Er,Cr:YSGG Laser in the Debonding of Feldspathic Porcelain Veneers: An In Vitro Study of Two Different Fluences

Do erbium lasers promote changes in the tooth enamel during debonding of ceramic laminate veneers? A systematic review

The longevity of ceramic laminate veneers can be influenced by several factors, which can result in the need for a removal process. Laser removal has emerged as a good alternative to facilitate the procedure, and its repercussions on tooth enamel have been investigated. We aimed to evaluate the efficacy of erbium lasers for debonding ceramic laminate veneers without damaging the tooth enamel. This systematic review based on the PICOS model adhered to the PRISMA statement. The PubMed/MEDLINE, Web of Science, Embase, and Scopus databases were systematically searched until December 1, 2022, and 2902 studies were retrieved. After screening, four in vitro studies that analyzed the dental morphology using scanning electron microscopy, optical analysis, stereomicroscopy, or x-ray dispersion spectroscopy were included. The risk of bias was assessed using the Cochrane Collaboration tool. Our findings suggest that erbium lasers are useful for ceramic laminate veneer removal without damaging the tooth enamel. However, the removal is influenced by the type and thickness of ceramic and type of cement used. It could be concluded that the application of Erbium laser did not promote superficial changes in the dental enamel. This effect was observed in all analysis performed.

Optimized Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser Parameters for the Removal of Dental Ceramic Restorations

OBJECTIVES

The use of lasers for debonding adhesively luted ceramic restorations is a rather recent oral laser application in dentistry. The removal of all-ceramic restorations in the mouth can often be a troublesome task. A novel method for the debonding of ceramic restorations without damaging the restorations is Er:YAG laser irradiation. The aim of this study was to evaluate the Er:YAG laser for debonding procedures of different dental ceramics and to identify appropriate laser settings.

MATERIAL AND METHODS

Lithium disilicate, zirconium-reinforced lithium silicate, feldspatic ceramic, and zirconium dioxide were investigated. Ten ceramic rectangular-shaped specimens with 1 and 2 mm thickness were produced from each material. All specimens were irradiated with four different power settings 1.5; 2.5; 3.5; 4.5 W, pulse duration 50 μs, laser repetition rate 10 Hz, time of irradiation 10 s. The transmitted energy was measured with a powermeter. Additionally the suitability of the Er:YAG laser to remove the adhesively bonded ceramic and the time until loss of retention was evaluated.

RESULTS

The transmission rate for 1 and 2 mm platelets was determined for zirconium-reinforced lithium silicate at 54.6%/35.6%, lithium disilicate at 53.2%/35.7%, zirconium dioxide at 40.6%/32.4%, and for the feldspathic ceramic at 19.4%/10.1%. For zirconium-reinforced lithium silicate and zirconium dioxide 2.5 W (250 mJ/10 Hz) was an appropriate energy level for effective debonding. Whereas for lithium disilicate and for feldspathic ceramic, 4.5 W (450 mJ/10 Hz) is required for efficient debonding.

CONCLUSIONS

There are differences regarding transmission rates between ceramic types for the Er:YAG laser light and additionally depending on the type of ceramic different energy settings should be used for adequate debonding. Based on our in-vitro experiments we recommend 2.5 W for zirconium-reinforced lithium silicate and zirconium dioxide and 4.5 W for lithium disilicate and feldspatic ceramic. Transmission rates of different ceramic types and varying influences of thicknesses and bonding materials should be considered to adjust the laser parameters during laser debonding of adhesively luted all-ceramic restorations.

Debonding of LDSVs utilising Er,Cr:YSGG laser irradiation with fractional technique: an in vitro study

BACKGROUND

The removal of porcelain laminate veneers with rotary instruments could be accompanied by microfractures because differentiation of the veneer from the dental structure and resin cement is not a highly selective procedure. This can lead to scratches and overheating of the enamel and patient discomfort. Therefore, this in vitro research aimed to examine the effectiveness of the 2790 nm Er,Cr:YSGG laser utilizing a fractional technique to debond lithium disilicate veneer.

METHODS

Six groups of 30 extracted permanent bovine mandibular incisors were selected. Twenty-five samples, G1-5, (n = 5) laser-irradiated groups, and the last five samples (C) were considered the control group. The tested groups were irradiated with 3-5 W output power of Er,Cr:YSGG laser for time intervals of 50 s. During irradiation, the temperature in the pulp chamber was monitored using a thermocouple connected to a digital multilogger thermometer inside the sample's pulp chamber. Subsequently, the shear bond strength was measured for all groups. Furthermore, the remaining adhesive index was measured using a stereomicroscope, the area was analysed, and then transformed into scores. Finally, one untreated sample and two samples of the highest power value from laser-treated groups were examined using a scanning electron microscope (SEM) for their surface morphology.

