1. Tissue Management I Flashcards

1
Q

What are some common issues seen in crown impressions

A
  • voids on finishlines
  • tears
  • partial set streaks of impression material
  • debris
  • impression separation from the try
  • incomplete recording of all necessary teeth
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2
Q

What should you as a patient coming in for a crown impression before administering local anesthesia

A
  • Is the provisional secure?

- Tooth asymptomatic?

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3
Q

What are the benefits of administering LA for crown impression

A
  • Patient comfort

- Reduces salivary flow

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4
Q

Why does LA reduce salivary flow

A

-Increased discomfort leads to increased saliva

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5
Q

When removing a provisional FDP where should the hemostat be placed

A

alternating at each connector.

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6
Q

What should you look at after removing the provisional

A
  • Adequate tooth prep (correct reductions- centric and eccentric)
  • Distinct regular continuous finishline
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7
Q

What are the three pre-requisites for a successful impression

A
  • Gingival health
  • Saliva control
  • Displacement of the gingival tissues
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8
Q

Cement can be removed from the prepped tooth with

A

explorer

prophy cup with pumice

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9
Q

Why is saliva control important for impressions

A
  • Impression materials are hydrophobic (blood and saliva produce voids, bubbles, and distortions)
  • Increases visibility for cord placement
  • Increased efficacy of cord chemicals
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10
Q

What is the most common method of saliva control? How else can saliva control be achieved?

A

mechanical (cotton rolls, dry angles, saliva ejector, Svedopter)…. pharmacologic

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11
Q

Use of LS (increases/decreases) salivation

A

decreases

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12
Q

What two pharmacologic classes of drugs can be used for saliva control

A
  • Anticholinergic drugs

- Antihypertensives

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13
Q

Anticholinergic drugs used to reduce salivation are? Antihypertensives?

A

Anticholinergic

  • Atropine sulfate
  • Pro-Banthine
  • Dicyclomine
  • Propantheline

Antihypertensives
-Clonidine

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14
Q

Contraindications for anticholinergic and antihypertensive drugs

A

Anticholinergic

  • Heart disease
  • Glaucoma

Antihypertensive
-None (But caution with patients using antihypertensive meds)

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15
Q

Why are anticholinergics contraindicated in people with gluacoma

A

causes permanent blindness

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16
Q

What are the goals of gingival management

A
  • Displace gingival tissues (make room for impression material to access margin)
  • Control hemorrhage (hydrophobic materials)
  • Control sulcular fluid (hydrophobic materials)
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17
Q

What are the three different methods of gingival management

A
  • Mechanical
  • Chemomechanical
  • Surgical (electrosurgery or laser)
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18
Q

What is the most common form of mechanical retraction? Less popular alternative

A

retraction cords Less popular alternative are the displacement pastes

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19
Q

Displacement pates contain what chemical

A

aluminum chloride

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20
Q

Which has a longer healing time (scalpel/electrosurgery/laser)

A

scalpel

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21
Q

What is the disadvantage of electrosurgery

A

potential for gingival recession

22
Q

What is the advantage of electrosurgery

A

control hemorrhage

23
Q

Electrosurgery is contraindicated in what patients

A

ones with electronic medical devices

-i.e pacemaker

24
Q

What area of the mouth is typically not good for electrosurgery due to thin keratinized gingiva

A

labial surface of the maxillary canine

25
Q

Describe the instruments you should use with electrosurgery

A

plastic (mirrors and evacuation tubes)- could cause an electric shock

26
Q

Soft tissue anesthesia with electrosurgery (is/is not) required

A

is

27
Q

What electrode for electrosurgery is best suited for sulcular enlargement

A

thin wire

28
Q

Loop electrode for electrosurgery is used for

A

gingival recontouring

29
Q

The electrosurgery machine should be on what setting when in use

A

unmodulated alternating current mode

30
Q

How do you know if the current on an electrosurgery is too low/high

A
low= if the tip is dragging 
high= sparking is visible in the tissue
31
Q

A cutting stroke with electrosurgery shouldn’t be repeated within _sec

A

5

32
Q

If the electrode contacts a metalic restoration what can happen

A

contact as long as 0.4 sec can lead to irreversible pulpal damage

33
Q

The sulcus should be irrigated with _ before the displacement cord is placed

A

hydrogen peroxide

34
Q

Anesthesia (is/is not) needed for soft tissue laser

A

is not

35
Q

Astringents can lead to _

A

transient ischemia and gingiva shrinkage

36
Q

Tissues collapse as quickly as _ sec after cord removal

A

30 sec

37
Q

What are the three types of retraction cords

A
  • Knitted*
  • Braided *
  • Twisted
38
Q

What are the two classes of chemical agents used for chemomechanical gingival retraction

A
  • vasoconstrictors

- astringents

39
Q

Compare and contrast knitted v.s braided cords

A

Knitted

  • May collapse in sulcus
  • Cord will shear when in contact with handpeice (better) – important if the cord is being used when refining the finishline

Braided

  • Doesn’t collapse in the sulcus (no memory– better tissue displacement)
  • Claimed better fluid absorotion
  • Claimed easier to pack
  • Cord will grab on bur and come out
40
Q

Braided cords are impregnated with

A

aluminum chloride (10%)

41
Q

Sizes of knitted and braided cords

A

Knitted

  • 000
  • 00
  • 0

Braided

  • 0a
  • 1a
  • 2a
42
Q

t/s aluminum chloride is a vasoconstrictor

A

f it is an astringent

43
Q

What are the three astringents and one vasoconstrictor

A

Vasoconstrictor
-Epi

Astringent

  • Potassium aluminum sulfate (ALUM)
  • Aluminum chloride (hemodent)
  • Ferric Sulfate (Viscostat, Astringident)
44
Q

Contraindications for epi use in tissue management

A
  • History of CVD
  • Hyperthyroidism
  • Allergy to epi
45
Q

1 inch of cord with 1.0mg of epi contains 2.5x the max dose
for healthy patients and 12x the dose recommended for
cardiac patients

A

ok

46
Q

Sign of epinephrine syndrome

A
  • Tachycardia
  • Increase respiration rate
  • Nervousness
  • Increase BP
  • Post op depression
47
Q

What % epi should be used when packing cord

A

0.1% (NOT 8%)

48
Q

Astringents stop blood flow how

A

coagulation

49
Q

Viscostat and hemodent are (acidic/basic)

A

acidic

50
Q

What are the implications of acidity of hemodent and viscostat

A
  • Decalcification of tooth (sensitivity)

- Removal of smear layer (affects adhesion to tooth if done right before cementation)

51
Q

How to minimize the deleterious effects of the acidity of hemodent/viscostat

A
  • Minimize contact with tooth
  • Min. application time
  • Before cementation clean tooth well with pumic and consider desensitizer