soft tissue management and the soft tissue of interest.pptx

Factors affecting soft tissue during various dental procedure

1. SOFT TISSUE MANAGEMENT

2. The soft tissue of interest IS Gingiva & Periodontium

3. Gingiva

4. Gingiva Marginal gingiva. Attached gingiva. Interdental Papilla.

5. Factors affecting soft tissue during various dental procedure Preparation Tissue Dilation & Impression Taking Final restorations

6. During Tooth Preparation

7. During Tissue Dilation & Impression Taking

8. One of the primary goals of the restorative dentist should be to accomplish the required procedure with a minimal degree of unintended alteration of the gingival tissue.

9. Tissue retraction Displacing the gingiva laterally, creating open, retracted sulcus that extends beyond the margins of the prepration to prevent soft tissue margin from collapsing onto the prepared tooth occluding access to the sulcular area.

10. Why Tissue retraction?

11. Purposes of Tissue Retraction Exposure & inspection of the subgingival finish line. Control of bleeding ( Hemostasis ). Acquire vertical &horizontal space for impression material within the gingival sulcus at the margin(1-2 mm apical to F.L.)

12. Retraction Technique Mechanical Chemico-Mechanical Surgical: Surgery Electro-surgery Rotary Curettage (Curettage With Stone While Cutting Preparation Finish Line) Laser

13. I. Mechanical displacement Copper band Used with impression compound and elastomeric impression materials. Uncomfortable method to the patients and the dentists.

14. Copper band

15. Mechanical displacement 2. Rubber dam .

16. Mechanical displacement 3 . Non-Impregnated cord

17. II. Chemico-mechanical displasment (Retraction cord impregnated with chemical) Combining the chemical action of hemostatic agents with a pressure packing of retraction cord in order to achieve enlargement of the gingival sulcus as well as control of fluid seeping from the walls of gingival sulcus

18. Chemico-mechanical displasment Ideal requirement of Hemostatic agents: Effectivness in gingival retraction & haemostasis . Absence of irrevesiable damage to gingiva . Systemically tolerant.

19. Drugs Used For Cord Retraction Epinephrine Alum (Aluminum potassium sulphate ) Ferric sulphate (15.5%). Aluminum chloride. Aluminum sulphate

20. Signs Of Epinephrine Reaction Increase in cardiac rate Increase in blood pressure Increase in respiration It become more dramatically if it is used on severly lacerated gingival tissue.

21. Limitation In Using Epinephrine Patients with cardiovascular diseas. Hyperthyrodism Hypertension Diabetes Patients with known hypersensitivity to epeniphrine

22. Epinephrine Syndrome Tachycardia Rapid respiration Elevated blood pressure Patient will appear nervous Patient may seem frightened Anexity & post operative depression

23. Hemostasis

24. Objectives Of Cord Placement Location of cord within crevice at or just below the finish line Avoidance of any trauma to tissue Placement of free end of cord for easy and quick removal

25. Selection Of A Recommended Cord Size

26. III. Surgical Displacement 1 -Surgical Technique: using gingivectomies Electro-surgery

27. Electro-surgery

28. Electro-surgery Uses : Troughing Gingivectomy Coagulation Disadvantages of using electrosurgery Need experienced hand Tendency of tissue recession after use

29. Delasco Electricator Accessories Electro-Surgery Limitations Precautions

30. IV. Rotary Curettage (Gingittage) Use of chamfered or torpedo-nosed diamond to remove epithelial tissue within healthy sulcus to expose subgingival finish line during its preparation.

31. IV. Rotary Curettage (Gingittage) Disadvantages: A slight deepening of the sulcus may result. Poor tactile sensation during instrumentation gives high potential for overextension & damage. Causes bleeding and post-operative discomfort .

32. V. Laser gingival displacement Removal of epithelial tissue using laser Diode & Nd;YAG laser through a fiberoptic light bundle which incise & cauterize tissue simultaneously creating hemostasis as well as retracted field. Advantages: Faster, more efficient, painless, more sterile, bloodless, less invasive & less painful postoperatively.

33. Lasers are commonly used for troughing. The top photo is immediately post-op, while the impression is shown below.

34. New Methods Of Tissue Retraction