# Should the Application of Diode Laser Completely Replace Conventional Pulpotomy of Primary Tenth?
## 4 Discussion
Nowadays, this contact laser is widely used in dental medicine, especially in procedures on soft tissues (e.g., excision, incision, ablation) which are in direct contact with the laser tip (micrometer range) [19]. Unlike soft tissues, the tooth structure absorbs this laser energy relatively poorly, which is why the diode laser has a minimal effect on hard dental tissues. Its application in dental medicine lies in its conductivity through optical fibers while its small size, portability, and relatively low price compared to other types of lasers available on the market additionally contribute to its practicality and accessibility [19]. Additionally, the diode laser offers a number of advantages, including minimal or no bleeding, faster healing, reduced incidence of postoperative infections, and minimal or no need for anesthesia [19,40]. The success of the results of applying the diode laser in pulpotomy differs in the available literature, depending on the spectrum of laser settings and method of use. If the pulp tissue is treated with laser radiation, a surface of coagulation necrosis is formed which is consistent with the underlying tissue and isolates the pulp from the harmful effects of the subbase [26]. Variations in laser application parameters, such as laser power, frequency, exposure time, and water/air dry-mode, result in different pulpal tissue responses varying the clinical and radiographic outcomes [26]. Such findings in the case of laser-assisted pulpotomy may be responsible for the conflicting results obtained in human clinical trials [26]. In general, however, the results of applying diode lasers are at least as good as those of other therapies such as ferrous sulfate, NaOCl, mineral trioxide aggregate (MTA), biodentine, or even better [46, 47, 48]. In a review article by [PERSON] et al. [49] from 2018, it was concluded that laser pulpotomy is better or comparable to formocresol pulotomy and suggests that it can be considered an alternative for vital pulp therapy on human primary teeth. On the other hand, [PERSON] et al. [50] in their review article concluded that after 18-24 months, formocresol, ferric sulfate, and MTA showed statistically significant better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomy. However, in the same review article, drop-out rates were regarded as a failure in the final meta-analysis which could affect the final results and consequently lead to different conclusions. Taking into account all the above, the data of our research are comparable to those of studies carried out to date. In this study, there is no statistically significant difference in the success of therapy (clinical and radiographic outcomes) after 6, 12, and 24 months between diode laser and conventional (burr) pulpotomy techniques, although in all observed parameters the success of the diode laser was slightly higher. These results are supported by numerous research available in the literature [18, 19, 25, 26, 27, 28, 29, 46, 48, 51, 52, 53, 54, 55]. In a study by [PERSON] et al. [25], there was no statistically significant difference between diode laser (810 nm, 10 W) pulpotomy in a non-contact mode and formocresol pulpotomy of human primary teeth after 6 and 12 months and a 100% clinical success rate of both laser and formocresol was reported. This result is also supported by the results of studies by [PERSON] et al. [51] in which the effectiveness of four pulpotomy techniques (Er:YAG laser, calcium hydroxide, ferric sulfate, dilute formocresol) was examined. Moreover, [PERSON] and [PERSON] [26] reported that no statistically significant difference was found between the clinical and radiographic outcomes of pulpotomy treatment performed with a diode laser compared to pulpotomy with formocresol and ferrous sulfate at 6, 9, and 12 months of follow-up.