Is water-laser treatment worth it? Costs and drawbacks｜證據鏈

Is water-laser treatment worth it? Costs and drawbacks｜證據鏈

F-Units（fact-unit account）

• F1｜Topic-selection basis: reconciliation of full GSC data across 14 clinic sites; 5 terms including “水雷射缺點”, “水雷射洗牙”, “水雷射費用ptt” and “水雷射心得” totalled 96,776 impressions across 2 sites ｜source: internal ledger (km-dental-backlog.md #41 appendix)｜confidence=high｜basis=internal_dataset｜period=GSC retention window (from 2025-03-22)｜geo: TW｜caveat: impressions are property-level figures, not deduplicated traffic; this is internal data, not a medical claim, and is not output by the publication transform.
• F2 [editorial structuring]｜The framework of changing “is it worth doing?” into 3 verifiable questions; laying out evidence certainty by application; the scope boundary with KM-DENTAL-27; and not listing contraindications because no citable list was obtained are this site's editorial decisions, not factual claims or an institutional classification｜confidence=n/a｜basis=editorial｜geo: TW｜caveat: do not mark as pending verification, which would create fictitious verification work.
• F3｜A systematic review's inclusion criteria list 5 high-power lasers and wavelengths: Nd:YAG (1064 nm), Er:YAG (2940 nm), Er,Cr:YSGG (2780 nm), diode (980 nm), and CO2 (10600 nm)｜source S17｜confidence=high｜basis=peer_reviewed (systematic review; 2255 initial records, 57 included; in-vitro and ex-vivo studies from 2010 to 2022)｜period=2023; on 2026-08-06, a search found no newer version replacing this article｜geo: universal｜caveat: wavelengths are device specifications, not efficacy claims.
• F4｜Er:YAG and Er,Cr:YSGG are highly absorbed by water and hydroxyapatite, enabling precise ablation with less thermal diffusion and collateral damage; laser wavelengths may also have bactericidal effects through thermal and photomechanical mechanisms, reducing microbial load in carious lesions｜source S5｜confidence=moderate｜basis=clinical_guideline (WFLD global consensus report)｜period=2025｜geo: universal｜caveat: the issuer is a laser-dentistry professional federation, whose consensus orientation can be expected to favour laser applications; its evidence base mixes in-vitro, ex-vivo and clinical research; this unit cites mechanism only, not an efficacy conclusion.
• F5｜The site searched the TFDA Medical Device Licence Dataset (CSV retrieved 2026-08-06; 104,204 rows): 2 deduplicated licences had Chinese names containing “water laser”, 1 current/non-cancelled with English name identifying an Er:YAG system and 1 cancelled; 54 deduplicated dental-related licences had names containing “laser”, 17 non-cancelled. All 17 performance fields said “see approved Chinese instructions for use” or “see approved Chinese manual”, and all were in subcategory “I.4810 laser instruments for general surgery, plastic surgery and dermatology”. Of those 17, 4 named the laser type and 13 did not. Searches of Chinese renderings for erbium-family lasers returned 10 “鉺雅鉻”, 8 “鉺雅克” and 3 “鉺雅各” licences after deduplication, including cancelled non-dental uses｜source S4｜confidence=high｜basis=official_statement (government open dataset supplied by the Taiwan Food and Drug Administration, synchronised every 7 days)｜period=snapshot retrieved 2026-08-06｜geo: TW｜caveat: the method was a product-name string search and can miss models whose names contain neither “laser” nor a dental character, including brand-only registrations; it must not be used to infer that any brand or wavelength is unapproved; no instructions for use were reviewed and no authorised indication is stated.
• F6｜2016 Cochrane systematic review (searched to 2016-06-22; 9 randomised trials, 662 participants; 6 Er:YAG, 2 Er,Cr:YSGG and 1 Nd:YAG): insufficient evidence to decide whether laser or drill is better for caries removal (risk ratio 1.00, 95% confidence interval 0.99 to 1.01; 2 studies, 256 treated caries); more moderate/high pain in the drill group (risk ratio 0.40, 0.28 to 0.57; 2 studies, 143 people); anaesthesia significantly more frequent with drills (risk ratio 0.25, 0.10 to 0.65; 3 studies, 217 children/adolescents); conclusion: low overall evidence quality and insufficient evidence to replace a traditional drill｜source S8｜confidence=high｜basis=peer_reviewed (Cochrane systematic review)｜period=2016 (CD010229.pub2); on 2026-08-06 the version chain was searched with CD010229[pg]: this was the only record, with no update or retraction marker; newer syntheses for the same question, S9 (2025) and S10 (2026), are presented alongside it｜geo: universal｜caveat: most included trials were small and at unclear or high risk of bias.
