Atraumatic removal of a zirconia-framework fixed partial denture using an Er,Cr:YSGG laser: a case report

A 3-unit fixed partial denture spanning the maxillary left central incisor, lateral incisor, and canine was fabricated with a zirconia framework and a pontic veneered with porcelain to replace the maxillary left lateral incisor. The prosthesis was attached to the abutment teeth using lingual wings that sat in preparations approximately 1.5 mm deep axially. When the veneering porcelain on the pontic developed a void 5 months after cementation, the patient was offered 3 options to eliminate the defect: (1) restoration with composite resin; (2) destructive removal of the prosthesis followed by fabrication of a replacement; or (3) attempted nondestructive removal of the prosthesis with an erbium, chromium-doped: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser followed by laboratory repair of the void with low-fusing porcelain. The patient selected the third option. The laser was set to 3 W, 20 Hz, 50% air, and 50% water using the turbo handpiece with a 700-μm-diameter tip, per the manufacturer's recommendations. The Er,Cr:YSGG laser operates in a noncontact mode at an ideal distance of 3 to 5 mm from the target tissue, in this case, the lingual surfaces of the maxillary left central incisor and canine. No anesthetic was administered to the patient. The laser beam was applied to the wings of the prosthesis intermittently for 8 cycles at a maximum of 60 seconds per cycle. During irradiation, the handpiece moved side-to-side in a scanning motion. Darkening of the cement was observed under the wing on the central incisor, indicating the initial disruption of the adhesive seal. Slight torquing pressure was applied using specially designed crown removal pliers, and the prosthesis was removed atraumatically. The recovered prosthesis was repaired with low-fusing porcelain and adhesively luted. Atraumatic debonding of a high-strength ceramic can be predictably performed with the Er,Cr:YSGG laser when appropriate settings are used.