This article proposes a new method: the use of a small cast loop instead of the standard removal button on single units, which will provide a place for the secure attachment of a dental ligature.

The removal button. The removal button (sometimes called the "knock-off button") is a small projection of metal placed on the lingual or palatal aspect of a cast restoration. It conventionally is cast at the same time as the coping. Its ideal uses are the following:

– as a handle to aid the laboratory technician in the application and firing of porcelain;

– to provide a ledge or purchase point that the clinician can use for removing the restoration while performing fitting procedures;

– to aid in the removal of the restoration if it has been temporarily cemented in place.

Ideally, the removal button is placed a minimum of 1 to 2 millimeters occlusal to the free gingival margin for periodontal considerations, as well as to minimize tissue interference while the restoration is being fitted into place. Most commonly, however, the restoration is returned to the clinician with the removal button already removed and the restoration ready for insertion.

The removal loop: an alternative to the button. As an alternative to the removal button, I propose the fabrication of a removal loop. Such a loop (Figure 1) will provide the technician and clinician with all of the advantages of the removal button, plus the added advantage of being able to attach dental ligature (Figure 2) to the restorative unit, thus reducing the possibility of the patient’s aspirating or swallowing the restoration. The main benefit of the ability to attach ligature is the retrieval of the restoration should it fall into the oropharynx.

View larger version (95K): [in this window] [in a new window]   Figure 1. Single-unit porcelain-fused-to-metal restoration with removal loop on master cast.

View larger version (108K): [in this window] [in a new window]   Figure 2. Single-unit porcelain-fused-to-metal restoration fitted in place with ligature affixed for prevention of aspiration or swallowing.

– ease of use;

– provision of a point of attachment for dental ligature;

– reduced chances of the patient’s aspirating the restoration;

– a larger purchase point for removal of the restoration during fitting should it become lodged between teeth with areas of excessively heavy contact.

Fabricating the removal loop. Manufactured patterns of loops are available commercially. Many laboratories have precision or semiprecision loop attachments available. Generally, preformed wax patterns or precision attachment loops will be much too large for this application, either interfering with periodontal health or compromising the lingual/palatal esthetics of the porcelain. Therefore, their use is not recommended; rather, the clinician should request that the technician use a small piece of sprue wax.

Placement of the removal loop. It is notable that removal buttons or loops are placed on the lingual or palatal aspect; because of esthetic concerns, they are placed on the facial/buccal aspect only rarely. The only instance in which buccal placement of a removal loop may be indicated would be for a patient who has an extreme occlusal scheme and arch malformation.

Making necessary adjustments. Should the clinician decide to cement the restorative unit in place temporarily, he or she should reduce the loop to a small conventional removal button and then use it in the usual manner. The clinician must verify that neither the loop nor the button interferes with periodontal health or irritates the soft tissues of the mouth, including the tongue. The only disadvantage of using a removal loop is that it may be more time-consuming to reduce the larger amount of metal and to carry out the subsequent polishing procedures required.

CONCLUSION
This article describes the use of a removal loop, rather than the usual removal button, to reduce the possibility of a patient’s aspiration of a dental restoration. This loop aids in restoration placement and removal and is easy to fabricate.

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