FLUID CONTROL AND SOFT TISSUE MANAGEMENT.pptx

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1. FLUID CONTROL AND SOFT TISSUE MANAGEMENT

2. NEED Patient comfort Patient safety Operator’s access Clear visibility Removal of saliva & water during instrumentation.

3. FLUID CONTROL During preparation of teeth During impression making During cementation

4. Rubber Dam : Most effective for restorative dentistry Mainly for inlays & onlays Care taken with vinyl gloves 2 .High – volume vacuum : Excellent retractor During preparation phase with the assistant Not practical during impression &cementation

5. Saliva ejector Svedopter Vacuum tip Vacuum tip saliva ejector

6. 3.Saliva ejector : Most useful as an adjunct to high- volume evacuation Used for maxillary arch Place in the corner of the mouth opposite quadrant Can be used for mandibular arch along with cotton rolls

7. The svedopter 4.Svedopter : For isolation & evacuation of mandibular teeth Effective when the patient is sitting upright Excellent for lone operator Care must be taken to avoid tissue bruising Mandibular tori – avoid this

8. Pt.sitting upright , fluids collect on the floor of the mouth where they are easily picked by svedopter

9. 5. Anti sialagogues : When no mechanical device is effective.. Excessively salivating patients.. Drugs like - Methantheline Bromide ( Banthine ) – 50mg ( Anticholinergics ) - Propantheline Bromide (Pro- Banthine ) - 15mg Side effects : drowsiness, blurred vision, unpleasant bitter aftertaste.

10. Contraindicated : -history of hypersensitivity to drugs -eye problems like glaucoma, - asthma, - obstructive conditions of GIT, urinary tracts. - congestive heart failure, lactating females. Potentiated by : antihistamines, tranquilizers, narcotics corticosteroids. Can be given intraorally 10 -15 min prior, acts for 1.5hrs. Other drugs : clonidine hydrochloride -0.2mg 1hr before. Side effects :dry mouth, drowsiness, Dryness of eye

11. Finish Line should be exposed- During preparation of teeth During impression making During cementation

12. FINISH LINE EXPOSURE Three techniques : Mechanical Chemico mechanical. Surgical.

13. FINISH LINE EXPOSURE 1.Mechanical : Copper band or tube ,rubber dam. Displaces gingiva to ensure exposure of gingival finish line Impression materials – impression compound, elastomeric impression material.

14. FINISH LINE EXPOSURE 1.Mechanical : Tube is festooned or trimmed to follow the profile of the gingival finish line which in turn follows free gingival margin. Tube is filed with impression compound, and seated carefully along path of insertion of tooth preparartion

15. 2. Chemicomechanical (retraction cord) : It can be defined as the process of deflection of the marginal gingiva in the apical direction and away from tooth. Gingival retraction cords : Non Impregnated: Available as: Braided Twisted Flattened Knitted. Pre Impregnated: They may be supplied as already impregnated with chemical.

16. Gingival retraction cords : Available in Sizes - 000, 00, 0, 1, 2, 3 -Indications- Smaller diameter Cord are used in anteriors where the sulcus depth is less. -Larger Diameter Cord are used in posterios as the sulcus depth is wide

17. Methods: Single cord technique Double cord technique

18. 2. Chemico mechanical ( pre imprignated retraction cord) : By combining chemical action with pressure packing, enlargement of the gingival sulcus as well as control of fluids. Chemicals like : VASOCONSTRICTOR : 0.1 % to 0.8% EPINEPHRINE. BIOLOGIC FLUID COAGULANTS : 100 % alum solution ( potassium aluminium sulphate ) 15 % to 25 % aluminium chloride solution 13.3 % ferric sulphate solution 15-25 % titanium acid solution 3 . SURFACE LAYER TISSUE COAGULANTS : 8 % & 40 % zinc chloride solution

19. Three criteria- effective gingival displacement & hemostasis - no damage to gingival tissues - no systemic untoward effects Epinephrine Causes : elevation of blood pressure, heart rate. ( more for lacerated gingiva) Not to be used : 1) Patients with CVS problems, hypertension, diabetes, hyperthyroidism, known hypersensitivity to epinephrine.

20. 2) Patients taking rauwolfia compounds, ganglionic blockers, epinephrine-potentiating drugs. 3) Patients taking Monoamino Oxidase Inhibitors for depression. Epinephrine syndrome : tachycardia, rapid respiration, elevated blood pressure, anxiety, postoperative depression. Nasal and ophthalmic decongestants- as gingival retraction agents

21. Cord Packer

22. The Instrument must be angled slightly towards the root to facilitate the subgingival placement of the Cord.

23. The Instrument is held parallel to the long axis of the tooth, the cord will be pushed against the wall of the gingival cervice , and it will be reduced.