• F7｜2025 meta-analysis (20 in-vivo studies, at least 2263 teeth and more than 1090 patients; laser versus conventional drill for cavity preparation/caries removal): no significant difference in restoration survival (risk ratio 1.51, 95% confidence interval 0.87 to 2.64) or pulp vitality (risk ratio 1.46, 0.33 to 6.46), both low certainty; fewer patients needed anaesthesia (risk ratio 0.29, 0.11 to 0.75, very low certainty); pain was lower (risk ratio 0.35, 0.22 to 0.54, very low certainty); laser required more scheduled time (mean difference 2.23, 1.89 to 2.57, low certainty); authors say clinical interpretation should be cautious｜source S9｜confidence=moderate｜basis=peer_reviewed (meta-analysis, RoB 2.0 plus GRADE)｜period=2025 (search without a time limit)｜geo: universal｜caveat: the authors rate certainty low and very low, which must not be omitted when the text cites these results; the original abstract does not give the time-unit for the mean difference, so this card repeats the figures and direction without converting them to minutes.
• F8｜2026 systematic review (PRISMA 2020; searched 2024-12-01 and updated 2024-12-05; 11 included studies: 5 in vitro, 6 in vivo): most studies found Er:YAG and Er,Cr:YSGG effective for caries removal, selective ablation of infected dentine and favourable histological features; Nd:YAG had lower ablation efficiency and was mainly for surface modification; lasers generally took longer than rotary instruments but produced less pain and anxiety in clinical studies; heterogeneity prevented meta-analysis; authors conclude erbium lasers, particularly Er:YAG, appear effective and conservative, but well-designed randomised trials remain needed because of methodological variation, limited Er,Cr:YSGG/Nd:YAG evidence and absent long-term outcomes｜source S10｜confidence=moderate｜basis=peer_reviewed (qualitative systematic review, no meta-analysis)｜period=2026｜geo: universal｜caveat: mixed in-vitro and in-vivo studies; the article expressly says Er,Cr:YSGG evidence is limited, so Er:YAG findings must not be applied to Er,Cr:YSGG.
• F9｜WFLD 2025 global consensus report: laser-assisted caries removal is a selectively ablative minimally invasive approach targeting demineralised tissue while preserving adjacent healthy enamel and dentine, consistent with contemporary conservative dentistry｜source S5｜confidence=moderate｜basis=clinical_guideline (consensus report)｜period=2025｜geo: universal｜caveat: interest relationship is disclosed in F4; this describes an orientation, not individual efficacy or success rate.
• F10｜EFP S3 clinical-practice guideline for stage I to III periodontitis: recommendation 2.4 states “We suggest not to use lasers as adjuncts to subgingival instrumentation”; its clinical-relevance/effect-size field says “There is insufficient evidence to recommend adjunctive application of lasers to subgingival instrumentation.”｜source S6｜confidence=high｜basis=clinical_guideline (S3 level, GRADE method)｜period=2020; on 2026-08-06 no revised guideline of the same stage I–III scope was found; the 2022 stage IV and 2023 peri-implant-disease guidelines are different scopes｜geo: universal｜caveat: span is from the openly accessible PMC full text retrieved with efetch db=pmc, not the PubMed abstract; recommendation strength is Grade B, direction against, with simple-majority consensus; a guideline informs clinical decisions and is not an individual prescription.
• F11｜The same guideline's supporting-evidence field records 2 randomised trials (n = 46; wavelengths 2780 nm and 2940 nm) and 3 randomised trials (n = 101; wavelengths 810 to 980 nm) with 6-month results after single laser application; its background groups lasers as 2780 to 2940 nm and 810 to 980 nm, with evidence from 5 randomised trials (total n = 147). It also states that only randomised trials reporting mean pocket-depth change were considered and that most studies had unclear risk of bias｜source S6｜confidence=high｜basis=clinical_guideline｜period=2020｜geo: universal｜caveat: span is from PMC full text retrieved with efetch db=pmc; wavelength groups are this guideline's analytical classification, not a device-regulation classification; the evidence limits—single application, only pocket-depth outcome and unclear bias risk—must accompany the recommendation rather than citing its sentence alone.
• F12｜The same guideline's economic-considerations field states: additional costs associated with adjunctive laser therapy may not be justified｜source S6｜confidence=high｜basis=clinical_guideline｜period=2020｜geo: universal｜caveat: span is from PMC full text; this is the guideline's economic judgement on the evidence as a whole, not an evaluation of any provider's fee or a price statement.
• F13｜The same guideline's benefits/harms-balance field states: the majority of studies did not report potential harm/adverse effects｜source S6｜confidence=high｜basis=clinical_guideline｜period=2020｜geo: universal｜caveat: span is from PMC full text; “not reported” is a data gap and must not be read as “proven safe”.
