Efficacy of Er:YAG, Er,Cr:YSGG, and Nd:YAG lasers for caries removal: A systematic review

Abstract

BACKGROUND: Laser technology is increasingly used in dentistry due to its minimally invasive properties. Among its applications, caries removal has gained attention. The most frequently used lasers in this context are Er:YAG, Nd:YAG, and Er,Cr:YSGG. AIM: To systematically evaluate the efficacy, treatment efficiency, and histological outcomes of different lasers used for caries removal in comparison with conventional methods. METHODS: A qualitative systematic review was conducted according to PRISMA 2020 guidelines. A comprehensive search was conducted on December 1, 2024, and updated on December 5, 2024, in the databases Medline, Scopus, SciELO, Web of Science, and The Cochrane Library. In vivo and in vitro studies assessing Er:YAG, Er,Cr:YSGG, or Nd:YAG lasers for caries removal were included. Risk of bias was assessed using RoB 2 and ROBINS-I V2 tools. RESULTS: Eleven studies met the inclusion criteria (five in vitro and six in vivo). Most studies reported thar Er:YAG and Er,Cr:YSGG lasers achieved effective caries removal, selective ablation of infected dentin and favorable histologlical features (open dentinal tubules, absence of smear layer). Nd:YAG showed lower ablation efficiency and was mainly effective for surface modification. Laser treatment generally required longer time than rotary excavation but caused less pain and anxiety in clinical studies. Heterogeneity among studies prevented meta-analysis. CONCLUSIONS: Erbium lasers, particularly Er:YAG, appear effective and conservative for caries removal, supporting their use within minimally invasive dentistry. However, due to methodological variability, limited evidence for Er,Cr:YSGG and Nd:YAG, and lack of long-term outcomes, further well-designed randomized trials are needed. CLINICAL SIGNIFICANCE: Laser-assisted caries removal represents a promising alternative to conventional methods, especially for patients with high dental anxiety or requiring minimally invasive procedures.