# SEM Studies Assessing the Efficacy of Laser Treatment for Primary Teetis: A Systematic Review
## 4 Discussion  
Based on the evidence found in the articles analyzed, the null hypothesis of this systematic review was largely confirmed. The majority of the reviewed articles state that the use of different laser systems does not result in a discernible difference in the surface changes of primary teeth when observed by scanning electron microscopy (SEM) imaging. However, as mentioned above, there are still some discrepancies in study results and this topic requires further research. Caries prevalence in young children remains a persistent challenge in dental health [37]. Deciduous teeth possess distinctive characteristics, such as a more prominent prismless layer [3,4] and lower mineral content coupled with higher organic content [5, 6, 7], rendering them inherently more susceptible to caries development compared to permanent teeth. Pulpal involvement tends to manifest more rapidly in deciduous teeth due to their proportionately larger pulp chambers and superficial location [38]. It is imperative to note that the pulp of primary teeth exhibits heightened susceptibility to overheating during laser treatment compared to adult pulp [39,40]. As posited by [PERSON] et al. [22], the superior ablation efficiency of lasers in enamel and dentin makes them more effective than traditional burrs for carious tissue removal in deciduous teeth. \begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline \multirow{3}{*}{ \begin{tabular}{c} **Reference** \\ **Publications/C Criteria** \\ \end{tabular}  } & \multirow{3}{*}{ \begin{tabular}{c} **Group Size** \\ **of min. 10** \\ **Samples** \\ \end{tabular}  } & \multirow{3}{*}{ \begin{tabular}{c} **Control** \\ **Group** \\ **Calculation** \\ \end{tabular}  } & \multirow{3}{*}{ \begin{tabular}{c} **Sample** \\ **Size** \\ **Calculation** \\ \end{tabular}  } & \multirow{3}{*}{\ \begin{tabular}{c} **Derived** \\ **Frequency**, \\ **Size** \\ **Sice** \\ **Sice** \\ **Sice** \\ **Sice** \\ **Sice** \\ **Sice** \\ **Sice** \\ **Sice** \\ \end{tabular}  } & \multirow{3}{*}{
\begin{tabular}{c} **Detailed** \\ **Frequency**, \\ **(Distance, \\ Time, \\ **Sice  
Nevertheless, a cautious approach is warranted due to the elevated thermal stress experienced by the dental pulp [16, 22]. To prevent overheating, [PERSON] et al. [32] recommend the use of laser systems characterized by a short pulse length set at low power density. Due to the reduced mineralization, bacterial acids have a swifter impact on deciduous tissue. Thus, implementing robust remineralization strategies becomes imperative to counteract the rapid onset of caries in children [40, 41]. Noteworthy studies by [PERSON] et al. [32] and [PERSON] et al. [15] substantiated that laser treatment enhances enamel resistance through the reduction of carbonate and hydroxyl groups and the decomposition of the organic matrix. Furthermore, heightened energy intensity leads to a lower mass percentage of carbon, rendering the enamel less soluble and more resilient to caries, as empirically demonstrated by [PERSON] et al. [15], who found that the enamel becomes less soluble and more resistant to caries. Laser irradiation exhibits the potential to amplify the efficacy of fluoride varnish, APF [32] or CPP-ACP [33], improving its interaction with the enamel and increasing the retention of fluoride for a longer period of time. [PERSON] et al. [32] further posited that Nd:YAG laser irradiation alone induces alterations in the chemical composition and microhardness of the enamel surface, without inducing significant morphological changes, effectively impeding the demineralization of deciduous teeth enamel. There are some discrepancies between authors considering obstruction of dentinal tubules. [PERSON] et al. [2] reported closed dentinal tubules and concluded that it was due to the ablation effect of the Er:YAG laser. The Er:YAG laser was set at 200 mJ/2 Hz with water cooling of 25 mL/min at a 12-mm distance. [PERSON] et al.