review aimed to study the long-term outcomes of lasers on soft and hard tissues in
dentistry.
Result: Tooth decay, gum disease, biopsy or lesion removal, teeth whitening, and other procedures are performed
using lasers. Lasers are frequently utilized because they cause less pain, require less anesthesia and avoid anxiety
in patients who are afraid of dental drills and instruments.
Conclusion: Laser technology in clinical dentistry practice is currently at an advanced stage of development and
has a bright future. With the expanding use of lasers on both hard and soft tissue in clinical dentistry, treatment
planning and prognosis have significantly improved.

Introduction
Since the 1960s, when lasers were first used in dentistry, their clin­
ical uses have been evaluated [1]. Roundabout 1600 systematic reviews
have been published in the literature on advances of lasers in dentistry.
Many dental procedures involve lasers because of their easy handling,
efficiency, and superior properties compared to older methods. Lasers
have been employed in various therapies, from identifying minor caries
to planning and treating even more severe lesions like cancers [1].
Miaman was the first to employ “lasers to treat both hard and soft
tissue” [2]. Diode lasers are most often utilized lasers for soft tissues [2].
Gingival contouring and troughing, unerupted teeth and operculectomy,
frenectomy, soft tissue incision, gingivectomy, and oral mucosal lesions
(mucositis, leukoplakia, lichen planus) ablation are some of its appli­
cations [2]. Scientists discovered that “carbon dioxide (CO2) and Nd:
YAG lasers” could be utilized for oral soft tissue to treat in the 1970s [3].
To increase interaction with dental hard tissues, the first pulsed “Nd:
YAG laser” was released in 1900 [2]. Surgical and non-surgical dental
lasers, low-level laser therapy, laser doppler flowmetry, PAD,
laser-based curing light, and other treatments are available [4].
Using lasers has benefited from conservative dentistry, endodontics,
periodontology, implantology, oral surgery, and other dental procedures
[5]. Lasers were employed in almost every aspect of modern dentistry
with ongoing advancement [6]. Gingival melanin hyperpigmentation
corrections were done by using lasers [7]. Non-surgical periodontal
therapy for untreated periodontitis and the peri-implant lesion was
successfully treated by incorporating the lasers [8]. In aesthetic
dentistry, lasers were used to remove tooth decay, reduce recrudescent
decay, reinforce restorations, and the tooth bleaching [9]. Other appli­
cations of Laser in surgery include curing lesions with minimal scarring,
lowering operation time, and reducing bleeding, edema, and pain
following an operation [9]. Lasers were also used to diagnose germs and

* Corresponding author.
E-mail address: saad_kcd@yahoo.com (S. Liaqat).

https://doi.org/10.1016/j.jpap.2022.100148
Received 7 July 2022; Received in revised form 8 October 2022; Accepted 11 October 2022
Available online 14 October 2022
2666-4690/© 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
S. Liaqat et al. Journal of Photochemistry and Photobiology 12 (2022) 100148

bacteria, as well as to eradicate bacteria and cure peri-implantitis and surgery, prosthodontics, orthodontics, and dental esthetics were
periodontitis [9]. The resistance to caries is strengthened when lasers emphasized.
are used on dental hard tissue. Laser irradiation could reduce mineral The total count of articles that were registered was 781. After
loss and demineralize the tooth structure [10]. Lasers were excellent in duplication, 213 articles were removed, so the count was reduced to
temporomandibular joint dysfunctions, implant rehabilitation, and 568. These articles were further investigated, and 221 articles were
periodontal disease treatment [11]. After extraction, the Laser increases excluded due to other reasons like full text not being available, case
degranulation, leading to hemostasis, disinfection, and healing [12]. reports, in vitro studies, and incomplete data. So the ultimate count
finalized after deductions were 434 articles. Out of which, original ar­
Methodology ticles were selected based on our systematic review. The count of articles
was then reduced to 46. Then, the following criteria were applied.
Information source
Inclusion criteria
To conduct a comprehensive search for our systematic review,
electronic databases like PubMed Central, Web of Science, and Cochrane i Only open access articles [full]
were used, and the literature for this article was searched. More than ii Studies were done on animals and humans
3000 articles were published in the last ten years, so we selected papers iii Articles mention details of lasers used
from the previous five years, from 2017 to 2022, using a key to avoid iv Published in the last five years
cognitive load words. After applying inclusion-exclusion criteria, 46
original articles were studied in detail (Figs. 1–4.Tables 1 and 2). Exclusion criteria

