Management Of Soft Tissues In Dentistry Flashcards
Maintenance periodontal care?
Check compliance to OHI
Simple professional cleaning at each available opportunity
Smoking cessation advice
Moniter in and maintenance scaling
In summary for gingival health and restorative care
Avoid placing restorations when gingivitis is present
Temporise and treat the gingivitis first
Remove excess
Polish all fillings
Institute adequate maintenance care
Important safety features
Remove all flammable liquids, objects, gases away from the patient- fire risk!
Do NOT use the unit within 20 metres of a patient with a cardiac pacemaker
Never use metal instruments in the mouth- retract soft tissues with a plastic mirror-risk of burning the patient if accidental contact of electrode with the instrument, in contact with the tissues.
ALWAYS connect the ground electrode as it minimises the above risks- not placed directly over the skin, large surface area of contact, no intervening metal keys, change, bra strap etc.
If not above then negligent…
Use of electrosurgical unit?…
Choose appropriate electrode shape, insert into handpiece
Choose hand or foot control
Place ground electrode under the patient’s back, connect the unit to complete the circuit
Select the operation mode, if appropriate to the machine
Ensure adequate anaesthesia and written consent
Gingiva cut should be moist- too dry causes charring, too moist causes inefficient cutting
Retract the cheek, the tongue, well out of reach- NO METALLIC INSTRUMENTS IN THE MOUTH
Assistant aspirates with a wide bore plastic aspirator tip to remove unpleasant odours
Before cutting, practice movement of the electrode, smooth, uninterrupted movement- but too slow will cause excessive tissue damage
Clean the electrode between sweeps remembering to deactivate the handpiece during this
Electrode should pass easily through the tissues
Slow slow causes charring, too fast causes inefficient cutting and the electrode drags through the tissue
Final gingival contour should be easy to keep clean
The electrosurgical unit- frequency and waveform outputs?
Produces a high frequency current- 1.3-2.2 MHz- cutting electrode to patient to ground electrode to unit
Weaveform outputs are cutting and coagulation, coagulation, cutting (on some electrosurgical units only).
PerFect TCS tissue contouring system what are some of the features?
Swivel cord connector improves handling
Handpiece holder keeps handpiece within reach
Foot switch for hands free electrode activation
Autoclavable electrode sheaths for infection control
What is an example of an electrosurgical unit?
PerFect TCS tissue contouring system
What are some indications of electrosurgery?
Crown lengthening
To access subgingival caries, cavities
To remove localised hyper plastic fibrous gingiva
To control localised bleeding when recording impressions for crown and bridgework
What are some contraindications to electrosurgery?
Generalise poor OHI
Very narrow width of attached gingiva present
Patient receiving large dose of anticoagulants
If large amounts of tissue require removal
Electrosurgery can be use for…
Gingivoplasty- the reshaping of gum tissue around teeth
Gingivectomy- the removal of gum tissue or gingiva
Methods of retraction?
Gingival retraction cord and ViscoStat/Astringedent
Astringent retraction paste
Features of normal adult gingiva healthy
Coral pink in colour
•Usually stippled
•Physiological pigmentation
•Knife edge papilla
•Gingival contour thickness and height may be variable
•Marginal and attached gingiva form the gingival unit
•Gingival sulcus shallow
Histological features
•Epithelial attachment formed from reduced oral epithelium attaches gingival tissue to enamel
•Apical end of the junctional epithelium is attached at the cement enamel junction
•The most coronal periodontal ligament fibres are located immediately apical to it
Alveolar bone margin is usually located
1-2mm away from the CEJ
Gingivitis and periodontitis?
Gingivitis is reversible and related to plaque accumulation
Periodontitis involves loss of connective tissue attachment
