13. Dls Flashcards
done right after tooth preparation to accurately copy the tooth preparation
TISSUE MANAGEMENT
upon taking the impression, rubber impression materials are used as they require low contamination of saliva or any other oral fluids
TISSUE MANAGEMENT
after the teeth are prepared and an interim restoration has been made, the health of the surrounding soft tissues is re-evaluated
TISSUE HEALTH
to avoid periodontal disease, formation of plaque and tartar, we cannot place the final restoration when there is ongoing tissue inflammation because tissue will progress to gingival recession and eventually there will be tooth mobility if periodontal disease is not treated
TISSUE HEALTH
prior to prosthodontic final restoration, we should be able to restore good health in the surrounding tissues so that it will not affect your final restoration
TISSUE HEALTH
periodontal disease must be treated and resolved before fixed prosthodontics treatment is initiated
TISSUE HEALTH
most effective method of moisture control
Rubber Dam
isolate a tooth in order to show the preparation
Rubber Dam
indicated when all margins are
supragingival
Rubber Dam
isolates teeth and prevent saliva/oral fluids from contaminating the operating field
Absorbent Cotton Rolls
→ also used together with the rubber dam
→ placed on areas where salivary ducts are located to absorb the saliva
produced
Absorbent Cotton Rolls
helps saliva control during impression making
Local Anesthesia
indicated when saliva control is especially difficult to achieve
Antisialagogue
What are the displacement of tissues?
MECHANICAL METHOD
CHEMICAL METHOD
CHEMICAL DISPLACEMENT
DISPLACEMENT CORD
→ widely used
→ most effectively achieved by placement of a cord (generally
impregnated with a chemical agent)
MECHANICAL METHOD
the cord is pushed into the sulcus and mechanically stretches the circumferential periodontal fibers
MECHANICAL METHOD
alternatively, foam or paste systems can be used, alongside with directed pressure
MECHANICAL METHOD
involves treatment of the string with one or more number of chemical compounds that will induce temporary shrinkage of the tissues and control the bleeding and fluid seepage
CHEMICAL METHOD
CHEMICAL METHOD
chemicals used along with retraction cords are classified as:
Vasoconstrictors
Astringents
Astringents
ferrous sulfate & ferric chloride
Vasoconstrictors
epinephrine
sulci can be enlarged better with a chemically impregnated cord or a cord dipped in an astringent (ex.: Hemodent)
CHEMICAL DISPLACEMENT
these materials contain aluminum or iron salts and cause transient ischemia and shrinking of the gingival tissue
CHEMICAL DISPLACEMENT
Advantages
Good tissue displacement Minimal tissue loss
Good hemostasis
Epinephrine
Disadvantages
Systemic reactions of patients with cardiovascular issues (uncontrolled blood pressure may cause excessive bleeding) Epinephrine syndrome
Epinephrine
Advantages
Minimal tissue loss
Extended working time
Alum
Disadvantages
Less hemostasis & tissue displacement
Alum Disadvantages
Advantages
Minimal tissue loss
Good hemostasis
Aluminum chloride
Disadvantages
Local tissue destruction
Aluminum chloride
Advantages
Compatible with aluminum chloride
Good displacement
Ferric sulfate
Disadvantages
Non-compatible with epinephrine
Tissue discoloration
Ferric sulfate
Advantages
Good tissue response
Tannic acid
Disadvantages
Less displacement
Minimal hemostasis
Tannic acid
even so, on cord removal, the sulcus closes quickly (less than 30 seconds)
DISPLACEMENT CORD
work fast and take advantage of the exposure of the shoulder
DISPLACEMENT CORD
some astringent solution can expand the sulcus
DISPLACEMENT CORD
therefore, the impression must be made immediately
DISPLACEMENT CORD
SURGICAL METHODS are?