• F14｜The same guideline's recommendation 4.15 states: “We suggest not to replace conventional professional mechanical plaque removal (PMPR) with the use of alternative methods (Er:YAG laser treatment) in supportive periodontal care”; its supporting evidence is a single randomised trial｜source S6｜confidence=high｜basis=clinical_guideline｜period=2020｜geo: universal｜caveat: span is from PMC full text; it concerns Er:YAG only and does not cover other wavelengths.
• F15｜Taiwan Academy of Periodontology 2021 consensus report: recommendations for the Taiwanese population were developed from the EFP S3 guideline and are generally parallel; extra caution is advised in treatment and maintenance because of Asian anatomical variation (shorter root trunks, a higher prevalence of supernumerary distolingual roots and lingual bony concavity in mandibular posteriors, and thinner anterior labial plates); the EFP guideline can be adopted for periodontitis treatment and periodontal-health maintenance in the Taiwanese population｜source S7｜confidence=high｜basis=clinical_guideline (domestic society consensus report)｜period=2021; on 2026-08-06 no newer consensus from this society was found｜geo: TW｜caveat: the abstract does not give a laser-specific position; this card cites only its general “parallel/can be adopted” statement, not an individual laser recommendation; on 2026-08-06 the society's official Chinese name could not be verified from its site because twperio.org.tw loaded blank, so this card uses the paper's English name and does not write an unverified Chinese name.
• F16｜2021 meta-analysis (16 randomised trials, 606 patients; Er,Cr:YSGG adjunct/substitute to scaling and root planing versus scaling and root planing alone; English/Chinese publications from January 2000 to January 2020): significant differences in pocket-depth reduction at 1 month (weighted mean difference −0.35) and 3 months (−0.342), and immediate post-treatment visual-analogue pain (−2.395); no significant difference in 6-month pocket-depth reduction or clinical-attachment-level change｜source S11｜confidence=moderate｜basis=peer_reviewed (meta-analysis)｜period=2021 (searched to 2020-01); on 2026-08-06, a post-2021 search for “Er,Cr:YSGG × periodontal” found no YSGG-specific systematic review replacing it; the newer 2026 meta-analysis (S12) could quantitatively pool Er:YAG only｜geo: universal｜caveat: the abstract's 3-month clinical-attachment confidence interval and P value conflict (−0.31 to 0.03 versus P = 0.017), so this card does not cite that figure; it cites only pocket depth, pain and no 6-month significant difference; included studies mix adjunct and replacement designs; disease terminology follows pre-2018 classification “chronic periodontitis”.
• F17｜2026 systematic review and meta-analysis (search January 2015 to October 2025; PRISMA 2020; 26 studies in qualitative synthesis; random-effects model, RoB 2.0, GRADE): quantitative pooling was possible only for Er:YAG; pooled clinical-attachment gain mean difference 0.319 mm (95% confidence interval −0.097 to 0.735), not statistically significant, I² about 54%; diode, Nd:YAG and antimicrobial photodynamic therapy showed small short-term effects but lacked standardised data for pooling; authors conclude laser-assisted periodontal treatment may offer small additional benefit, with Er:YAG relatively consistent but clinically limited and supplementary rather than routine｜source S12｜confidence=moderate｜basis=peer_reviewed (SR + MA)｜period=2026｜geo: universal｜caveat: the primary result is not statistically significant and must not be written as effective; Er,Cr:YSGG was not quantitatively pooled.
• F18｜2024 umbrella review (searched 2011 to 2023; 472 initial records, 4 systematic reviews included; AMSTAR 2 ratings high, moderate, low and critically low): despite weak observed evidence of effectiveness for Er:YAG in non-surgical periodontal treatment, clinical benefits remain insufficient｜source S13｜confidence=moderate｜basis=peer_reviewed (umbrella review)｜period=2024｜geo: universal｜caveat: only 4 systematic reviews with uneven quality; applies only to Er:YAG.
• F19｜2025 systematic review and meta-analysis (15 randomised trials, 540 patients, 658 implants; 10 in meta-analysis): Er:YAG reduced bleeding on probing 35.6% (95% confidence interval 17.3% to 53.9%, I² = 83%) and probing depth 0.65 mm (0.33 to 0.97, I² = 0%); mechanical debridement plus Er,Cr:YSGG improved probing depth 1.23 mm (0.76 to 1.70, I² = 0%) and reduced bleeding on probing 47.3% (38.4% to 56.1%, I² = 0%); no therapy had significant advantage preventing crestal bone loss; laser therapy did not show significant superiority over conventional therapy (p > 0.05)｜source S14｜confidence=moderate｜basis=peer_reviewed (SR + MA)｜period=2025｜geo: universal｜caveat: the two statements “not superior to conventional therapy” and “did not prevent bone loss” must not be omitted; bleeding-on-probing heterogeneity is high (I² = 83%).
