Fluid Control Flashcards
- 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
Fluid Control
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.
Gingival Control
Managed with lasers, Electrosurge, or a scalpel to re-contour the
gingiva as well as move or remove it from the operative environment.
Soft tissue management
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)
Rubber Dam
_______ 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.
Rubber Dam
Primary way to manage fluid during
preparations is with ________
high speed suction
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
Isovac and Isolite
T/F: Medications can be used to reduce saliva (anti-sialagogues)
True
-Decreases stomach acid and other secretions
including saliva
-Contraindicated in patients with heart disease /
glaucoma/ asthma
GI Anticholinergics (Robinul / Pro-Banthine)
-Safer that anticholinergics but have side effects like
sedation, blurred vision, allergic reactions
-Caution for hypertensive patients.
Clonidine (anti-hypertensive drug)
________ is critical in the preparation and
design process of a crown or bridge.
Periodontal health
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
inflammatory
________ for two weeks prior to crown
preparation can be useful in more significant
inflammation situations.
Chlorhexidine 0.12%
Crown Finish line ideally no deeper than _____ the depth of the sulcus.
-Usually ___-____mm sub gingival
half
the depth
0.5 – 1.0
______ gingiva– More
susceptible to damage and
recession.
Thin, scalloped
Rapid marginal recession may occur as
soon as __ weeks. (results in
unpredictable tissue levels).
2 weeks
These all cause ______
- Damage during tooth preparation
- Over contoured provisional
- Over contoured final crowns
- Injury caused by cord packing
- Poor OH resulting in inflammation
Poor gingival control causing inflammation
Tissue displacement must be _____.
gentle
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
Tissue Retraction
Placement of \_\_\_\_\_\_ prior to preparation. -Improves visibility -Reduces tissue trauma -Acts as a guide for margin placement
retraction cord
T/F: Most often, begin with a rough
preparation supragingival to start. Then
pack cord. Proceed to finalization of
preparation and margin.
True
_____ 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.
Cord
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.
Packing Cord:
_______ medicaments control crevicular fluids
and seepage
Hemostatic
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.
Epinephrine
\_\_\_\_\_\_ 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.
Astringents
What astringent do we use?
Aluminum chloride
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
Buffered aluminum chloride
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
Ferric Sulfate (15%) Astringedent
Which astrigent is used for fixed prosthodontics?
Aluminum chloride
: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.
Dentin Darkening
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
Retraction cord
-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
Single Cord Technique
_______ 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.
Double Cord
Should local anesthetic used in tissue retraciton?
Yes:
Patient comfort
Aids in heme and salivary flow reduction
SHould you pack cord at a straight up and down angle?
No; 45 degree angle
Packing _____ starting point will keep cord in place3-5 minutes.
toward
Allow cord to sit and be isolated (dry and heme free) for how long?
3-5 minutes.
-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
Electrosurge
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
Laser
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.
Rotary
