Dental ablation. Techniques. Directions
Prosthetic correction of malocclusion with zirconia-backed ceramic crowns.
Prosthetic works are pieces made in the dental laboratory with a role in restoring the original morphology or replacing teeth affected by pathological processes.
They are fitted to the remaining teeth, prepared in advance.
The lifespan of a prosthetic work depends on certain factors and is different from case to case.
The general health of the patient: some general pathologies considerably reduce the lifespan of prosthetic work.
The patient’s local health: caries, malposition, loss of bone attachment accompanied by tooth mobility are factors which, if present, compromise the strength of prostheses.
Correctness of the prosthetic workmanship: suggests the patient’s compliance with the proposed treatment plan and the quality of the dental laboratory’s work.
Over time, due to changes that may occur in the oral cavity, local conditions may require changes in the treatment plan. Existing permanently cemented prosthetic work may need to be removed, a process that can often be difficult.
Dental ablation is the dental technique by which prosthetic work is removed: dental bridges, posts, inlays, dental crowns.
Circumstances requiring the removal of prosthetic work
Poor fit at the boundary between the prosthetic piece and the gum: overcuts or unfinished edges may injure the gum or generate the deposition of food debris.
Thus, we will have gingival inflammation and the patient will present to the dental surgery complaining of tenderness that can range from simple embarrassment to pain that prevents optimal feeding.
Following the clinical and radiological examination, the dentist will indicate the restoration of the prosthesis, respecting the biological tissues.
Periapical processes requiring endodontic treatment: endodontic treatment, which involves devitalization of the tooth, may be an indication for treatment prior to prosthetic grinding.
However, over time, tooth roots may develop infections and in this case re-treatment with endodontics is indicated.
Although we can often drill the crown of the tooth to make the access cavity, we cannot leave the prosthetic piece in this way because there is a risk of bacterial infiltration. Thus, ablation of the crown and restoration is required
Carious processes under the prosthetic work: radiologically, we can observe areas of opacity in the tooth structure associated with carious lesions. These require removal of the crown and treatment of carious processes.
Ablation of crowns and prosthetic bridges can be performed in two ways:
Sectioning: with this method, the prosthetic work is cut using diamond burs, obtaining a vertical section. Then, using hand tools, the prosthetic piece is removed. After removal, the prosthetic piece can no longer be cemented in place, requiring re-cementing.
Non-sectioning: instruments that perform vibratory movements are used. Theoretically, the prosthetic part is not compromised and can be cemented in place after the operations. In practice, we cannot always remove dental crowns using this technique.
Ablation of prosthetic work is a procedure that can be performed without anesthesia if the tooth is devitalized. It consists of three parts:
Sectioning the prosthetic work
Removal from the abutment tooth: ultrasonic instruments can also be used to remove the cementing material
Removal of the prosthetic part from the tooth
Sometimes accidents can occur due to instruments slipping, creating apical lesions due to untimely maneuvers or even fracturing or sectioning of the abutment.
The dentist will analyze the conditions in the oral cavity and weigh up the indications and risks to which the patient is exposed and choose the optimal ablation method.