1. Tissue Management I Flashcards
Before starting the impression what should you do first (3 things)
Ask the patient
- Secure provisional?
- Tooth aysmptomatic?
Administer LA
Benefits of administering LA before impression
- Patient comfort
- Reduced salivary flow
- Reduced bleeding
Why does LA contribute to less saliva flow
Pain increases saliva flow (less pain less saliva)
When removing an RDP provisional the hemostat should be placed where
at the connector- should alternate from one connector to the other
After removing the pateint’s temp and before the impression you should consider what
- Is the tooth prep adequate
- (Correct reductions and distinct finishline)
Pre-reqs for a good impression are (3 things)
- Gingival health
- Saliva control
- Displacement of gingiva
Reasons to make a well fitting temp
- Maintain tooth comfort
- Maintain gingival health and position
If you are going to take an impression and the patients tissues are inflammed you should
- Reinforce OHI
- Perscribe chlorhexidine (1 week)
Chlorhexidine shouldn’t be used for more than how long
10 days
What are the reasons these issues occur with temps
- Cement washout
- Debris collection
- -Cement washout=Poor fit
- Debris collection=Rough surface
Cement can be removed from the tooth with
Explorer
Prophy cup and pumice
Impression materials for crown and bridge are (hydrophilic/hydrophobic)
hydrophobic
Blood and saliva lead to what issues with impression
- Bubbles
- Voids
- Distortions
- Dilution of cord chemicals
What is the most common saliva control method (mechanical/pharmacologic)
mechanical (saliva ejector, cotton rolls, dri-angles, etc.)
What are the two pharacologic categories of anti-sialogogue meds
- Anticholinergic meds
- Antihypertensive meds
Give examples of anticholinergic and antihypertensive meds
Anticholinergic
-Atropine sulfate
-Pro-banthine
(Also dicyclomine and propantheline)
Antihypertension
-Clonodine
Contraindications for anticholinergic and antihypertensive meds
Anticholinergic
- Heart disease
- Glaucoma
Antihypertensive
- No specific contraindications
- Caution in patients using hypertensive meds
What are anti-cholinergic drugs contraindicated in people with glaucoma
can lead to permanent blindness (prevalence of undiagnosed gluacoma in the population is high and come physicians suggest that all patients be evaluated opthalmologically before anticholinergics are used)
What are the three categories of gingival managment
- Mechanical
- Chemomechanical
- Surgical (electrosurgery or laser)
What are the two forms of mechanical gingival retraction
- Rectraction cords (most common)
- Displacement paste
Describe displacement paste
- Contains AlCl3
- Less effective retraction compared to cords
What are the advantages of electrosurgery over surgical gingivectomy with a scalpel
- Less discomfort
- Less bleeding
Disadvantages of electrosurgery
- Can cause recession
- Contraindicated in patients with electronic medical devices (i.e pacemaker)
- Not suitable on thin attached gingiva
What types of instruments (i.e mirrors) should be used with electrosurgery
plastic (metal –> electric shock)
_Electrode is best for sulcular enlargement and _ is best for gingival contouring
Thin wire…loop
T/F anesthesia is not required for electrosurgery
f
What mode should the electrosurgery machine be set to
unmodulated alternating current
How do you know is the instrument setting is too high and too low
too high= sparking
too low= tip will drag
Cutting strokes shouldn’t be repeated within _sec of each other
5
Contact with metal restorations greater than 0.4 sec has ben shown to cause what in dogs
irreversible pulpitis
After electrosurgery and before the cords are place the sulcus should be irrigated with
hydrogen peroxide
Advantages of soft tissue laser for gingival displacement
- No anesthesia needed
- Achieves tissue ablation and hemostasis
- Favorable tissue healing
Astringent causes what to the gingival tissues
- Transient ischemia
- Shrinkage of gingival tissues
Tissues start to relapse as quick as _ sec after cord removal
30
What are the three types of retraction cords
- Twisted
- Knitted
- Braided
Compared knitted and braided cords
Knitted
- May collapse in sulcus
- Shear when hit with handpeice (better
Braided
- Doesn’t collapse in sulcus (no memory) –> better displacement
- Better fluid absorption
- Easier to apck
- Cord grabs on to but and comes out
The smallest and largest sizes of knitted and braided cords are
Knitted
- Smallest= 000
- Largest= 0
Braided
- Smallest= 0
- Largest= 2
Braided cords are impregnated with
aluminum potassium sulfate
Braided cords shouldnt be combined with what astringent and why
ferric sulfate —> staining
T/F Epinephrine is the more potent astringent
F- epi is not and astringent it is a vasoconstrictor
Hemodent –>
Viscostat –>
Astringident –>
Viscostat clear –>
Hemodent –> Aluminum chloride
Viscostat –> Ferric Sulfate
Astringident –> Ferric sulfate
Viscostat clear –> aluminum chloride
Contraindications for epi use in the cord
- History of cardiovascular disease
- Hyperthyroidism
- Allergy to epinephrine
Signs of epinephrine syndrome
- Tachycardia
- Increased respiration rate
- Nervousness
- Increased BP
- Post op depression
Conc of epi to use in cords is
0.1%
Astringents constrict blood flow through what mechanism
coagulation
pH of viscostat is? hemodent?
both are acidic
Implications of acidity of viscostat and hemodent
- Decalcification of tooth structure –> sensitivity
- Removal of smear layer –> affects adhesion to tooth if done right before cementation
Recommendations to reduce the implications of the acidity of astringents
- Minimize contact with tooth
- Minimize application time
- Before cementation clean the tooth with pumice and consider use of desensitizer
