Effect of laser irradiation associated with fluoride in decreasing erosive tooth wear: a systematic review with a network meta-analysis

Statement of problem : Erosive Tooth Wear (ETW) is a clinical condition with a high prevalence. Suggested preventive/treatment strategies include fluoride application and high-power laser irradiation. Controversial results have been reported regarding the effect of high-power lasers against ETW. Objective : The present systematic review with a network meta-analysis (NMA) aimed to evaluate the effect of high-power lasers, associated or not with fluoride compounds, to control and prevent ETW. Material and Methods : The review was registered in the PROSPERO (CRD42021242547) and followed the PICO question: P (population): enamel and dentin substrate; I (Intervention): high-power laser irradiation, associated or not with fluoride compounds; C (Control): no-treatment; and O (Outcomes): prevention/control of ETW. The electronic databases PubMed, Scopus, and EMBASE were searched. Two independent reviewers evaluated in vitro and in situ studies. The risk of bias was assessed using the RoBDEMAT tool. The estimated treatment effect derived from direct and indirect comparisons were analyzed and the difference between these effects was calculated based on the data of enamel and dentin surface loss (in µm). Results : A total of 179 studies were retrieved and after the exclusion of duplicates, 103 studies had their titles and abstracts evaluated. Thirty-nine studies had their full text analyzed for data extraction (Cohen Kappa = 0.88). For sound enamel, the laser irradiation (L), fluoride application (F) and, the association of treatments (L+F) promoted higher protection than No-Treatment (NT). For eroded enamel, L+F and F did not differ, but both treatments reduced surface loss compared to NT and L. For sound and eroded dentin, treatments with laser increased surface loss. Conclusions : Although a high-power laser has some potential to prevent erosive tooth wear, this effect is not better than that of standard fluoride. The use of laser in the management of dentin erosive wear can be harmful.