i Articles are written in languages other than English

Search methods ii Case reports
iii Studies involving cell/tissue cultures and not a whole organism
Four authors searched the articles independently by different key­ iv Incomplete data
words and from other Databases. Articles related to the Laser, its uses v Full text not available
and applications in dentistry, Laser in endodontics, periodontics, oral

Fig. 1. Prisma flow chart of laser in dentistry: a systematic review.

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S. Liaqat et al. Journal of Photochemistry and Photobiology 12 (2022) 100148

Fig. 2. Risk of bias chart for assessing the methodological quality of 3 papers reporting in-vivo studies in this systematic review.

Fig. 3. Risk of bias chart for assessing the methodological quality of 1 paper reporting in-vitro studies in this systematic review.

Fig. 4. Risk of bias chart for assessing the methodological quality of 1 paper reporting randomized trial in this systematic review.

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S. Liaqat et al. Journal of Photochemistry and Photobiology 12 (2022) 100148

Table 1
Studies assessment tools table of risk of bias.
Study type Assessment tool Year Citation
In-vivo SciRAP(Science in Risk Assessment 2017 Sant’Anna et al
Studies and Policy) Tool [13].
OHAT (Office of Health Assessment 2017 Molnar E,
and Translation) Tool Molnar B et al
[14].
SYRCLE (Systematic Review Centre 2018 Saberi et al.
for Laboratory Animal [23].
Experimentation)Tool
In-vitro Study OHAT(Office of Health Assessment 2017 Sun M, et al.
and Translation) Tool [15].
Randomized SIGN(The Scottish Intercollegiate 2021 Sokouti et al.
Trial Guidelines Network) checklist [33].
Results
Soft tissue
Our systematic review is based chiefly upon original articles
comprising 46 articles. There is an evidence-based table that encom­
passes different articles that are included in this systematic review.
Different studies highlighted the basic structure, mechanism of laser
therapy, its contraindications, side effects, and the uses of laser treat­
ment in different fields of dentistry. The last five years were the timeline
for the research articles.
Different wavelengths were used to treat capillary haemangioma, lip
vascular malformation, and vascular pool; after six months, it showed
satisfactory cosmetic results [6]. There was no correlation between
power increase, incision depth, and thermal tissue damage. However,
the efficiency factors describe those correlations and enable us to predict
expected tissue interaction and thermal effects [31]. "Er: YAG” laser
irradiation using PIPS-activated irrigation” as laser-activated irrigation
was the less harmful and more efficient method and could be used as a
supplement in RCT of the primary tooth [39]. Laser with 635 nm and
405 nm wavelength causes an increase in proliferation of gingival
fibroblast. So these lasers can be used in periodontal procedures such as
periodontal plastic surgery to obtain increased fibroblasts to regenerate
soft tissue [11].
Laser Speckle Contrast Imaging helps us better determine microcir­
culation of flap in oral mucosa after periodontal surgeries [14]. Physi­
ologic hyperpigmentation of the gingiva is removed by 940 nm diode
liquid nitrogen therapy, and cryotherapy proved safe and efficient [40].
Smear layer clearance in RCT was equivalent to that of Laser and EDTA
with NaOCl irrigation. Laser irrigation failed to remove debris from root
canals compared to conventional EDTA and NaOCl irrigation methods.
[41]. Human Beta Defensin 2 mRNA’s expression in an oral fibroblast
cell line is efficiently increased by laser irradiation compared to human
oral keratinocytes. This study is well established that using an 810 nm
diode laser increases the expression of Human Beta Defensin 2 and TGF
beta one signaling, thus promoting tissue healing [42].
Hard tissue
When the "Nd: YAG and Er: YAG" Laser was used to differentiate hard
tissue from soft, the soft tissue was intact even after numerous circular
crossings of the laser beam, but hard tissues ablated [26]. The com­
posite material was removed from the dental cavity using Er: YAG
irradiation, which is safe and efficacious [27]. Surface fusion is caused
by the high Laser, which reduces the titanium surface’s roughness. The
effect of laser irradiation on titanium was compromised with moisture.