ELECTROSURGERY
SOFT TISSUE LASER
ROTARY GINGIVAL CURETTAGE
electric cutting machine (also used in dermatological field)
ELECTROSURGERY
denotes surgical reduction of sulcular epithelium using an
electrode to produce gingival retraction
ELECTROSURGERY
CONTRAINDICATIONS
→ patients with cardiac pacemaker
→ patients with delayed wound healing
o refer patient to hematologist → patients on steroid therapy
o need to have medical clearance prior to performing dental procedures
→ in the recently irradiated area
ELECTROSURGERY
Advantages
→ clear operating areas without or no bleeding
→ healing by primary intention
→ less tissue loss after healing
ELECTROSURGERY
Disadvantages
→ unpleasant odor
→ slight loss of crestal bone
→ burn mark on the root
surface
→ not suitable for thin gingiva
ELECTROSURGERY
also useful for tissue contouring procedures
SOFT TISSUE LASER
enable predictable removal of tissue by creating a trough
around the prepared tooth
SOFT TISSUE LASER
→ quite expensive
→ advanced technology
SOFT TISSUE LASER
Advantages
→ minimum pain or discomfort
→ minimum or no anesthesia
→ lesser chair time
→ reduced postoperative
complications
SOFT TISSUE LASER
Disadvantages
→ overuse causes shrinkage of tissue and results in exposure of crown margin
→ quite expensive
SOFT TISSUE LASER
technique of using rotary diamond instruments to enlarge the sulcus
ROTARY GINGIVAL CURETTAGE
it involves preparation of the tooth subgingivally while simultaneously curetting the inner lining of the gingival sulcus
ROTARY GINGIVAL CURETTAGE
be careful in manipulating because you might cut the crest since
the crest is where you hide the junction of your prosthesis and
tooth surface
ROTARY GINGIVAL CURETTAGE
the goal is to eliminate the trauma from pressure packing and
the need for electrosurgical procedures
ROTARY GINGIVAL CURETTAGE
chemomechanical:
o using retraction cord and epinephrine or different astringent solutions
ROTARY GINGIVAL CURETTAGE
indicated in patients with a gummy smile whose gingival architecture and biotype could result in recession with more aggressive retraction methods
SINGLE CORD
“gummy smile”: patients whose gums are seen when smiling
SINGLE CORD
indicated in patients with shallow sulcus due to reduced biologic width
SINGLE CORD
the resultant recession could have significant aesthetic consequences
→ be careful when manipulating the gingiva
SINGLE CORD
0
big
00
smaller
000
smallest
used in cases wherein multiple tooth preparations is done
DOUBLE CORD
indications:
o impression of multiple prepared teeth
o when tissue health is compromised
o excess gingival fluid exudates
DOUBLE CORD
CLASSIFICATION OF RETRACTION CORDS
Configuration
Surface Finish
Chemical Treatment
Number of Strands
Surface Texture
Thickness
→ knitted
→ braided
→ twisted
Configuration
→ waxed
→ unwaxed
Surface Finish
→ impregnated
→ plain
Chemical Treatment
→ single
→ double-string
Number of Strands
→ wet
→ dry
Surface Texture
→ 000,00,0,1,2,3
Thickness
interlocking loops
KNITTED
longitudinally
KNITTED
→ elastic
→ transversely resilient
KNITTED
→ one of the best retraction cords used now
KNITTED
→ flexible
→ multistrand
BRAIDED
→ does not separate when inserted into the sulcus
→ easy to use
→ also good to use
BRAIDED
allows the dentist to customize the cord as individual strands can be removed
TWISTED
→ common in cheaper brands
→ easily dislodge in the sulcus
→ does not stay
TWISTED
→ use of epinephrine or stringent solution
A. Impregnated
B. Plain
A
no chemical incorporated in retraction cord
A. Impregnated
B. Plain
B
000
Color?
Black
Color?
00
Yellow
Color?
O
Purple
Color?
1
Blue
Color?
2
Green
Color?
Red
3
Advantages
→ asset during tooth preparation as it exposes the finish line
→ excellent impressions are obtained due to fluid control
RUBBER DAM
Disadvantages
→ useful only when limited number of teeth in one quadrant are being restored
→ used in simple preparations with minimal subgingival preparations
RUBBER DAM
without the technology of retraction cords, this was mainly used in the 1900s
COPPER BRAND IMPRESSION
→ utilized to retract or expose margins
→ for placement of the impression material
COPPER BRAND IMPRESSION
Advantages
→ good method to confirm gingival margins (ex.: in multiple abutments)
→ easy to cut and manipulate
→ easy to bend
COPPER BRAND IMPRESSION
Disadvantages
→ incisional injuries to the gingival tissues
→ excess pressure tends to stipple the tissues from the tooth
COPPER BRAND IMPRESSION
In SINGLE CORD TECHNIQUE
Placement of the cord begins by
pushing it in the sulcus on the
_____ surface of the tooth
mesial
In SINGLE CORD TECHNIQUE
It should be tucked into the
______ to hold the cord
in place. Be sure to surround
the specific tooth without
contamination of saliva
distal crevice
In DOUBLE CORD TECHNIQUE
An initial (____) cord is trimmed and placed so that it’s ends
do not overlap.
thin
In DOUBLE CORD TECHNIQUE
A second (___) cord is then saturated with astringent,
placed in the normal manner, and removed after several
minutes.
thicker