24. Excess cord is cut off in the mesial interproximal area

25. Rotary curettage : ( troughing technique) Described by Amsterdam in 1954. Limited removal of the epithelial tissue in the sulcus. Determined by factors – no bleeding on probing sulcus depth less than 3mm presence of adequate attached gingiva

26. Must be done on healthy, inflammation-free gingival tissue to avoid tissue shrinkage. Torpedo shaped bur is used for the finish line. The shoulder finish line achieved before forms Chamfer and also simultaneously removes the epithelial lining.

27. Electro surgery : Described for removal of irritated tissue that has proliferated over the finish line. Recommended for enlargement of gingival sulcus and control of hemorrhage to facilitate impression making. Unquestionably capable of tissue damage It consist of high-frequency oscillatory transmitter that delivers high frequency electric current.

28. Called as surgical diathermy. Produces controlled tissue destruction of the cells adjacent to the electrode due to rise in the temperature.

29. Indications • In areas of inflamed gingival tissue, where it is impossible to use retraction cord. (Inflamed tissues give an exaggerated response to the procedure). • In cases with gingival proliferation around the prepared finish lines

30. Contraindications • Patient with cardiac pacemakers because the frequency of the electrical current in the electrode can interfere with the functioning of the pacemaker. • The use of topical anaesthetics such as ethylchloride and other inflammable aerosols should be avoided when electrosurgery is to be used.

31. Advantages • Sophisticated technique. • Can be done in cases with gingival inflammation. • Produces little to no bleeding. • Quick procedure. Disadvantages • Very technique sensitive. • Application of excessive pressure may produce severe tissue damage .

32. Electrosurgical electrodes An electrosurgical unit with active electrode (A) and ground electrode (B) Five commonly used electrosurgical electrodes: A—coagulating Prob; B—diamond loop; C—round loop; D—small straight; E—small loop; Note: A, B and C have straight shanks while D, and E have ‘J’ shaped shanks

33. Types of current : Unrectified damped current Partially rectified damped Fully rectified Fully rectified filtered.

34. Unrectified, damped current ( Oudin or Telsa Current): It is characterised by recurring peaks of power that rapidly diminishes. This type of current is produced in an old Hyfurcator or Spark gap generator . It produces intense lack of moisture (dehydration), necrosis and coagulation of the cells. It produces slow and painful healing, hence, it is avoided Unrectified damped current

35. Partially rectified, damped current (Half wave modulated): Here the current during the second half of each cycle is damped so that only the peak waves act on the electrode. It produces good coagulation and haemostasis . But it also produces slow and painful healing with considerable tissue destruction because the electrical flow is intermittent. Partially rectified, damped (half-wave modulated) current

36. Fully rectified current (Full wave modulated ): Here the frequency is similar to a partially rectified current but it is continuous. It produces adequate sulcus enlargement with good cutting characteristics along with good haemostasis. Fully rectified (full-wave modulated) current

37. Fully rectified, filtered current : Here the peak waves are repeated so that there is continuous flow without any dip. Lower frequency waves are filtered in this current. It produces excellent cutting. Hence it is the most preferred. Full rectified, filtered current

38. Recent techniques for gingival retraction LASERS: For gingival retraction Nd - YAG lasers are used. Advantage : Bloodless, painless incision. Controlled tissue removal. Rapid healing. Disadvantage: Slow technique. Expensive

39. MAGIC FOAM CORD SYSTEM: Magic FoamCord is a new non- hemostatic gingival retraction system by Coltène / Whaledent . Vinyl polysiloxane material Magic FoamCord material is syringed around the crown preparation margins and a cap ( Comprecap ) is placed to reportedly maintain pressure. After five minutes, the cap and foam are removed and the tooth is ready for the final impression.

40. RETRACTION BY DILATATION OF GINGIVAL SULCUS: 1.Gingifoam: 2 paste system: -Base paste: poly dimethyl siloxane . - Catalyst paste: Tin On mixing the two paste Hydrogen gas is formed resulting in formation of foam this foam cause retraction of gingiva. 2.Paste of aluminium chloride kaolin & water which is delivered using a gun directly into the gingival sulcus without any trays.

41. Conclusion: Healthy Soft tissues and the control of saliva are essential for a successful impression. Mechanical, chemical and surgical methods for enlargement of the gingival sulcus can be used to obtain access to subgingival margins of prepared teeth.