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Case Study
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Er,Cr:YSGG Laser and CAD/CAM Technology

Case Presentation of a Minimally Invasive Approach to Full-Mouth Rehabilitation

Learning Objectives:

This study discusses the use of an Er,Cr:YSGG laser to prepare the hard tissue for full-mouth rehabilitation with CAD/CAM prostheses. Upon reviewing this study, the reader should:

  • Be aware of the procedure involved in minimally invasive tooth preparation using emerging technologies.
  • Recognize the role of emerging technologies on the delivery of optimal care.

 

Recent advances in laser and CAD/CAM technology have opened the doors to both patients and clinicians, offering minimally invasive and timely delivery of acceptable dental restorations, often in “same day” timelines. Application of current bonding methodologies with less-than-ideal remaining tooth structure has allowed practitioners to restore compromised dentition while achieving their final desired position, color, and shape.  

There are many significant advantages to restoring dentition with conservative and minimally invasive techniques. These include a reduced need for anesthesia, the absence of postoperative sensitivity, secure bonding to the remaining enamel, reduced flexing stress, the potential for reversal of treatment, and higher treatment acceptance. In such instances, case selection is extremely important. Prior to advising patients of any treatment option, the clinician should perform a thorough medical history evaluation and a clinical examination, including photographs, radiographs, periodontal evaluation, mounted models and patient interview. A comprehensive review of hard and soft tissue structures is also required. In addition, the patient’s craniomandibular status as it applies to TMJ/TMD must be documented to effectively prepare a treatment plan that ultimately leads to harmonious dental/alveolar function. Only following this comprehensive review of the patient’s current condition can the practitioner determine the options available to achieve the final restorative results. The clinician should then select the least invasive modaility to achieve the desired clinical outcome. This article will demonstrate how laser and CAD/CAM technologies may be utilized to create these desired results in a manner that is minimally invasive and in a reduced number of office visits. 

By combining two relatively new dental treatment modalities (lasers and CAD/CAM technologies), it was possible to rehabilitate this patient’s dentition and dental health. The authors demonstrated that this restorative case could be completed in fewer office visits without the use of the conventional handpiece, no local anesthetic, and implementing same-day milled ceramic restorations.

 

*Private practice, Whitefish, MT; Adjunct Faculty, Arizona School of Dental Oral Health, Phoenix, AZ.

  

Related Reading:

  1. West NX, Hughes JA, Addy M. The effect of pH on the erosion of dentine and enamel by dietary acids in vitro. J Oral Rehabil 2001;28(9):860-864.
  2. Trident Laboratories, Hawthorne, CA.
  3. Tally RL, Murphy GJ, Smith SD, et al. Standards for the history, examination, diagnosis, and treatment of the temporomandibular disorders (TMD): A position paper. J Craniomand Pract 1990; 8(1):60-77.
  4. Shankland WE 2nd. Temporomandibular disorders: Standard treatment options. Gen Dent 2004;52(4):349-355.
  5. Colonna M. Crown and veneer preparations using the Er,Cr:YSGG Waterlase hard and soft tissue laser. Contemp Esthet Restor Pract 2002;10:80-86.
  6. Rizoiu I, Kohanghadosh F, Kimmel AI, Eversole LR. Pulpal thermal responses to an erbium, chromium:YSGG pulsed laser hydrokinetic system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;86(2):220-223.
  7. Matsumoto K, Hossain M, Hossain MM, et al. Clinical assessment of Er,Cr:YSGG laser application for cavity preparation. J Clin Laser Med Surg 2002;20(1):17-21.
  8. Walsh LJ. Laser Dentistry: Membrane-based photoacoustic and biostimulatory applications in clinical practice. Austral Dent Pract 2006;17(5):62-64.
  9. Rekow ED, Erdman AG, Riley DR, Klamecki B. CAD/CAM for dental restorations—Some of the curious challenges. IEEE trans Biomed Eng 1991;38(4):314-318.
  10. Margolis F. The Star Wars of dentistry. Using the erbium laser to treat tooth decay. CDS Rev 2002;26-29.
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