Using an Er,Cr:YSGG laser to remove lithium disilicate restorations: A pilot study

Statement of problem. The use of lasers is growing widely in dentistry. Despite its clinical implications, most information and clinical data related to the removal of ceramic restorations with the aid of a laser is either anecdotal or in the form of clinical reports. Purpose. The purpose of this in vitro study was to establish a parameter on the removal of lithium disilicate crowns with a laser and conduct an in vitro trial of crown removal based on the wattage and time of application. Material and methods. Twenty extracted molars were prepared to accommodate a lithium disilicate disk specimen, which was cemented with resin cement. An erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser was applied at different wattages (3, 3.5, 4, and 5 W) to determine the optimal wattage for the removal of the lithium disilicate specimens. Once the optimal wattage was established, 25 extracted teeth were mounted in stone, then prepared to receive milled lithium disilicate computer-aided design/computer-aided manufacturing complete coverage crowns. The crowns were cemented with a dual-polymerizing resin cement. The groups comprised 3.5 and 4 W output with 30-, 60-, and 90-second application time (n=5), and 5 crowns were removed using traditional handpiece and electric handpiece with coarse grit diamond rotary instruments. The results and time required to remove the crown were recorded. The chi-square test was performed to assess any significant differences in removing the crown with the laser according to wattage or time of application (alpha=.05). Results. Laser application at 3.5 and 4W was best for removing crowns conservatively. Eight crowns (40%) of 20 specimens were successfully removed at the first attempt. The majority of the crowns came off during the second attempt. The chi-square test revealed no significant difference between the combination of wattage and time of application (P=.92). The mean time to remove the lithium disilicate crown with a diamond rotary instrument was 6 minutes, and removal required 1.8 instruments on the average. Conclusions. An Er,CrYSGG laser can safely remove lithium disilicate crowns with the settings used this study.