Оптимізація процесу дебондингу непрямих реставрацій фронтальної групи зубів

Abstract

В даній статті представлено результати різних методів дебондингу непрямих реставрацій фронтальної групи зубів, згідно яких можна стверджувати про перевагу використання лазерної енергії, яка забезпечує безпечність даної процедури, зменшує виникнення больових відчуттів та потребу у знеболенні, що значно усуває ймовірність розвитку алергічних реакцій.

В данной статье представлены результаты различных методов дебондинга непрямых реставраций фронтальной группы зубов, согласно которых можно утверждать о преимуществе использования лазерной энергии, которая обеспечивает безопасность данной процедуры, уменьшает возникновение болевых ощущений и необходимости в обезболивании, значительно устраняет вероятность развития аллергических реакций.

Dental veneers are very thin porcelain facings placed on front teeth to improve esthetics. Today, porcelain laminate veneers are mainly used to optimize tooth form and position, close diastema, replace discolored or unesthetic composite resin restorations, restore teeth with incisal abrasions or tooth erosion, and mask or reduce tooth discoloration. They are a valid alternative to complete-coverage restorations since they avoid aggressive dental preparation, thus maintaining tooth structure. However, even such high-precision restorations have a failure rate and complications. The least common problems associated with porcelain laminate veneers are marginal discoloration and loss of color stability. A possible cause of marginal discoloration and the loss of color stability of the restoration is marginal leakage or a breakdown of the bond either between the cement and the tooth or between the cement and the veneer. This discoloration starts as a dark line but eventually works its way under the restoration, with a resultant diffused discoloration that spreads from the involved margin. Another rare occurrence is the cohesive failure of either the tooth or the porcelain. In the first instance, the fracture of the underlying tooth is usually the result of poor judgment in selection of the tooth to be veneered. Vital anterior teeth with large existing restorations on the mesial and distal surfaces and nonvital anterior teeth might be better served with full-coverage porcelain restorations bonded to the additional surface area of the crown preparation on dentin. A more common problem is the cohesive failure of the porcelain itself, which may occur during cementation as a result of a poorfitting restoration, a resin that is too thick (viscous), or a resin that has gone through some initial setting. The latter can result if the resin is left too long in ambient light or unit light. Cohesive failure also may occur after cementation as the result of poorly planned occlusion or traumatic injury. Veneer removal is generally performed with a rotary instrument. Using this method the veneer removal is complete, but is relatively time consuming and this technique is not ideal as the underlying tooth structure may be damaged. Moreover, the irritating noise, uncomfortable vibration and pain during veneer removal with high-speed handpieces are unpleasant for the patients. These disadvantages led to the search for new techniques for hard dental tissue removal, such as lasers, which would make treatment less painful to patients, with no need of local anesthesics. With the recent introduction of lasers in dentistry, there may be beneficial application of lasers in removing veneers with lasers. Using an Er:YAG laser allows debonding porcelain veneers from teeth without aggressive destruction or removal of underlying tooth structure and without destroying the veneers. Purpose. The aim of our study was to investigate the appearance of tooth sensitivity and the need for anesthesia during debonding of front indirect restorations. Object and methods. Clinical studies conducted at Shupyk National Medical Academy of postgraduate education. According to a survey of 65 patients who had 356 veneers, complication rate was 19.8% (67 veneers). According to our study following groups were created: group 1 (control) - veneer removal using rotary instruments; group 2 - veneer removal using a solid-state laser (Er: YAG); group 3 - veneer removal using a solid-state laser (Er, Cr: YSGG). Results of the study. According to the results of our study using an Er:YAG and Er, Cr: YSGG laser allows debonding porcelain veneers from teeth without aggressive destruction or removal of underlying tooth structure and in most cases without destroying the veneers, make veneer debonding less painful to patients, with no need of local anesthesics, significantly eliminates the developing of allergic reactions.