Clinical Investigation of the Methods for Removing Cast Restorations : To Shorten Removal Time, and to Ensure Better Removal, the Least Damage, and Safety for Patients

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  • 鋳造修復物の除去方法に関する臨床的検討 : 鋳造修復物除去の時間短縮,除去の確実性,患者への最小限の侵襲および安全性を求めて

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Abstract

Dentists usually remove cast restorations to prolong the life of the tooth by conservative treatment. However, as the removal of cast restorations is difficult and involves risks (tooth fracture or root fracture), it is necessary to remove cast restorations "speedily" and "surely", and to minimize the stress for patients in order to offer dental treatment "safely" ("3S"). Therefore, this study clinically investigated the methods of removing cast restorations which might attain the 3S. The subjects were patients who have visited Ouki Dental Clinic from May 21 to July 31 in 2009, and their cast restorations were removed by one of the following methods. We then evaluated the time taken to remove the cast restoration, tooth (root) fracture, spontaneous or percussion pain and so on. 1. Metal Crown: The tooth was grooved in the center of the buccal and occlusal side lengthwise by a #1/2 carbide bar for FG, then the tip of a flat-head driver was inserted into this groove and twisted slowly and gently, finally the metal crown was removed with Inlay and Crown Remover (CR, YDM). 2. Metal Inlay/Onlay: The tooth was grooved in the circumferential metal margin by a #1/2 carbide bar for FG, then the tip of an excavator was inserted into this groove and twisted slowly and gently for removal of the metal inlay/onlay. 3. Cast Post: The tooth was grooved at two locations, one on the buccal side and the other on the lingual side, on the metal core margin by a #1970 carbide bar for FG, then the two tips of Post and Core Remover (PR, YDM) were inserted into these locations and the cast post was slowly removed by gently clasping force of the PR. Almost all cast restorations were removed within 5 minutes [metal crown: 25/26, metal inlay/onlay 18/18, cast post: 18/18 (unit: piece)]. The average time for removing cast restorations was 133±82 (metal crown), 78±62 (metal inlay/onlay), and 103±77 (cast post) (unit: second); the removal time for metal inlay/onlay was significantly shorter than that for metal crown (Mann-Whitney U test, p<0.05). The average time for removing cast posts was 88±64 (front teeth), 93±78 (premolar teeth), and 133±91 (molar teeth) (unit: second), and the removal time classified by part was not significantly different (Mann-Whitney U test, p≧0.05). Using a #1/2 or #1970 narrow carbide bar for FG might decrease tooth matter minimally. Furthermore, using the PR for removing cast posts is unlikely to cause root fracture, spontaneous pain, percussion pain, periodontal pocket deepening and tooth mobility after removal. In particular, percussion pain, periodontal pockets (probing pocket depth) and tooth mobility more than one month after removing cast posts were significantly improved compared with before removal (Wilcoxon signed rank test, p<0.05). These results indicated that cast restorations might be removed speedily, surely and safely (3S).

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