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Evaluation of the effectiveness and practicality of erbium lasers for ceramic restoration removal: A retrospective clinical analysis - PubMed

  • ️Sun Jan 01 2023

Evaluation of the effectiveness and practicality of erbium lasers for ceramic restoration removal: A retrospective clinical analysis

Janina Golob Deeb et al. PLoS One. 2023.

Abstract

Background: The purpose of this study was to assess the effectiveness and practicality of erbium lasers in the removal of ceramic restorations and appliances from natural teeth and dental implant abutments in clinical practice.

Methods: A retrospective analysis was conducted, involving 29 clinical cases with a total of 52 abutments requiring the removal of various ceramic restorations. The analysis evaluated the clinical procedures performed, including the type and material of the prosthetic, the type of cement used, laser setting parameters, retrieval time, and retrieval success.

Results: Out of the 52 abutments, 50 were successfully retrieved without causing any damage (>95%) using either an Er,Cr:YSGG laser (N = 6) or an Er:YAG laser (N = 46). In one case, a crown was partially sectioned to prevent any negative impact of laser irradiation on the adhesive strength between the post and tooth, and in another case, a fracture occurred during debonding. The restorations consisted of 13 lithium disilicate and 39 zirconia units, including six veneers, 38 single crowns, and three fixed partial dentures (FPDs). The retrieval time varied depending on the restoration type, material thickness, cement type, retention form/fitting of the abutment and restoration, ranging from 2.25 ±0.61 minutes for veneers, 6.89 ±8.07 minutes for crowns, to 25 ±10 minutes per abutment for FPDs. Removal of a zirconia crown required more time, 7.12±8.91 minutes, compared to a lithium disilicate crown, 5.86 ±2.41 minutes. The debonding time was influenced by the laser settings as well as materials and types of prosthesis.

Conclusions: Erbium lasers present a safe and effective alternative to invasive methods for removing ceramic restorations, without causing harm to the abutment or prosthesis. Laser-assisted debonding allows for recementation of the restorations during the same appointment, making it a conservative and viable option for ceramic crown retrieval in clinical settings.

Copyright: © 2023 Deeb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Debonding and recementation of posterior zIrconia crown on natural tooth abutment.

(A) Existing crown on tooth #19, (B) Periapical radiograph demonstrating an open margin (indicated by red arrow) on the distal due lack of appropriate adjustment of distal crown contact area, (C) Laser-irradiation, (D) Retrieved crown with darkened ablated cement, (E) Abutment tooth after laser-assisted crown removal, and (F) Periapical radiograph demonstrating proper seated definitive crown (indicated by green arrow).

Fig 2
Fig 2. Debonding and re-cementation of anterior zIrconia crown on implant abutment.

(A) and (B) Periapical radiographs demonstrating #7 zirconia crown was missed seated during the cement due to insufficient interproximal adjustment, red arrows indicating the open unseated mesial and distal margin, (C) Periapical radiograph taken after successful laser-assisted crown retrieval and existing crown re-cementation, green arrows indicating appropriate seating of the crown.

Fig 3
Fig 3. Debonding and re-cementation of posterior lithium disilicate crown on natural tooth abutment.

(A) Bitewing radiograph indicating improper seating with open distal margin shown by red arrow, (B) and (C) Buccal and lingual preoperative views, (D) abutment tooth immediately after crown removal demonstrating darkened ablated residual cement, (E) and (F) Buccal and lingual view of re-cemented crown, and (G) Bitewing radiograph indicating appropriate seating with sealed distal margin shown by green arrow.

Fig 4
Fig 4. Debonding and re-cementation of anterior lithium disilicate crown on natural tooth abutment.

(A) Existing recently cemented #8 crown was wrongly positioned during the cementation process resulting in the mesial diastema see red arrow, (B) Abutment tooth after Er:YAG laser debonding, (C) Retrieved intact crown with ablated cement remaining, (D) Abutment after cement removal, (E) and (F) Crown in place after re-cementation.

Fig 5
Fig 5. Debonding and re-cementation of zirconia FPD on natural tooth abutments.

(A) and (B) FPD was improperly seated during cementation, note the open margin facially and lingually shown by red arrows, (C) and (D) FPD and abutments immediately after Er:YAG debonding, (E) and (F) FPD was air-abraded and steam cleaned, and (G) and (H) Re-cemented FPD with closed margin, see green arrows.

Fig 6
Fig 6. Retrieval of cement-retained implant-supported zirconia FPD.

(A) Periapical radiograph demonstrating one peri-implantitis bone loss of #12 and 14 implants, (B) Preoperative FPD before debonding, (C) Titanium abutments after debonding, D) FPD after debonding, being air-abraded, and steam cleaned, (E) flap opening and removal of peri-implantitis tissue, (F) Bone decortication, (G) and (H) grafting and membrane in place, (I) FPD re-cementation after suturing.

Fig 7
Fig 7. Removal of cement-retained zirconia implant crown.

(A) Bitewing radiograph demonstrating miss-seating #29 crown, (B) Preoperative buccal view, (C) Intaglio surface of the crown immediately after removal, and (D) Implant abutment after crown removal.

Fig 8
Fig 8. Removal of Implant-supported cement-retained FPD with fractured zirconia abutments.

(A) Periapical radiographs demonstrating fracture of zirconia abutments #8 and 9, (B) Debonded FPD, (C) Healing abutment was placed on #8 and 9 implants, (D) composite resin was added to convert existing FPD to be used as provisional FPD, (E) Converted provisional FPD in place, (F) Postoperative image after a few weeks of removal, (G) New definitive custom titanium abutments, (H) New definitive prosthesis in place, and (G) Postoperative periapical radiographs.

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