Intraoral metal laser welding: a case report

Soldering in Dentistry: An Updated Technical Review

INTRODUCTION

The need to permanently join two or more pieces of metal using heat is a frequent condition in various fields of medicine such as dentistry. Welding, brazing and soldering are permanent joining techniques between different metals that require in-depth background knowledge in order to obtain predictable results.

AIM

This review examines the different methods of joining metals using heat and their fields of application.

DISCUSSION

It is possible to create permanent metal joints in various phases of the creation of final products that will be used on the patient. In several cases, welds are also made directly by the manufacturer during industrial processing. In dentistry, dental laboratories perform complex welds mainly on dental prostheses and orthodontic appliances during the production process. It is also possible to obtain intraoral welding carried out by the clinician inside the patient's oral cavity. Welding can be carried out using combustible gases, electric current, infrared light and laser light through different technical procedures which must be chosen according to the specific needs and the metals to be joined.

CONCLUSIONS

It is useful for the dentist and dental technician to know the different welding methods, including those carried out in the factory by the manufacturer, to better understand the physical properties and mechanical resistance of the components marketed for the construction of prostheses and orthodontic appliances. The enormous variety of conditions in which those who practice welding can find themselves therefore presupposes in-depth knowledge in this field in order to apply the most suitable technique.

The Ball Welding Bar: A New Solution for the Immediate Loading of Screw-Retained, Mandibular Fixed Full Arch Prostheses

Purpose

To present a new intraoral welding technique, which can be used to manufacture screw-retained, mandibular fixed full-arch prostheses.

Methods

Over a 4-year period, all patients with complete mandibular edentulism or irreparably compromised mandibular dentition, who will restore the masticatory function with a fixed mandibular prosthesis, were considered for inclusion in this study. The “Ball Welding Bar” (BWB) technique is characterised by smooth prosthetic cylinders, interconnected by means of titanium bars which are adjustable in terms of distance from ball terminals and are inserted in the rotating rings of the cylinders. All the components are welded and self-posing.

Results

Forty-two patients (18 males; 24 females; mean age 64.2 ± 6.7 years) were enrolled and 210 fixtures were inserted to support 42 mandibular screw-retained, fixed full-arch prostheses. After two years of loading, 2 fixtures were lost, for an implant survival rate of 97.7%. Five implants suffered from peri-implant mucositis and 3 implants for peri-implantitis. Three of the prostheses (3/42) required repair for fracture (7.1%): the prosthetic success was 92.9%.

Conclusions

The BWB technique seems to represent a reliable technique for the fabrication of screw-retained mandibular fixed full-arch prostheses. This study was registered in the ISRCTN register with number ISRCTN71229338.

Temperature changes of pulp chamber during in vitro laser welding of orthodontic attachments

The use of lasers has been suggested for orthodontists to fabricate or repair orthodontic appliances by welding metals directly in the mouth. This work aimed to evaluate the temperature changes in the pulp chamber during welding of an orthodontic wire to an orthodontic molar band using Nd : YAG laser in vitro. A freshly extracted human third molar with eliminated pulpal tissues was used. J-type thermocouple wire was positioned in the pulp chamber. A conductor gel was used in the transferring of outside temperature changes to the thermocouple wire. An orthodontic band was applied to the molar tooth and bonded using light cured orthodontic cement. Twenty five mm length of 0.6 mm diameter orthodontic stainless steel wires was welded to the orthodontic band using Nd : YAG laser operated at 9.4 watt. Temperature variation was determined as the change from baseline temperature to the highest temperature was recorded during welding. The recorded temperature changes were between 1.8 and 6.8°C (mean: 3.3 ± 1.1°C). The reported critical 5.5°C level was exceeded in only one sample. The results of this study suggest that intraoral use of lasers holds great potential for the future of orthodontics and does not present a thermal risk. Further studies with larger samples and structural analysis are required.

Laser welding and syncristallization techniques comparison: "Ex vivo" study

BACKGROUND AND AIMS

Stabilization of implant abutments through electric impulses at high voltage for a very short time (electrowelding) was developed in the Eighties. In 2009, the same procedure was performed through the use of laser (laser welding) The aim of this study is to compare electrowelding and laser welding for intra-oral implant abutments stabilization on "ex vivo models" (pig jaws).

MATERIALS AND METHODS

Six bars were welded with two different devices (Nd:YAG laser and Electrowelder) to eighteen titanium implant abutment inserted in three pig jaws. During the welding process, thermal increase was recorded, through the use of k-thermocouples, in the bone close to the implants. The strength of the welded joints was evaluated by a traction test after the removal of the implants. For temperature measurements a descriptive analysis and for traction test "values unpaired t test with Welch's correction" were performed: the significance level was set at P<0.05.

RESULTS

Laser welding gives a lower thermal increase than Electrowelding at the bone close to implants (Mean: 1.97 and 5.27); the strength of laser welded joints was higher than that of Electrowelding even if nor statistically significant. (Mean: 184.75 and 168.29) CONCLUSION: Electrowelding seems to have no advantages, in term of thermal elevation and strength, while laser welding may be employed to connect titanium implants for immediate load without risks of thermal damage at surrounding tissues.