• F20｜2023 systematic review of upper-labial-frenulum surgery (searched 2012-11-13 to 2022-11-22; 8 articles included): an upper labial frenulum can be treated with a conventional scalpel or laser; laser had intra-/postoperative benefits including faster healing, fewer side effects/discomfort and greater patient compliance; it requires a higher learning curve, especially calibration of appropriate laser power; no laser type can yet be identified as achieving the best clinical result for upper-labial-frenulum treatment｜source S15｜confidence=low｜basis=peer_reviewed (qualitative systematic review, no meta-analysis)｜period=2023｜geo: universal｜caveat: only 8 studies and a single anatomical site; the overall orientation is favourable, but the “cannot identify which laser is best” limitation must be stated together; do not extrapolate to other soft-tissue surgeries or wavelengths.
• F21｜2022 systematic review (searched to March 2022; 486 initial records, 7 randomised trials included): Er,Cr:YSGG parameters were 2780 nanometres, 0.25 to 0.5 watts and 20 to 60 seconds; follow-up immediate to 3 months; all included studies found Er,Cr:YSGG effective in alleviating dentine hypersensitivity; conclusion: adverse effects may be limited with appropriate parameters (the original uses “power density” for values in watts, an inconsistent physical term/unit; this card repeats the numbers without conversion or interpretation)｜source S16｜confidence=low｜basis=peer_reviewed (qualitative systematic review, no meta-analysis)｜period=2022｜geo: universal｜caveat: 2 published correction notices, one PMID 35761892; only 7 trials, at most 3 months' follow-up and no meta-analysis; complete desensitisation comparison is in KM-DENTAL-27 and is not repeated here.
• F22｜2023 systematic review (2255 initial records, 57 included, in-vitro/ex-vivo studies, QUIN risk-of-bias tool): Er:YAG was most often assessed and associated with dentine ablation, no smear layer and open dentinal tubules; Nd:YAG generated vitreous surfaces and thermal damage such as carbonisation and cracks; other lasers caused irregular surfaces without adverse thermal effects; only Er,Cr:YSGG reduced collagen matrix chemically; effects intensified with higher dosage｜source S17｜confidence=moderate｜basis=peer_reviewed (systematic review, in-vitro/ex-vivo evidence)｜period=2023｜geo: universal｜caveat: in-vitro/ex-vivo findings must not be extrapolated to clinical efficacy or a clinical risk incidence.
• F23｜2026 review corresponding to an FDI policy statement: laser outcomes vary with wavelength, energy settings and clinical protocols, highlighting the need for standardisation｜source S18｜confidence=low｜basis=peer_reviewed (narrative, not systematic, review)｜period=2026｜geo: universal｜caveat: narrative review, lower evidence level than systematic review; its overall conclusion is favourable to lasers, but this card cites only the limitation statement that outcomes vary with parameters and need standardisation, not its benefit conclusion.
• F24｜The current NHIA Medical Service Payment Items and Payment Standards (CSV) contain local and full-mouth dental-calculus-removal items. Notes state: “patients with treatment needs may claim at most once every half-year”; “local calculus removal performed in stages for the full mouth within half a year is considered one course”; and “calculus removal requires oral-hygiene instruction followed by tooth-brushing review”. Separate items for pregnant women, people with diabetes, people with high-risk diseases and people with xerostomia have their own claim intervals｜source S2｜confidence=high｜basis=official_statement (NHIA open data, updated every 1 day)｜period=retrieved 2026-08-06 (file 1,692,784 bytes; parsed by csv module as 6,088 data rows; 8 treatment items containing “dental-calculus removal”)｜geo: TW｜caveat: this card cites no payment points; coverage always follows the current NHIA announcement and this card makes no individual determination; whether device assistance is additionally self-paid is outside this dataset's decision scope.　[On the official page the label appears in Chinese only: 「醫療服務給付項目及支付標準（csv 檔）」]
• F25｜Self-pay charge items follow fee standards approved by local health authorities; verified example: Taipei City Department of Health “Taipei City Medical Institution Dental Fee Standard Table” (approved 1090117), whose page provides the attachment “Taipei City Medical Institution Dental Fee Standard Table (approved version-1090117)” PDF download｜source S3｜confidence=high｜basis=official_statement｜period=approved 1090117; on 2026-08-06 the page was loaded with ego-browser and its title/attachment name matched verbatim (page-data update date 115-07-15)｜geo: TW｜caveat: same anchor as KM-DENTAL-03/11/18/26/36; only one county/city example and other counties/cities publish their own notices; this card did not download that PDF and cites none of its amounts.　[On the official page the label appears in Chinese only: 「臺北市醫療機構牙科收費標準表」、「臺北市醫療機構牙科收費標準表(奉核版-1090117)」]
• F26｜The NHIA “Medical Device Price Comparison Network” has no dental category in either query track; dental self-pay items cannot be verified there｜source S19｜confidence=high｜basis=official_statement (verified cross-card fact, same anchor)｜period=verified 2026-08-05｜geo: TW｜caveat: this card did not repeat the live check; it cites the verified record in km-compliance/VERIFIED-FACTS.md.　[On the official page the label appears in Chinese only: 「醫材比價網」]
• F27｜Article 87(2) of Taiwan's Medical Care Act: publication of medical knowledge or research reports, patient health education and academic publications that do not solicit medical business are not treated as medical advertisements｜source S1｜confidence=high｜basis=law｜period=current text (on 2026-08-06 loaded with ego-browser; page title “醫療法§87-全國法規資料庫” and both provisions matched verbatim)｜geo: TW｜caveat: basis for this card's positioning, not legal advice.