Cone-shaped threads can help decrease surface modification, which is
essential for titanium dental implant debridement [29].
When the outcomes of CO2 and Er: YAG laser were assessed on
demineralization around the composite restoration, the four laser
groups of “CO2 laser-NaF, NaF- CO2, NaF-Er: YAG, and Er: YAG-NaF"
exhibited the least amount of Ca and phosphorus ions lost, the overall
hardness of the NaF-CO2 and NaF-Er: YAG laser groups was more sig­
nificant than the standard hardness of the other groups [10]. The results
were surprising when 53 essential extractions were irregularly assigned
to the laser or control groups. After the treatment, the laser group had no
discomfort, bleeding, or swelling. One patient in the control group
experienced bleeding five days after extraction, 2 had inflammation, and
3 experienced postoperative pain for up to 3 days. The laser
post-extraction process improves bone repair and is a simple and
effective procedure [12].
All lasers increased the zirconia’s resistance to resin cement
compared to the untreated surface. On a bond strength equal to sand­
blast, the Er: YAG laser was the most successful laser therapy [43].
Microleakage rates were examined between two laser sources, with the
Er: YAG group having the lowest and the Nd: YAG group having the
highest [35]. When Diode Performance, Nd: YAG, and Er: YAG Lasers
were evaluated and compared in dentinal tubule obstruction, there were
fewer open dentinal tubules after using all three lasers, and they can
effectively restrict the tubules [44]. According to "ANOVA and Tukey,
in" an analysis of numerous pairs at 30 s, the control group’s shear bond
strength varies significantly from that of the study group. “Nd: YAG
group and Ti: sapphire” laser group. The power of the shear bond of the
titanium sapphire laser is the strongest [45]. With the Er, Cr: YSGG Laser
without flap reflection, crown lengthening provides sufficient tooth
height for restoration compared to the traditional method of crown
lengthening [32].
In contrast to untreated and APF-gel groups, Laser dramatically
reduced the area and depth of erosion lesions. However, when Laser and
APF-gel were combined, they did not produce a secondary effect [18].
For a primary teeth root canal, diode lasers of 810 nm and 980 nm
should not be used because they result in high temperatures when
applied [24].
Laser treatment for eliminating lesions and pathogenic organisms is
an effective therapeutic procedure that does not cause significant tem­
perature rise that could harm pulp vitality [21]. Fluoride varnish, diode
laser, and the combination can help reduce primary enamel deminer­
alization [22]. Er obstructs dentinal tubules: YAG laser irradiation en­
hances dentin surface cracks. These changes in the surface break can
retain microbial plaque, leading to caries and gum disease. The use of
CO2 on practically relevant blockage of dentinal tubules along with
cracks in the surface has sound effects [23]. However, various negative
impacts on bonded restorations’ have restricted their use in restorative
dentistry [24].
Discussion
Soft tissue
High-power lasers are employed in soft tissue procedures in
dentistry. Some lasers use coolant systems, while others do not.
Regardless of laser production, a vacuum aspiration system must be
employed in all processes to prevent air-water spray or smoke from
spreading and polluting the environment [46]. Capillary haemangioma,
venous lake, and lip venous malformation were treated with better scar
quality and stunning results [6]. In the Amelie Hankie et al. study, eight
wavelengths were tested on gingival tissue samples to examine the ef­
fects of Laser in the range of 400–1500 nm and concluded that power
increases do not correspond with incision depth or thermal tissue injury
[31]. Barbara Sterczala et al. concluded that they had better results in
preventing soft tissue scarring when using a 635 nm laser [11].
Laser-induced TGF-1 signaling and increased HBD-2 expression can
promote healing in tissues near high-powered surgical lasers, and
low-frequency lasers can also be therapeutic [42]. Degranulation, ster­
ilization, de-escalation of the gingiva, stabilization of clot, and photo­
therapy were all accomplished using Er: YAG and Nd: YAG lasers [12].
Jokar L et al. concluded that laser treatment and cryosurgery

