Objective: The aim of this research is to evaluate those techniques and optimal parameters of Erbium Chromium Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser use in delivering predictable painless (or with very limited discomfort) restorative cavity preparation without the aid of injected local anesthesia. Material and methods: This study was conducted on 30 patients (26 adults and 4 youth 9–16 years old; average age, 37) treated in a private practice. For each patient, a single cavity was prepared using the Er,Cr:YSGG laser (2780 nm). An Electric Pulp Tester (EPT) was used to monitor the changes in pulp sensibility threshold. The patient experience was tested before and after the treatment using a modified Visual Analogue Scale (VAS) and Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) to evaluate pain and anxiety. Results: Pain analysis indicated that 80% of patients (24 out of 30) felt no pain and no discomfort, or only a very slight sensation. None of the 30 patients requested anesthesia. EPT was found to be unreliable in evaluating pulpal pain threshold levels. A tendency was noted wherein greater discomfort was felt by anxious patients. On average, the older the patient, the less discomfort was felt. The factors that have a greater tendency to promote discomfort were: posterior teeth, greater caries depth, greater use of higher power levels and ablation time. Conclusions: Using the Er,Cr:YSGG laser, it was possible to avoid local anesthesia during cavity preparation with a bur. The treatment was effective in a high number of cases (80%), leading to reduction in the anxiety frequently associated with dental care.
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