| Objective:With the development of oral biological materials and minimally invasive technology,Er:YAG laser has been applied to caries removal and cavity preparation.Although a lot of researches have been performed so far,there is not a systematic and comprehensive evaluation of the application of Er:YAG laser in caries removal and cavity preparation in children has not been shown.This study aims to evaluate the effectiveness of Er:YAG laser in caries removal and cavity preparation in children by Meta analysis,and provide scientific guidance for the clinical application.Methods:1 MethodsThe searching databases of this study include: CNKI,CBM,VIP,Wangfang,Pubmed,Cochrane library,OVID,Science Direct databases,in which the related articals are from 1997 to December 2016(Er:YAG laser was initially approved for caries removal and cavity preparation in 1997 by the FDA).2 The inclusive criteria2.1 Study design: randomized controlled trails about the comparison of the Er:YAG laser with the traditional mechanical method in the application to caries removal and cavity preparation in the children simultaneously.2.2 Patient population: children were diagnosed as dental caries of 3-15 years old.2.3 Intervention: the experimental group were removed caries and preparated cavity by Er:YAG laser.2.4 Comparison: the control group were removed caries and preparated cavity by traditional mechanical method.loration,marginal adaptation and secondary caries incidence.2.6 Drop-out rate was under 20%.There are effective analyzed data.Trials were identified independently by two reviewers to decide whether to be included.Differences were resolved through discussion or assistance of professors.3 Qualitative assessmentsThe quality of eligible trials was evaluated by two observeres indepently with the revised Jadad's scale.The studies were classified to high-quality trials(more than 4 scores)and low-quality trials(less than 4 scores).Meanwhile the useful data was extracted.4 Statistical analysisMeta-analysis was performed by STATA version 11.0.The effect size of the measurement data was evaluated using sdandardized mean difference(SMD)and 95% confidence interval and the binary response data using relative risk(RR)and 95% confidence interval.At first,Q-test was conducted to analyze raw data of literatures included for heterogeneity test.Subsequently,according to heterogeneity results fixed-effects model or random-effects model will be performed for the calculation of pooled SMD or RR with 95%CI.The potential publication-bias was tested by Begg's test.Results:1 There were 768 references related in total.Of these,7 randomized controlled trials met the inclusion criteria.2 There were 4 high-quality studies in which the score was more than 4according to the Jadad.The qualities of the literatures were generally low.3 Meta analysis3.1 The time of caries removel and cavity preparation by Er:YAG laser was longer than that of traditional mechanical method(SMD=1.945,95% CI=0.942-2.948,P<0.001);3.2 Compared to the the traditional mechanical method,the Er:YAG laser preparation was less painful(SMD=-1.013,95%CI=-1.829,-0.196,P<0.001);2.5 Criteria of evaluation: ti me,pain,complete retention rate,marginal disco-mental group and the controlled group in the complete retention rate(there months laser: RR = 1.015,95%CI = 0.925-1.113,P=0.773;sixmonthslater:RR=1.011,95%CI=0.937-1.091,P=0.495;one year later:RR=1.021,95%CI=0.936-1.114,P=0.190);3.4 There were no statistically significant differences between the experimental group and the controlled group in the marginal discoloration(three nonths later:RR=0.337,95%CI= 0.036-3.169,P=0.992;sixnonthslater: RR=1.298,95%CI=0.300-5.615,P=0.892;one year later: RR=1.638,95%CI=0.224-11.986,P=0.594);3.5There were no statistically significant differences between the experimental group and the controlled group in the marginal adaptation(threemonths later:RR=0.969,95%CI=0.063-14.799,P=0.000;one year later:RR=1.480,95%CI=0.257-8.515,P=0.692).3.6 The data of secondary caries was insufficient.The SPSS results showed that there were no statistically significant differences between the experimental group and the controlled group about secondary caries one year after the treatment according to Rodrigo A V and Gilia G.Conclusion:1 The quality of the random control trials in this research was low and limited,which should be generally improved especially in the following aspects: study design,the sample size,randomization,and blinding.And well-designed randomized control trials of Er:YAG laser application were still needed to verify the effectiveness.2 The sensitivity analysis showed that: the results of this meta-analysis are stable and reliable.The clinical effect of the Er:YAG laser in caries removal and cavity preparation was effective credible.3 The meta-analysis showed that:1)There were no statistically significant differences between theexperimental group and the controlled group in the complete retentionrate,marginal discoloration and marginal adaptation.2)The Er:YAG laser preparation was significant less painful3.3 There were no statistically significant differences bet ween the experi-3)The time of caries removal and cavity preparation by Er:YAG laser was longer than that in traditional mechanical method.4 The Er:YAG laser used in caries removal and cavity preparation of children is a clinical effective technology. |
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