RESULTS

All debonding protocols were safe regarding intrapulpal temperature increment. The highest temperature elevation was recorded at 5 W, which increased by 1.7 °C. Considering the shear bond strength measurement, there was a significant reduction after laser irradiation for G1-5 compared with group C.

CONCLUSIONS

Er,Cr:YSGG laser with a fractional technique can be used successfully for veneer removal. Besides safe temperature rising, veneers can be reused because there was neither a fractured specimen during the whole study nor major irregularities or cracks shown in SEM pictures analysis for the veneer surfaces; thus, they can be removed quickly, safely, and comfortably using Er,Cr:YSGG. © 2023 Australian Dental Association.

Erbium laser-assisted ceramic debonding: a scoping review

PURPOSE

Removal of ceramic restorations and appliances can be time consuming, invasive, and inconvenient. Erbium lasers offer an alternative noninvasive method for debonding of ceramic appliances. This paper aims to provide a comprehensive review of current literature on the effectiveness of erbium lasers for removal of ceramic restorations and appliances from natural teeth and dental implants.

METHODS

A comprehensive search of 7 databases, including Medline (Ovid), Embase, Dentistry and Oral Sciences Source (DOSS), Web of Science, Cochrane Library, and ProQuest Dissertations and Theses was performed. The inclusion and exclusion criteria were agreed prior to the literature search. Two reviewers independently screened the title and abstract. A third reviewer then broke the tie, if any. The selected articles then underwent full text review and the data was extracted.

RESULTS

The search identified 4117 unique articles published through June 10, 2021. Studies were assessed and categorized based on the type of restoration/appliance, type of abutment, type of laser, laser settings, efficacy of debonding, and pulpal temperature rise. Thirty-eight full-text articles were reviewed for inclusion. Time for ceramic debonding varies depending on the type of restorations and materials. Removal of zirconia crowns from teeth and implant abutments requires a longer period of time compared to lithium disilicate crowns. Temperature increases were reported as 5.5 degrees or less. Laser setting and laser type affect the debonding time and the increase in temperature. Examinations of debonded ceramics demonstrated no known structural damages resulting from laser applications.

CONCLUSIONS

Erbium lasers are effective noninvasive tools to remove all ceramic restorations/appliances from natural teeth and implant abutments without causing harm to abutments. Laser-assisted debonding should be considered as a viable alternative to rotary instrumentation for ceramic crowns; however, clinical studies of erbium-assisted ceramic retrieval are needed.

The efficiency of ErCr:YSGG laser on the debonding of different thicknesses of ceramic veneers

Aims: To verify the efficacy of Er,Cr:YSGG laser for debonding of lithium disilicate (LD) reinforced glass ceramic veneers of different thicknesses. Methods: Forty bovine teeth were prepared and randomly divided into four groups (n=10/group) according to the ceramic disc thickness: C0.5 (Control group) and L0.5 (Laser irradiated group) in which LD discs had a thickness of 0.5mm and 5mm diameter; C1 and L1 in which LD discs had a thickness of 1mm and 5mm diameter. The lithium disilcate discs (IPS E.max®, shade HTA2) were fabricated following the manufacturer’s recommendations and cemented to the prepared tooth surface. The Er,Cr:YSGG laser was applied to the laser groups at 2.5W and 25Hz for 60seconds. Universal testing machine was used to evaluate the shear bond strength for all samples at a cross head speed of 1mm/min in an inciso-gingival direction parallel to the sample surface. After debonding, the samples were examined under stereoscope to evaluate the mode of failure according to the adhesive remnant index (ARI). Results: Laser irradiation significantly diminishes the shear bond strength from 10.868 MPa to 3.778 MPa for C0.5 and L0.5 groups respectively (p=0.00) and from 14.711 MPa to 4.992 MPa for C1 and L1 groups respectively (p=0.00). The shear bond strength required for debonding increased with increasing thickness of discs, but without significant difference (p=0.110). Higher ARI scores were seen in the laser groups (more cement remaining adhered to the tooth) when compared to the control groups. Conclusions: The Er,Cr:YSGG laser could be an effective and useful tool in debonding of lithium disilicate ceramic veneers as it decreases the shear bond strength required for veneer debonding.