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S. Liaqat et al. Journal of Photochemistry and Photobiology 12 (2022) 100148

Table 2
Evidence-based table of laser in dentistry: a systematic review.
Citation Year Type of study Aim of study Laser protocol Conclusion

Sant’Anna et al 2017 In vivo To study how HILT can be used in Low-level and high-level laser Despite the several reasons for using lasers
[13]. orthodontic treatment. therapy. in orthodontics, they are currently under
by Brazilian trained professionals. In any
case, these sales will undoubtedly increase
in the next generations.
Molnar E, Molnar 2017 In vivo Gender may influence postoperative Laser speckle contrast imaging The most significant affecting factor was
B et al [14]. circulation and inflammation. gender.
Males reestablished mucosal blood flow
more quickly than females. The LSCI
approach is viable for assessing
postoperative flap circulation in the oral
mucosa.
Sun M, et al. [15]. 2017 In vitro study A new strategy for attaining fast enamel Diode laser 980 nm The advantage of employing a laser is that
mineralization in a physiologically it speeds up mineralization and allows you
to control crystal formation precisely. This
technology could enable enamel
biomimicking repair in dental clinics.
Molnár E, et al 2017 In vitro To investigate how laser-activated TGF-1 Diode laser 810 nm The Laser activated TGF-1 signaling, and
[16]. affects the antimicrobial peptide HBD-2 in HBD-2 expression was induced, both of
periodontal and peri-implant disease which can promote tissue healing in areas
treatment. close to surgical laser treatments with high
power.
Meier et al [17]. 2017 In vitro After "Er: YAG," bacterial biofilms could be “Er: YAG” With a wavelength of The Er: YAG Laser provided distinct
removed. On dentin and titanium surfaces, 2940 nm advantages over the other debridement
epithelial cells, gingival fibroblasts, and cells modalities.
that resemble osteoblasts may attach.
Pereira DL, et al 2018 In vitro The effects of the "Nd: YAG laser" on root "Nd: YAG laser" with a Dentin erosion and abrasion can be treated
[18]. dentin’s compositional, crystallographic, and wavelength of 1064 nm with Nd: YAG laser light as a prophylactic
morphological consequences. Additionally, measure.
topical acidulated phosphate fluoride
treatment and laser therapy have been
investigated.
Agrawal AA, et al. 2018 In vitro Staining can be used in conjunction with 940 nm "diode laser." Staining could be linked to the use of lasers
[19]. lasers to boost efficacy. to increase efficacy.
Scatolin RS et al 2018 In vivo To determine how well "Er: YAG" laser “Er: YAG laser." Therapy with the "Er: YAG" did not stop
[20]. therapy controls the development of abrasive enamel structure degradation, but it did
lesions-induced enamel deterioration. prevent abrasion after the erosion.