Use of laser in orthodontics: applications and perspectives

Laser technology got in these years a more and more important role in modern dentistry and, recently, also in orthodontics was proposed the utilization of laser devices. The aim of this work is to describe the utilization of this technology both in soft and hard oral tissues to improve orthodontic treatment. Several cases, with different wavelengths (532, 810, 980, 1064, 2940 and 10600 nm) and in different times of the treatment (before, during and after) are presented. All the cases reported showed, according to the literature, that the use of the laser related to orthodontic treatment offers several advantages when compared with conventional methods. In the soft tissues surgery it allows to reduce or eliminate the use of anesthetic injection, to avoid use of sutures and to bond bracket in dry enamel; associated with orthophosphoric acid, it gives a stronger adhesion of the brackets to the enamel and, in the case of porcelain brackets, it detaches them without damages; at low power (LLLT) it permits to control the pain of the first period after bonding and, by increasing the speed of teeth movement in the bone, reduces the time of the treatment.

Use of laser in orthodontics: applications and perspectives

Laser technology got in these years a more and more important role in modern dentistry and, recently, also in orthodontics was proposed the utilization of laser devices. The aim of this work is to describe the utilization of this technology both in soft and hard oral tissues to improve orthodontic treatment. Several cases, with different wavelengths (532, 810, 980, 1064, 2940 and 10600 nm) and in different times of the treatment (before, during and after) are presented. All the cases reported showed, according to the literature, that the use of the laser related to orthodontic treatment offers several advantages when compared with conventional methods. In the soft tissues surgery it allows to reduce or eliminate the use of anesthetic injection, to avoid use of sutures and to bond bracket in dry enamel; associated with orthophosphoric acid, it gives a stronger adhesion of the brackets to the enamel and, in the case of porcelain brackets, it detaches them without damages; at low power (LLLT) it permits to control the pain of the first period after bonding and, by increasing the speed of teeth movement in the bone, reduces the time of the treatment.

Intraoral Laser Welding (ILW) in Implant Prosthetic Dentistry: Case Report

The aim of this clinical study was to describe the possibility of using the Nd:YAG laser device utilized in the dental offices to weld metals intraorally. The authors, before applying this technique “in vivo” on human subjects, tested the “in vitro” metal welding efficacy of dental Nd:YAG device firstly by interferometry, SEM, and EDS and subsequently by thermal camera and thermocouples in order to record temperature changes during the welding process on bovine jaws. Four implants were inserted in the edentulous maxillary arch of a 67 years old male patient. Immediately after that, a bar previously made by the dental technician was intraorally welded to the abutments by Nd:YAG laser (Fidelis Plus III, Fotona, Slovenia) with these parameters: 9.90 mJ, 1 Hz, 15 msec, 0.6 mm spot. Then the prosthesis was connected to the bar with four OT Caps. This clinical study, even if preliminary, suggests that laser welding technique may be intraorally used without side effects.

Thermal increase in the oral mucosa and in the jawbone during Nd:YAG laser applications. Ex vivo study

Objective: Literature reports bactericidal and biostimulant effects for Nd:YAG laser procedures on bone and oral mucosa but the possible overheating can cause damage to anatomical structures. The aim of the study is the evaluation of thermal increase in different levels of oral tissues: mucosa, periosteum and bone during defocused application of Nd:YAG laser at different parameters. Study Design: Superficial thermal evaluation was performed in pig jaws with a thermal camera device; deep thermal evaluation was realized by 4 thermocouples placed at a subperiosteal level and at 1,2 and 4 mm depth in the jaw bone. Laser applications of 1 minute were performed 5 times (with a pause of 1 minute) on a surface of 4 cm2 with a Nd:YAG laser (VSP mode, 320 micrometer fiber, defocused mode) with different parameters. Temperatures were recorded before and after laser applications and after each pause in order to evaluate also the thermal relaxation of tissues. Results: At submucosal level, mean thermal increase was between 1.1°C and 13.2°C, at 1 mm depth between 1.1°C and 8.5°C, at 2 mm depth between 1.1°C and 6.8°C, at 4 mm depth between 1.0°C and 5.3°C. Temperature decrease during the rest time period was variable between 0°C and 2.5°C. Conclusions: Temperatures reached during clinical procedures with parameters reported in the literature in biostimulation protocols (1.25-2 Watts) for the five minutes of application are not dangerous for biological structures. The decrease in temperature during the rest time period is less considerable in the bone in comparison to oral mucosa.

Key words:Nd:YAG laser, thermal increase, thermocouple, thermal camera, low level laser therapy.

Intraoral laser welding: ultrastructural and mechanical analysis to compare laboratory laser and dental laser

The Nd:YAG laser has been used since 1970 in dental laboratories to weld metals on dental prostheses. Recently in several clinical cases, we have suggested that the Nd:YAG laser device commonly utilized in the dental office could be used to repair broken fixed, removable and orthodontic prostheses and to weld metals directly in the mouth. The aim of this work was to evaluate, using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS) and dynamic mechanical analysis (DMA), the quality of the weld and its mechanical strength, comparing a device normally used in dental laboratory and a device normally used in the dental office for oral surgery, the same as that described for intraoral welding. Metal plates of a Co-Cr-Mo dental alloy and steel orthodontic wires were subjected to four welding procedures: welding without filler metal using the laboratory laser, welding with filler metal using the laboratory laser, welding without filler metal using the office laser, and welding with filler metal using the office laser. The welded materials were then analysed by SEM, EDS and DMA. SEM analysis did not show significant differences between the samples although the plates welded using the office laser without filler metal showed a greater number of fissures than the other samples. EDS microanalysis of the welding zone showed a homogeneous composition of the metals. Mechanical tests showed similar elastic behaviours of the samples, with minimal differences between the samples welded with the two devices. No wire broke even under the maximum force applied by the analyser. This study seems to demonstrate that the welds produced using the office Nd:YAG laser device and the laboratory Nd:YAG laser device, as analysed by SEM, EDS and DMA, showed minimal and nonsignificant differences, although these findings need to be confirmed using a greater number of samples.