• F28｜The EFP guideline's consistency field states that studies differed in laser type, tip diameter, wavelength, periodontal-treatment mode, number of treated sites, population and several possible combinations of these parameters｜source S6｜confidence=high｜basis=clinical_guideline｜period=2020｜geo: universal｜caveat: span is from PMC full text; this is a heterogeneity description, not an efficacy statement.
• F29｜2022 network meta-analysis (37 randomised trials, 7 periodontal interventions; electronic and hand searches to January 2020; random-effects network model; no inconsistency detected): at 6 months versus mechanical scaling and root planing, Er,Cr:YSGG as adjunct (standardised mean difference 0.53, 95% confidence interval 0.23 to 0.84) and monotherapy (0.37, 0.04 to 0.71) had statistically significant pocket-depth reductions; diode laser adjunct also differed at 3 months (0.61, 0.27 to 0.96) and Nd:YAG adjunct at 6 months (0.29, 0.03 to 0.55); authors conclude laser-assisted periodontal treatment has better pocket-depth reduction｜source S20｜confidence=moderate｜basis=peer_reviewed (network meta-analysis)｜period=2022 (searched to 2020-01)｜geo: universal｜caveat: this conflicts with F16 and both must be cited together, never one alone; effect sizes are standardised mean differences, not millimetres, from indirect network comparisons; authors partially overlap with F16 and searches end at the same time; disease terminology uses pre-2018 “chronic periodontitis”; no ranking result is used to infer treatment superiority.

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Chinese labels to look for on the official pages

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Compliance note

This is patient health-education information under Article 87 of Taiwan's Medical Care Act, not a medical advertisement. It does not recommend a provider or recommend/rate any medical device or brand. Laser-assisted dental treatment has risks and contraindications; the evidence certainty for the applications cited here varies and does not cover authorised indications for any model (authorised performance follows its licence and Chinese instructions for use). Actual treatment and outcomes vary by person and require a dentist's assessment.[F5][F13][F27]

Sources

• S1 醫療法 第 87 條（全國法規資料庫）。law.moj.gov.tw pcode=L0020021 flno=87（2026-08-06 以 ego-browser 實載，頁面標題「醫療法§87-全國法規資料庫」，兩項條文逐字對得上）
• S2 衛生福利部中央健康保險署「醫療服務給付項目及支付標準(csv檔)」開放資料集（政府資料開放平臺資料集 174450，每 1 日更新）。info.nhi.gov.tw 介接端點 rId=A21030000I-D20021-001（2026-08-06 實測取回 HTTP 200、1,692,784 bytes，表頭逐字為「診療項目代碼,健保支付點數,生效起日,生效迄日,英文項目名稱,中文項目名稱,備註」；本卡引用之中文項目名稱與備註逐字取自此檔，未引用任何支付點數）
• S3 臺北市政府衛生局－收費標準：「臺北市醫療機構牙科收費標準表」(1090117核定)。health.gov.taipei 收費標準頁（2026-08-06 以 ego-browser 實載，頁面標題與附件名稱逐字對得上；本卡未下載該 pdf）
• S4 衛生福利部食品藥物管理署「醫療器材許可證資料集」（政府資料開放平臺資料集 9576，每 7 日與藥證業務管理系統同步）。data.gov.tw/dataset/9576（2026-08-06 以 ego-browser 實載，頁面標題「醫療器材許可證資料集 ｜ 政府資料開放平臺」、提供機關與欄位清單逐字對得上）；資料檔 data.fda.gov.tw export/68/csv（2026-08-06 實測取回 HTTP 200、16,191,210 bytes 之壓縮檔，解出 104,204 列，欄位含許可證字號、註銷狀態、有效日期、中文品名、英文品名、效能、醫器次類別一、限制項目）
• S5 Nammour S, Brugnera Junior A, Zeinoun T, et al. Global consensus report of the World Federation for Laser Dentistry (WFLD) on laser-assisted caries treatment and prevention. Dent Med Probl. 2025;62(5):783-800. PMID 41267668. https://pubmed.ncbi.nlm.nih.gov/41267668/（2026-08-06，efetch 取回摘要）。逐字 span：「Laser-assisted caries removal is a minimally invasive approach based on selective ablation, targeting demineralized tissues while preserving the adjacent healthy enamel and dentin」「Erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium-doped yttrium scandium gallium garnet (Er,Cr:YSGG) lasers are highly absorbed by water and hydroxyapatite (HAP), enabling precise ablation with minimal thermal diffusion and collateral damage」「Laser wavelengths can also exhibit bactericidal effects through thermal and photomechanical mechanisms, reducing the microbial load in carious lesions」