Baraba A, et al 2018 In vitro Using two lasers: a fluorescence-feedback “Er:YAG laser FFC Er: YAG” An effective treatment option that does not
[21]. controlled "Er: YAG laser" and a non- produce high temperatures could harm the
fluorescence-feedback controlled "Er: YAG pulp.
laser." the effectiveness of ablation to remove
cariogenic bacteria and carious dentin will be
evaluated.
Chokhach et al 2018 In vitro “Diode laser (810 nm)” with or without Diode laser Fluoride stains, diode laser, and their
[22]. fluoride had any effect. This procedure aims combination reduce lacquer
to prevent deciduous enamel microhardness respect and maybe prevent
demineralization. demineralization of deciduous finishes.
Saberi et al. [23]. 2018 In vivo Dentinal tubule blockage and dentin surface “Er: YAG CO2” Er: YAG Laser illuminates a nearby water
roughness after treating dentin cooler in the second segment. The CO2 the
hypersensitivity with a combination of lasers. Laser illuminates a neighboring water-
cooling system in the third part. Initially,
non-contact AFM was used on the surfaces.
Seraj B, et al. [24]. 2018 In vivo The primary roots’ outer surface temperature “810 nm, 980 nm diode” Major root channels within the zeroed-in
increased when "diode lasers with on constraints due to their temperature
wavelengths of 810 nm and 980 nm" were increase during application.
utilized.
Mohammed et al. 2019 In vitro To study the effectiveness of a 445nm diode “445 nm and 810 nm diode The 445 nm laser irradiation is beneficial
[25]. laser in preventing caries. lasers. 0.3 W, 60 s, and 90 J/ in preventing caries, but it is less effective
cm2 doses." than the argon ion laser.
Abbasi, H., et al 4/03/ In vitro study Laser osteotomy in soft and hard tissue. "Ho: YAG at 2.1 µm, Er, Cr: “Soft tissue” was preserved while hard
[26]. 2020 YSGG at 2.79 µm, Er: YAG at tissue was ablated.
2.94 µm, and CO2 at 9.3, 9.6,
and 10.6 µm."
Mehdipour, M., et 15/ In vivo research Laser application should be taught in general All lasers The incorporation of Laser has a positive
al [9]. 03/ dentistry classes. impact on students; thus, this laser credit
2020 can be incorporated.
Zakrzewski, W., 07/ In vitro study After removing the composite filling "Er: YAG laser with a The "Er: YAG" Laser may safely and
et al [27]. 07/ material, the root canals surface in the wavelength of 2940 nm at a efficiently remove composites.
2020 cervical region. power of 3.4 W."
Kaplan, T et al 24/ Parallel The impact of a diode laser on the severity of 980 nm diode laser coupled Diode Laser shows efficient results in pain
[28]. 07/ randomized post-RCT pain. with a 200 μm optical fiber management after RCT.
2020 controlled trial,
Fenelon, T., et al In vitro To see how the “Nd: YAG and Er: YAG” lasers “Nd: YAG Conical fibers are pertinent to clinical
[29]. affected titanium. 1064 nm protocols for titanium dental implant
(continued on next page)

