Effects of laser treatment on bond strength of epoxy resin and calcium silicate-based sealers: a systematic review and meta-analysis of in vitro studies

ObjectiveThis study aimed to systematically review the effect of laser treatment on the bond strength of epoxy resin-based and calcium silicate-based endodontic sealers to root dentine.MethodsThe search encompassed four databases: PubMed/MEDLINE, EMBASE, Scopus, and ISI Web of Science. Inclusion criteria were limited to in vitro studies conducted on extracted human teeth evaluating bond strength in megapascals (MPa) of either epoxy resin-based or calcium silicate-based sealers, using the push-out test. Two independent reviewers appraised the methodological quality of the selected studies to assess the risk of bias. Meta-analysis was performed for different laser types, endodontic sealers, and control groups. Standard Mean Difference and 95% Confidence Interval values were calculated.Results17 studies met the inclusion criteria for qualitative synthesis, and 15 for quantitative analysis. Meta-analyses revealed that certain lasers (Er,Cr:YSGG, Er:YAG) significantly increased bond strength for epoxy resin-based sealers when compared to negative controls (inert solutions), but did not show a significant advantage over EDTA agent. For calcium silicate-based sealers, laser treatment did not show significant enhancement in bond strength compared to either inert solutions or EDTA. The subgroup analysis suggested that erbium lasers, especially in the PIPS mode, potentially increase the bond strength of epoxy resin-based sealers.ConclusionLaser treatment enhances the bond strength of epoxy resin-based sealers compared to inert solutions, but not more than EDTA. For calcium silicate-based sealers, laser treatment does not significantly improve bond strength over inert solutions or EDTA.Clinical relevanceLaser treatment increases the bond strength of epoxy resin-based sealers.