• S6 Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I-III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4-60. 開放取用全文 PMCID PMC7891343，https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891343/（2026-08-06 以 NCBI efetch db=pmc 取回全文 XML 並以去標籤正規化文字逐字比對；本條 span 取自全文、非 PubMed 摘要，故不掛 PMID 前綴、亦不進 --spans 自動比對）。逐字 span：「We suggest not to use lasers as adjuncts to subgingival instrumentation」「There is insufficient evidence to recommend adjunctive application of lasers to subgingival instrumentation.」「The evidence reported to inform the current guidelines has grouped lasers into two main wavelength categories: lasers with a wavelength range of 2,780–2,940 nm and lasers with a wavelength range of 810–980 nm.」「Evidence was available from five RCTs (total n = 147)」「Studies differed in terms of laser type, tip diameter, wavelength, mode of periodontal treatment, number of treated sites, population and several possible combinations of these parameters.」「Only RCTs reporting mean PPD changes were considered and this recommendation is made in the light of this approach to the systematic review.」「The majority of studies displayed unclear risk of bias.」「The majority of the studies did not report on potential harm/adverse effects.」「Additional costs associated with adjunctive laser therapy may not be justified.」「We suggest not to replace conventional professional mechanical plaque removal (PMPR) with the use of alternative methods (Er:YAG laser treatment) in supportive periodontal care.」
• S7 Chen JT, Wu IT, Huang RY, et al. Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology. J Formos Med Assoc. 2021;120(12):2072-2088. PMID 34294496. https://pubmed.ncbi.nlm.nih.gov/34294496/（2026-08-06，efetch 取回摘要）。逐字 span：「The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population.」「The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population」
• S8 Montedori A, Abraha I, Orso M, D'Errico PG, Pagano S, Lombardo G. Lasers for caries removal in deciduous and permanent teeth. Cochrane Database Syst Rev. 2016;9(9):CD010229. PMID 27666123. https://pubmed.ncbi.nlm.nih.gov/27666123/（2026-08-06，efetch 取回摘要）。逐字 span：「We included nine randomised trials, published between 1998 and 2014, involving 662 participants」「Six trials used Er:YAG (erbium-doped yttrium aluminium garnet) lasers, two trials employed Er,Cr:YSGG (erbium, chromium: yttrium-scandium-gallium-garnet) lasers, and one trial used Nd:YAG (neodymium-doped yttrium aluminium garnet) laser」「There was insufficient evidence to suggest that either lasers or drill were better at caries removal (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.99 to 1.01; 2 studies; 256 treated caries」「The incidence of moderate or high pain was greater in the drill group compared to the laser group (RR 0.40, 95% CI 0.28 to 0.57; 2 studies; 143 participants」「the need for anaesthesia was significantly higher in the drill group than in the laser group (RR 0.25, 95% CI 0.10 to 0.65; 3 studies; 217 children/adolescents」「Given the low quality of the body of evidence, we concluded that evidence was insufficient to support the use of laser as an alternative to traditional drill therapy for caries removal」
• S9 Esteves-Oliveira M, Schaffrath K, Wierichs RJ. Efficacy of laser-assisted caries removal and hard tissue preparation: A meta-analysis. J Dent. 2025;156:105697. PMID 40120794. https://pubmed.ncbi.nlm.nih.gov/40120794/（2026-08-06，efetch 取回摘要）。逐字 span：「Twenty in vivo studies with at least 2263 teeth being assessed in more than 1090 patients were included」「restoration survival (risk ratio (RR)[95%CI]=1.51 [0.87;2.64, low level of evidence) and pulp vitality (RR[95%CI]=1.46 [0.33;6.46], low level of evidence) was not significantly influenced by the use of a laser」「significantly fewer patients required anesthesia (RR[95%CI]=0.29 [0.11;0.75, very low level of evidence) and patients' pain sensation was significantly decreased (RR[95%CI]=0.35 [0.22;0.54], very low level of evidence)」「when using a laser for excavation/preparation significantly more time has to be planed compared to the use of a conventional bur (mean difference [95%CI]=2.23 [1.89;2.57], low level of evidence)」「results should be interpreted with caution considering the low level of the evidence」
