Abstract
Clinical laser dentistry has evolved rapidly across multiple wavelengths, devices, and treatment concepts, but its growth has been accompanied by considerable heterogeneity in terminology, indications, parameter selection, and claims of clinical benefit. Until now, no broad international consensus has attempted to define what is genuinely established across the major domains of clinical laser dentistry and which topics remain unresolved.
This lecture presents the results of the first global Delphi consensus framework in clinical laser dentistry, developed through collaboration between experts from the International Society for Laser Dentistry (ISLD) and the Academy of Laser Dentistry (ALD). Thirty experts with postgraduate education in laser dentistry at MSc level or higher participated in Round 1 and evaluated 120 statements covering laser safety, endodontics, periodontology, operative dentistry and cariology, photobiomodulation, prosthodontics, orthodontics, and oral surgery. Agreement consensus was predefined as ≥70% of participants rating a statement 4 or 5 on a five-point Likert scale.
Round 1 produced consensus for 110 of 120 statements. The 10 unresolved statements were reassessed in a second blinded round by 25 experts, with four additional statements reaching consensus. The final framework therefore achieved agreement on 114 of 120 statements (95%), while six topics remained unresolved. These controversies primarily involved claims of superiority, mandatory treatment sequencing, ceramic debonding, laser surface modification, and specific device-related applications.
Importantly, this initiative was intentionally designed as a foundational consensus rather than an attempt to establish universal treatment protocols or fixed parameter sets. Patient variability, tissue characteristics, clinical indication, wavelength, emission mode, delivery system, and device configuration all limit the validity of one-size-fits-all protocols.
The resulting framework provides a common international basis for education, clinical governance, research reporting, and future wavelength- and indication-specific recommendations. It marks a transition in laser dentistry from technological fragmentation toward structured, evidence-informed global consensus.
Learning Objectives
- Discuss the need for an international consensus framework in clinical laser dentistry and the challenges created by heterogeneous wavelengths, devices, protocols, and clinical indications.
- Explain the Delphi methodology used to develop the first global consensus framework in clinical laser dentistry, including expert selection, consensus thresholds, and the two-round evaluation process.
- Describe the major areas of agreement identified across laser safety, endodontics, periodontology, operative dentistry, photobiomodulation, prosthodontics, orthodontics, and oral surgery.
- Demonstrate an understanding of the distinction between established expert consensus, areas of continuing controversy, and claims that currently lack sufficient support for standardization.
- Explain why universal laser protocols and fixed parameter sets were intentionally not included in this first consensus, considering patient variability, tissue characteristics, wavelength-specific interactions, and differences among laser systems.
- Discuss how the consensus framework can support clinical decision-making, education, research reporting, and the development of future indication- and wavelength-specific recommendations.
- Identify the priority areas for future research and consensus development, including the progression toward evidence-informed therapeutic ranges, safety boundaries, and protocol-level recommendations.
