Fluid Control

Question 1

• Controlling water and saliva during tooth preparation
• Too much water – you can’t see and patient is drowning
• Too little water – you can heat tooth and cause pulpal necrosis

Answer 1

Fluid Control

Question 2

Saliva and crevicular fluid management is crucial for making a quality
impression and for proper cementation
-Soft tissue management, such as gingival displacement, is important for
the preparation, impression, and cementation.

Answer 2

Gingival Control

Question 3

Managed with lasers, Electrosurge, or a scalpel to re-contour the
gingiva as well as move or remove it from the operative environment.

Answer 3

Soft tissue management

Question 4

Uses for \_\_\_\_\_\_\_:
-Still the gold standard for isolation and 
moisture control
-Caries, O&R, removing old restorations
-Placing a Core
-During Post and Core procedures
-When tissue retraction is difficult 
(hypertrophied tissue or a pseudopocket)

Answer 4

Rubber Dam

Question 5

_______ can be used during
preparation and cementation of
Inlays and Onlays.

-provides necessary
isolation for resin cement
procedures.

-used during
preparation for Inlay/Onlay.
Then, it is removed to check
occlusion and clearance.

Answer 5

Rubber Dam

Question 6

Primary way to manage fluid during

preparations is with ________

Answer 6

high speed suction

Question 7

Isolates both Max and Mand at the same time.
Retracts tongue and cheek
Continually aspirates fluids and oral debris
Obturates throat – prevents aspiration of material
**Used in clinics at UMKC

Answer 7

Isovac and Isolite

Question 8

T/F: Medications can be used to reduce saliva (anti-sialagogues)

Answer 8

True

Question 9

-Decreases stomach acid and other secretions
including saliva
-Contraindicated in patients with heart disease /
glaucoma/ asthma

Answer 9

GI Anticholinergics (Robinul / Pro-Banthine)

Question 10

-Safer that anticholinergics but have side effects like
sedation, blurred vision, allergic reactions
-Caution for hypertensive patients.

Answer 10

Clonidine (anti-hypertensive drug)

Question 11

________ is critical in the preparation and

design process of a crown or bridge.

Answer 11

Periodontal health

Question 12

Poorly contoured restorations are responsible for 
\_\_\_\_\_\_\_ reactions:
-Roughness and porosity of materials
-Inaccessibility for patient OH
-Lack of patient OH
-Defective crown margins
-Invasion of biological width

Answer 12

inflammatory

Question 13

________ for two weeks prior to crown
preparation can be useful in more significant
inflammation situations.

Answer 13

Chlorhexidine 0.12%

Question 14

Crown Finish line ideally no deeper than _____ the depth of the sulcus.
-Usually ___-____mm sub gingival

Answer 14

half
the depth
0.5 – 1.0

Question 15

______ gingiva– More
susceptible to damage and
recession.

Answer 15

Thin, scalloped

Question 16

Rapid marginal recession may occur as
soon as __ weeks. (results in
unpredictable tissue levels).

Answer 16

2 weeks

Question 17

These all cause ______

• Damage during tooth preparation
• Over contoured provisional
• Over contoured final crowns
• Injury caused by cord packing
• Poor OH resulting in inflammation

Answer 17

Poor gingival control causing inflammation

Question 18

Tissue displacement must be _____.

Answer 18

gentle

Question 19

Purpose of _______ –

• To Displace the Gingiva for margin exposure
• As a cutting guide during tooth preparation
• Tissue protection during margin placement
• Visualization of finish line
• Displacement of gingival tissue for impression
• When margin is at or below the gingival contour
• For impression and die trimming
• Control of crevicular fluids
• water, saliva, blood

Answer 19

Tissue Retraction

Question 20

Placement of \_\_\_\_\_\_ prior to 
preparation.
-Improves visibility
-Reduces tissue trauma
-Acts as a guide for margin placement

Answer 20

retraction cord

Question 21

T/F: Most often, begin with a rough
preparation supragingival to start. Then
pack cord. Proceed to finalization of
preparation and margin.

Answer 21

True

Question 22

_____ causes horizontal and vertical displacement of tissues to visualize the margin placement
Allows subgingival margins without significant damage to tissues
Can be left in place for final impression using 2 Cord technique
Aiming for no deeper than half the depth of the sulcus.