• S10 Sae-Ferrández O, Pecci-Lloret MP, García-Ríos P, Pérez-Guzmán N. Efficacy of Er:YAG, Er,Cr:YSGG, and Nd:YAG lasers for caries removal: A systematic review. J Dent. 2026;164:106264. PMID 41285306. https://pubmed.ncbi.nlm.nih.gov/41285306/（2026-08-06，efetch 取回摘要）。逐字 span：「A comprehensive search was conducted on December 1, 2024, and updated on December 5, 2024」「Eleven studies met the inclusion criteria (five in vitro and six in vivo)」「Nd:YAG showed lower ablation efficiency and was mainly effective for surface modification. Laser treatment generally required longer time than rotary excavation but caused less pain and anxiety in clinical studies. Heterogeneity among studies prevented meta-analysis」「due to methodological variability, limited evidence for Er,Cr:YSGG and Nd:YAG, and lack of long-term outcomes, further well-designed randomized trials are needed」
• S11 Li MM, Jia JH, Wu MX, Zhao CY, Jia LY, Shi H, Zhang XL. Clinical effectiveness of Er,Cr:YSGG lasers in non-surgical treatment of chronic periodontitis: a meta-analysis of randomized controlled trials. Lasers Med Sci. 2021;36(4):889-901. PMID 33037559. https://pubmed.ncbi.nlm.nih.gov/33037559/（2026-08-06，efetch 取回摘要）。逐字 span：「Sixteen RCTs with 606 patients were included in the meta-analysis」「compare Er,Cr:YSGG lasers adjunct/substitute to scaling and root planing (SRP) with SRP alone for the treatment of chronic periodontitis published in English or Chinese from January 2000 to January 2020」「There were no significant differences of PD reduction and CAL change at 6-month follow-up」
• S12 Sunar A, Sır E, Taş Ç, Tekin E. Meta-analysis of laser-assisted periodontal therapy (2015-2025). Lasers Med Sci. 2026;41(1):72. PMID 41984346. https://pubmed.ncbi.nlm.nih.gov/41984346/（2026-08-06，efetch 取回摘要）。逐字 span：「Twenty-six studies were included in the qualitative synthesis, and quantitative meta-analysis was feasible only for Er: YAG lasers」「The pooled mean difference in CAL gain favored Er: YAG adjunctive therapy (MD = 0.319 mm; 95% CI: −0.097 to 0.735 mm), without statistical significance. Moderate heterogeneity was observed (I² ≈ 54%)」「Er: YAG lasers showed the most consistent, though clinically limited, effects and should be considered supplementary rather than routine adjuncts」
• S13 Gufran K, Alqahtani AS, Alasqah M, et al. Effect of Er: YAG laser therapy in non-surgical periodontal treatment: an umbrella review. BMC Oral Health. 2024;24(1):1347. PMID 39548487. https://pubmed.ncbi.nlm.nih.gov/39548487/（2026-08-06，efetch 取回摘要）。逐字 span：「A total of 472 studies were initially identified. After removing the duplicates and screening, a total of four studies were selected for the current overview」「Even though weak evidence of effectiveness was observed for Er: YAG laser application in non-surgical periodontal treatment, the clinical benefits are still lacking」
• S14 Srinivasan M, Kamnoedboon P, Papi P, Romeo U. Efficacy of non-surgical laser therapy for the management of peri-implantitis: A systematic review and meta-analysis. J Dent. 2025;154:105562. PMID 39805490. https://pubmed.ncbi.nlm.nih.gov/39805490/（2026-08-06，efetch 取回摘要）。逐字 span：「A total of 15 randomized controlled trials (RCTs) involving 540 patients and 658 implants met the inclusion criteria, with 10 studies eligible for meta-analyses」「Er:YAG laser therapy significantly reduced bleeding on probing (BOP) by 35.6 % (95 % CI: 17.3 % to 53.9 %; I2 = 83 %) and probing depth (PD) by 0.65 mm (95 % CI: 0.33 to 0.97; I2 = 0 %)」「The combination of mechanical debridement (MD) and Er,Cr:YSGG laser therapy improved PD by 1.23 mm (95 % CI: 0.76 to 1.70; I2 = 0 %) and reduced BOP by 47.3 % (95 % CI: 38.4 % to 56.1 %; I2 = 0 %)」「However, none of the therapies showed any significant advantage in preventing crestal bone loss (CBL). Laser therapies did not demonstrate any significant superiority over traditional therapies (p > 0.05)」
• S15 Inchingolo AM, Malcangi G, Ferrara I, et al. Laser Surgical Approach of Upper Labial Frenulum: A Systematic Review. Int J Environ Res Public Health. 2023;20(2):1302. PMID 36674058. https://pubmed.ncbi.nlm.nih.gov/36674058/（2026-08-06，efetch 取回摘要）。逐字 span：「A total of eight articles were selected for the purpose of the review」「The latter is the better option due to its intra- and post-operative benefits for both the patients and the clinicians, in terms of faster healing, fewer side effects and discomfort, and greater patient compliance. However, a higher learning curve is required for this technique, especially to calibrate the appropriate power of the laser. To date, it is not possible to identify which type of laser achieves the best clinical results for the treatment of ULF.」