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S. Liaqat et al. Journal of Photochemistry and Photobiology 12 (2022) 100148

Table 2 (continued )
Citation Year Type of study Aim of study Laser protocol Conclusion

11/ Er: YAG debridement or cleaning and can

08/ 2940 nm” minimize undesirable surface
2020 modification.
Valizadeh, S., et al 03/ In vitro work Seeing how “CO2 and Er: YAG lasers” “CO2 laser, CO2 laser-NaF, NaF- “CO2 and Er: YAG lasers" synergize when
[10]. 10/ influenced demineralization surrounding CO2 laser, Er:YAG laser, Er:YAG combined with NaF varnish.
2020 composite fillings with and without fluoride
varnish
Nammour, S., et al 22/ In vivo Quality of scar, frequency of recurrence, and Nd:YAG(1064 nm), Er,Cr:YSGG The "Er, Cr: YSGG and CO2 laser" therapies
[6]. 11/ patient satisfaction were assessed after laser (2790 nm), CO2 (10,600 did not reveal recurrence throughout the
2020 numerous laser wavelength operations. nm), and diode laser (980 nm) one-year follow-up period.
Agop-Forna 2020 In vivo The treatment of oral premalignant lesions, Erbium lasers wavelength CO2 lasers are used to treat vascular
Doriana et al the elimination of oral benign mucosa (2780 nm, 2940 nm) lesions, oral benign and premalignant
[30]. lesions, and the therapy of oral vascular Diode wavelength (810–1064 lesions, and moderate to severe mucosal
lesions using lasers. nm) Nd: YAG laser wavelength lesions. Premalignant or benign lesions of
(1064 nm) CO2 lasers the oral mucosa are removed with diode
wavelength (10600 nm) lasers, and vascular lesions are often
released with Nd: YAG lasers. Erbium
lasers excise benign oral lesions, such as
pyogenic granuloma, lip mucocele, oral
papilloma, or oral irritation fibroma.
Hanke, A., et al 26/ Ex vivo study Cut efficiency during soft tissue surgery is Diode laser 400,1500 nm Power increases are not proportional to
[31]. 01/ measured quantitatively. incision depth or thermal tissue damage.
2021
Sterczala, et al 04/ In vitro To examine the effect of Vitro models on the Nd: YAG (1064 nm), infrared Both Lasers at a specific frequency
[11]. 02/ development of human gingival fibroblasts. diode laser (980 nm), and promote gingival fibroblast activity.
2021 prototype led Laser emitting
405, 450, and 635 nm
Krizaj Dumi et al 2021 In vitro To compare the alveolar bone regrowth after Er: YAG(7um) and Nd: YAG Post-extraction technique improves bone
[12]. laser post-extraction therapy. (300 um) lasers repair following extraction in a safe and
effective method.
Tianmitrapap, et 2021 In vivo Crown lengthening treatment, the "Er, Cr: Er, Cr: YSGG laser with a setting Crown lengthening without flap reflection
al [32]. YSGG laser," versus the conventional flap. of 1.5 W, 7% water, and 11% may give sufficient tooth height for
air. restoration.
Sokouti et al. 2021 Randomized Diode low-level laser therapy affected pain The Laser was a low-level Diode A low-power laser is valuable for inducing
[33]. clinical trial alleviation in dental patients. laser operating at 810 nm, 200 sedation and reducing patient anxiety.
MW constant power, the 30 s of
exposure duration, and a 6 J
energy dose.
Nejad et al. [34]. 2021 In vitro study To assess and contrast the effects of three “CO2 All lasers increase zirconia’s shear bond
various lasers on the strength of the zirconia- Er: YAG strength.
resin cement bond. Nd: YAG”
Zaid Kamel, et al 2021 In vitro study To compare and contrast the efficacy of Diode:980 nm wavelength, 0.5 The dentinal tubules could be successfully
[35]. "diode, Nd: YAG, and Er: YAG lasers" with W power, Nd:YAG: 1064 nm obstructed by all three types of lasers used.
fluoride to treat blockage in the dentinal wavelength, 0.5 W power, Er:
tubule. YAG: 2940 nm wavelength, 0.5
W power
Mahdian M et al 2021 Randomize To compare the results of using lasers in the In-office lasers Compared to placebo/no therapy, general
[36]. control trial office with a control laser. laser application may lessen pain intensity
when tested using air blast or tactile
stimuli throughout a short, medium, or
long period.
Muhammad U et 2021 In vivo Lasers are used to reduce the impact on soft Hard tissue, Soft tissue, and Modern dental procedures have
al [37]. tissues after the procedure. non-surgical lasers (Erbium significantly benefited from lasers, which
laser, YAG, etc.) have supplemented more traditional
mechanical methods.
Hui Ren et al, 2022 In vivo To determine if low-level laser therapy LLLT using various wavelengths The use of LLLT showed greater
Jingying Liu et (LLLT) using various wavelengths is effective (632.8–672 nm, 780-904 nm, effectiveness in lowering pain for TMD
al [38]. in treating pain caused by and 910–1100 nm) patients. LLLT with wavelengths between
temporomandibular disorders (TMD) 910 nm and 1100 nm in the short term
offered comparatively optimum pain
management. In TMDs, LLLT, particularly
diode ones, can help reduce discomfort,
improve maximum opening, and eliminate
noises.

