Clinical effectiveness of Er, Cr: YSGG laser compared with conventional rotary instrumentation for caries removal in primary teeth: a randomized split-mouth clinical trial

To compare the clinical efficacy of erbium, chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser versus conventional air-rotor handpiece for caries removal in primary teeth and their effects on children’s anxiety and pain levels, to provide evidence for optimizing pediatric dental treatment. A total of 90 children (aged 6–10 years) with primary tooth caries were enrolled. Using a split-mouth design, two carious teeth from each child were randomly assigned to air-rotor handpiece treatment (Group A, 90 teeth) or Er, Cr: YSGG laser treatment (Group B, 90 teeth). Clinical efficacy, restoration quality (United States Public Health Service [USPHS] criteria), masticatory function (bite force, chewing efficiency), adverse events, and children’s anxiety (Venham Anxiety and Behavior Rating Scale, Faces Image Scale [FIS], pulse rate) and pain levels (Wong-Baker FACES ® Pain Rating Scale) were compared. Group B exhibited significantly lower Venham scores, pulse rates, FIS scores, and Wong-Baker pain scores post-treatment ( P < 0.01). Additionally, no significant difference was observed in overall clinical efficacy (Group A 83.33% vs. Group B 91.11%, P = 0.18). However, Group B showed significantly better USPHS scores in sensitivity, secondary caries, and marginal staining ( P < 0.01), greater improvement in masticatory function ( P < 0.05) and a lower incidence of adverse events ( P = 0.01). Er, Cr: YSGG laser may represent an effective minimally invasive alternative for caries removal in primary teeth, particularly due to its potential benefits in reducing treatment-related pain and anxiety. Further long-term studies are required to confirm its effects on restoration longevity and clinical outcomes.