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Is there a difference in tooth structure removed with an erbium laser vs. a rotary instrument?

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This is a summary of the article: "Composite removal by means of erbium, chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments" in the December 2019 edition of the Journal of the American Dental Association.

Complete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument.

Clinical Implications

Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument.

The erbium, chromium:yttrium-scandium-gallium garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite.

Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites.

When removing existing composite restorations, an Er,Cr:YSGG laser saved more tooth structure than did a rotary instrument. In addition, fewer composite remnants were left in the preparation when using the Er,Cr:YSGG laser for composite restoration removal.

I hope you you find the  information helpful. We always look forward to hearing your thoughts and receiving your questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
Chiraz Guessaier, CDA Oasis Manager

References

Bibliography: Composite removal by means of erbium, chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments (PDF)

1 Comment

  1. Dr Paul Belzycki December 8, 2019

    Several important comparative factors are absent from this post.

    1. What is the comparative cost to remove the composite resin filling when one considers the following:
    a) initial cost of the laser
    b) maintenance cost of the laser.
    c) how many zaps can said laser device deliver before it is zapped and requires replacement?
    d) What is required in terms of time and equipment to sterilize laser between patients?
    e) how much longer than 15 to 60 seconds, the average time to remove old composite filling with air-rotor, will be wasted?
    f) What if I bump into different filling materials under the resin? Will I need to haul out air-rotor and now incur additional cost to sterilize yet another piece of equipment?

    And finally, of what significance is the removal of some additional tooth structure?

    More to the point, if the preservation of every enamel rod is so sacrosanct, then amalgam should be used, as this material will typically last 2 to 3 times longer. Hence, in the course of a tooth’s lifetime, it does not need to be insulted as many times.

    I propose the following study. Count the number of times amalgam fillings need to be replaced compared to resin fillings due to recurrent decay.
    Of course we all know the outcome apriori, don’t we.

    Furthermore, I posit that the skill and attention to detail a caring dentist possesses has more to do with the exactness of cavity preparation and amounts of “unnecessary” enamel loss than the use of a laser.

    Regardless of science and common sense, dentists will buy said laser. Not because it is better, but so they can call in CBC news and boast they are superior to the rest of us.

    Bin der, seen dat.
    What a waste of time and research funding…
    Dr. Paul Belzycki

    Reply

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