successfully removed gingival physiologic hyperpigmentation. The
Laser has a higher efficiency than cryotherapy [40].
Hard tissue
In laser osteotomy, H. Abbasi et al. employed the Nd: YAG and Er:
YAG lasers to discriminate soft from hard tissue, the Nd: YAG for tissue
type detection, and the Er: YAG for bone excision [26]. After removing
the composite filling material, W. Zakrzewski et al. used an Er: YAG
Laser to examine the root surface in the cervical region [27]. Nd: YAG
and Er: YAG laser energy was employed during implant osseointegration
to increase the surface area accessible for bone apposition [29]. CO2 and
Er: YAG lasers were used to demineralize surrounding composite res­
torations, with and without fluoride varnish, because fluoride varnish
applied before laser irradiation increases the tooth structure’s resilience
and hardness [10]. The effect of three distinct types of lasers on zirconia
to resin cement’s shear bond strength was investigated and compared
using laser irradiation [43]. To test if lasers can replace etching cavities,

6
S. Liaqat et al.
S. Aghayan and colleagues use Nd: YAG and Er: YAG laser tooth surface
conditioning to analyze the microleakage of self-etch sticky resin cement
[35]. In crown lengthening, Tianmitrapap et al. compared the Flapless
Er, Cr: YSGG laser to the standard flap [32].
Gounder et al. looked into laser science and its applications in
prosthetic restoration to educate physicians about using lasers in their
clinical practices. Lasers are non-invasive and respond quickly to tissue
[35]. The increase in temperature induced by intracanal laser treatment
might harm surrounding periodontal tissues. B. Seraj and colleagues
investigate the effects of diode lasers on the temperature of the outer
layer of primary roots [21]. Mohammed Abood Al-Maliky and col­
leagues investigate the caries-prevention efficacy of 445 nm diode la­
sers. Lasers improve fluoride preventive action on enamel. Topical
fluorides cause fluoridated hydroxyapatite or CaF2 to form, which re­
duces enamel solubility [24].
Conclusion
Laser technology in clinical dentistry practice is currently at an
advanced stage of development and has a bright future. Laser therapy in
dentistry is a new vision and era that meets the public’s demands for
painless, non-invasive, and effective dental caries. With the expanding
use of lasers on both hard and soft tissue in clinical dentistry, treatment
planning and prognosis have significantly improved. In many ways, the
introduction of this technology has turned dentistry into a painless,
bloodless industry with better predictability and instant outcomes. Laser
encourages a faster and effortless operation with little or no discomfort,
resulting in reduced tissue damage. Further research could be done to
enhance its thermal effects, and its wavelength monitoring could be
added to the advanced research.
Limitations
• The Laser’s effects on hard and soft tissues in conjugation lack the
inter-relationship aspects.
• The thermal effects of lasers on tissues should be emphasized in the
future.
• The accuracy of wavelengths in future studies should be maintained.
• The selection of potentially relevant research for many Systematic
Reviews was based on a small number of databases.
• This Systematic Review is based on the data available and the quality
of studies from which the data is obtained.
Future recommendations
Future pediatric dental treatment will be enhanced due to the
intrinsic benefits of lasers like local analgesia, bloodless surgical tech­
niques, and a comfortable healing phase. Future research is required to
understand lasers’ clinical efficacy and cost-effectiveness and excep­
tionally well-designed double-blinded RCTs [36]. A recent innovation in
root canal therapy created by DiVito EE uses photons to produce pho­
toacoustic streaming, which generates strong shockwaves at sublative
levels to clean the entire root canal system three-dimensionally with
disinfecting irrigants [37]. Older patients and those with persistent
periodontitis might benefit most by adding lasers to the post-extraction
modalities. Early restoration, better cosmetic results from prosthetic
rehabilitation, and easier implant insertion are all made possible with
fewer complications and enhanced bone healing [12]. By calculated
wavelength monitoring, the thermal effects can be approximated in the
future. New laser wavelength development will be accelerated (such as
445 nm, 514 nm, and 532), especially for dental purposes [31].
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
7
Journal of Photochemistry and Photobiology 12 (2022) 100148
the work reported in this paper.
Data Availability
No data was used for the research described in the article.
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.jpap.2022.100148.
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