• S16 AlHabdan A, AlAhmari F. Phototherapy Using Er,Cr:YSGG Laser as a Definitive Treatment for Dentin Hypersensitivity: A Systematic Review. Int J Gen Med. 2022;15:4871-4880. PMID 35592535（更正啟事 PMID 35761892）。https://pubmed.ncbi.nlm.nih.gov/35592535/（2026-08-06，efetch 取回摘要）。逐字 span：「A total of 486 studies were found, of which 7 randomized controlled trials were included in the review」「The Er,Cr:YSGG laser wavelengths, power density and duration of irradiation used in the studies were 2780 nanometers, 0.25-0.5 watts and 20-60 seconds, respectively」「All studies showed that the Er,Cr:YSGG laser was effective in alleviating DH」
• S17 Ramirez I, Bertolini GR, Candemil AP, Sousa-Neto MD, Souza-Gabriel AE. Chemical and morphological analysis of dentin irradiated by different high-power lasers: a systematic review. Lasers Med Sci. 2023;38(1):255. PMID 37932490. https://pubmed.ncbi.nlm.nih.gov/37932490/（2026-08-06，efetch 取回摘要）。逐字 span：「five high-power lasers: Nd:YAG (1064 nm), Er:YAG (2940 nm), Er, Cr:YSGG (2780 nm), diode (980 nm), and CO2 (10,600 nm)」「The search resulted in 2255 matches and 57 studies composed the sample」「The Nd:YAG laser generated vitreous surface and thermal damage, such as carbonization and cracks. The other lasers caused an irregular surface and no adverse thermal effects. Regarding the chemical structure, only the Er,Cr:YSGG laser caused collagen matrix reduction. The effects found were more intense with higher dosimetry.」
• S18 Grzech-Leśniak K. Lasers in Dentistry - Overview Based on FDI Policy Statement. Int Dent J. 2026;76(2):109369. PMID 41505924. https://pubmed.ncbi.nlm.nih.gov/41505924/（2026-08-06，efetch 取回摘要）。逐字 span：「A narrative review was conducted using PubMed, Scopus, and Web of Science databases」「However, outcomes vary with wavelength, energy settings, and clinical protocols, underscoring the need for standardization」
• S19 衛生福利部中央健康保險署「醫材比價網」兩查詢軌之品項分類（跨卡已驗事實，同錨）。info.nhi.gov.tw INAE2000/INAE2010S01（2026-08-05 由 OP 以 ego-browser 實測並複驗，紀錄見 km-compliance/VERIFIED-FACTS.md；本卡未重複實測）
• S20 Jia L, Jia J, Wu M, Li T, Zhao C, Shi H, Zhang X. Probing depth reduction of laser application in periodontal therapy: a network meta-analysis. Lasers Med Sci. 2022;37(2):1217-1226. PMID 34327566. https://pubmed.ncbi.nlm.nih.gov/34327566/（2026-08-06，efetch 取回摘要）。逐字 span：「This NMA analysed seven periodontal treatments through 37 RCTs」「Randomized controlled clinical trials (RCTs) were searched through electronic-search and hand-search up to January 2020」「Er,Cr:YSGG as monotherapy (SMD = 0.37; 95% CI range: 0.04-0.71) and Er,Cr:YSGG as adjunct (SMD = 0.53; 95% CI range: 0.23-0.84) at 6 months after treatment」「significant differences were in favour of diode laser (DL) as adjunct at 3 months (SMD = 0.61; 95% CI range: 0.27-0.96)」「Laser-assisted periodontal treatment has better PD reduction」

Internal citation chain

• Full discussion of water-laser use for gingival recession and root coverage, including the 2018 meta-analysis and small water-laser trial: Can gingival recession still be treated? What does treatment cost? (KM-DENTAL-27)
• Procedures and fee structure for periodontal surgery and gingival soft-tissue treatment: Gum graft surgery: costs, insurance and recovery in one guide (KM-DENTAL-14)
• Canonical card for whether caries needs restoration and how it is restored: Does a cavity always need a filling? How are fillings done? (KM-DENTAL-12)
• Components of filling fees and how to read a quotation: How much does a filling cost? Filling gaps and chipped corners (KM-DENTAL-36)

Publication-gate reminder: this card is a draft. It must not enter `km_entries` until zh-Hans/en/ja versions exist. S6 spans come from PMC open-access full text rather than the PubMed abstract, so `--spans` does not automatically compare that source; the manual-review record is in REVIEW. F5 is this site's product-name-search snapshot of an official open dataset that synchronises every 7 days; figures change over time, so re-verification requires a new download and rerunning the same search conditions.