Clinical and Radiographic Evaluation of Diode Laser Pulpotomy in Primary Teeth: A Systematic Review

Abstract

Pulpotomy remains the most widely accepted vital pulp therapy for carious or traumatically exposed primary teeth. While conventional medicaments such as formocresol and ferric sulfate have shown satisfactory results, concerns regarding cytotoxicity and systemic risks have prompted interest in diode lasers as an alternative. This systematic review aimed to evaluate the clinical and radiographic success of diode laser pulpotomy in primary teeth and compare outcomes with conventional pharmacotherapeutic techniques. Electronic searches were conducted in PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar for studies published between 2015 and 2025. Studies reporting clinical and radiographic outcomes of diode laser pulpotomy in primary teeth were included. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool and the Newcastle–Ottawa Scale. Data were synthesized narratively. Fourteen studies involving over 800 primary molars were included. Diode laser pulpotomy achieved clinical success rates of 90–100%, broadly comparable to those of formocresol, ferric sulfate, and MTA. Radiographic success rates were more variable but were generally comparable to, and in some studies exceeded, those reported for conventional pulpotomy agents, particularly when diode laser treatment was combined with bioactive materials such as MTA or Biodentine. No statistically significant differences were observed in most comparative studies (p > 0.05). Diode laser pulpotomy is a safe and effective alternative to conventional agents in primary teeth. Its bactericidal action, immediate hemostasis, and biocompatibility offer tangible clinical advantages. However, the lack of standardized protocols limits definitive recommendations regarding optimal laser parameters.