Answer 22

Cord

Question 23

Tissue covering subgingival margins must be
retracted or displaced horizontally by _______:
-Provides space for enough impression
material to record this anatomy.
-Removes fluids and anatomy to accurately
record the crown margins.
-Helps arrests heme
-Aid in cleanliness and dryness prior to
impression.

Answer 23

Packing Cord:

Question 24

_______ medicaments control crevicular fluids

and seepage

Answer 24

Hemostatic

Question 25

Retraction Cord soaked in \_\_\_\_\_\_
Advantages:
-Can be kind to tissues
-Sulcus not overly harmed and left clean
-No additional tissue loss
Disadvantages:
-Extra epinephrine systemically for patient.

Answer 25

Epinephrine

Question 26

\_\_\_\_\_\_ are substances that cause constriction of soft tissues. They have a massive use in 
bleeding control in various dental procedures such as impression making in fixed prosthodontics, 
class V restorations and root surface restorations, etc.

Answer 26

Astringents

Question 27

What astringent do we use?

Answer 27

Aluminum chloride

Question 28

Advantages:
-Moderate hemostasis and tissue shrinkage
-Precipitates protein
-Contracts blood vessels
-Extracts fluid from tissues
-Leaves sulcus clean
-Sulcus not overly harmed
-Does not inhibit PVS polymerization
Disadvantages:
-Nasty taste

Answer 28

Buffered aluminum chloride

Question 29

Advantages:
-Stypic (clotting agent)
-Applied to cut tissue for best hemostasis
Disadvantages:
-Leaves a dark residue (esthetic issue)
-Causes dentin discoloration (delayed)
-don’t use with veneers or esthetic 
anterior cases.
-Inhibits setting of PVS impression materials
-leads to inaccurate impressions
Dentin darkening

Answer 29

Ferric Sulfate (15%) Astringedent

Question 30

Which astrigent is used for fixed prosthodontics?

Answer 30

Aluminum chloride

Question 31

:Possible high acidity of gingival retraction fluids (GRFs) and the high
affinity of iron for hard tooth tissues, resulting in an interaction with
bacterial byproducts and precipitation of insoluble ferric sulfide in
the porous demineralized dentin.

Answer 31

Dentin Darkening

Question 32

Provide adequate thickness of impression material and access to the
preparation margin.
Reduces tears and distortions of impression material
Sulcus is opened in a cone shape

Answer 32

Retraction cord

Question 33

-Use of single cord for entire circumference
-In deeper sulcus, a second cord could be
used in select area
-Remove all cords for impression
-Best used in shallow sulcus

Answer 33

Single Cord Technique

Question 34

_______ Technique
-#000 or #00 pre-packed into sulcus.
-Second cord placed over the top of existing cord
-For impression, top cord is removed. Second cord
(lower, smaller cord is left in place for the
impression).
-If smaller cord is picked up in impression, it is cut off
prior to pouring up in stone
-Remember – must remove first cord after impression
and before patient goes home! Severe
inflammation and pain can occur.
-This technique is considered the gold
standard for impression taking. All other
techniques are compared to this.

Answer 34

Double Cord

Question 35

Should local anesthetic used in tissue retraciton?

Answer 35

Yes:
Patient comfort
Aids in heme and salivary flow reduction

Question 36

SHould you pack cord at a straight up and down angle?

Answer 36

No; 45 degree angle

Question 37

Packing _____ starting point will keep cord in place3-5 minutes.

Answer 37

toward

Question 38

Allow cord to sit and be isolated (dry and heme free) for how long?

Answer 38

3-5 minutes.

Question 39

-Burns tissue away
-Burnt tissue odor
-Cauterizes (no bleeding after)
-Tissues heal quickly
-Predictability of final tissue contour or location is
unpredictable
-Inexpensive! (maybe $500 versus $5,000 for laser)
-Easy to use

Answer 39

Electrosurge

Question 40

Vaporizes tissue
”Cut” around the tooth is usually ragged
Laser can be slow to cut. Best for fine detail work. If there
is a lot of tissue to contour or remove, use Electrosurge.
Hemorrhage is not a problem
Tissue heals well
Laser available in UMKC Clinic

Answer 40

Laser

Question 41

Intentional use of a handpiece to remove excess gingiva
Hemorage can be a problem here
Tissues will heal, but may have some discomfort to patient
Healing contour and levels is unpredictable
Final impression not likely to happen same day. Patient
will have to come back for assessment of healing
results and of tooth preparation and impression.

Answer 41

Rotary