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Fixed Prosthodontics > Soft Tissue Management > Flashcards

Soft Tissue Management Flashcards

1
Q

What should be done before the crown prep

A

Assess the periodontal stats and give OHI

Should complete any periodontal treatment required ± surgery to ensure a healthy periodontium

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2
Q

Why should we ensure that there is a healthy periodontium before the crown prep

A
  • Untreated gingivitis creates swollen, inflamed and loose gingival tissues
  • Can create difficulties when assessing and preparing the finish line you want, obtaining moisture control, reproducing the finish lines in the impression
  • Can result in suboptimal marginal crown fit and increase risk of further perio deterioration and caries
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3
Q

Why are sub-gingival preparations risky when doing a crown prep

A
  • Difficult to do and risks marginal leakage
  • Risks encroaching on the biological width leading to persistent gingival inflammation, alveolar bone loss and gingival recession
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4
Q

What can dictate more apically placed margins in crown prep

A
  • Deep extensive restorations or short clinical crown height
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5
Q

What can be done if more apically placed margins are indicated in crown prep

A

Surgical crown lengthening should be considered

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6
Q

When is soft tissue management required in the impression stage of crown preps

A

If some or all of the preparation finish line are at or are sub-gingival

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7
Q

Why is gingival retraction (soft tissue management) needed for sub gingival preparations in the impression stage

A
  • To prevent bleeding
  • to act as a physical barrier and retract the gingival tissues?
  • Allows an accurate impression of the preparation margins
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8
Q

What is the aim of the plain retraction cord method of soft tissue retraction

A

Sulcus enlargement to physically displace the gingivae away from the finish line

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9
Q

What is a disadvantage of the plain retraction cord method of soft tissue retraction

A

Sulcular haemorrhage (this method is quite shit)

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10
Q

Why can sulcular haemorrhage be problematic in the crown procedure

A

leads to moisture control difficulty and poor impression accuracy (impression materials are hydrophobic)

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11
Q

What is the aim of the copper band method of soft tissue retraction

A

To displace the gingivae and helps to carry the impression material to ensure the finish line is captured in the impression (this method is shit)

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12
Q

What are the disadvantages of the copper band method of soft tissue retraction

A
  • Traumatic
  • Not effective
  • Not accurate
    (method is shit)
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13
Q

What is the impregnated retraction cord method of soft tissue retraction

A
  • Retraction cord soaked in a chemical solution

- Then its the same as the plain retraction band method

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14
Q

What is the aim of the impregnated retraction cord method of soft tissue retraction and what is the benefit of the chemical action

A

Aim = enlarge the sulcus

Chemical action = control sulcular haemorrhage creating a more accurate impression of the preparation margins

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15
Q

What are the disadvantages of the impregnated retraction cord method of soft tissue retraction

A
  • Systemic side effects
  • Inflammation and tissue necrosis
  • Staining
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16
Q

What solutions are used in the impregnated retraction cord method of soft tissue retraction

A
  • Ferric Sulphate 15%
  • Alum AlK(SO4)3
  • Aluminium sulfate
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17
Q

What does the crown lengthening method of soft tissue retraction involve

A

Bone removal and gingival re-contouring

18
Q

What are the advantages of the crown lengthening method of soft tissue retraction

A
  • Increases the crown height and retention
  • create supra gingival margins
  • Improves aesthetics
19
Q

What are the disadvantages of the crown lengthening method of soft tissue retraction

A
  • Discomfort
  • Finish line on root surface cementum (bonding issues)
  • Furcation involvement (cleaning)
  • Increased crown:root ration
  • Need to allow time for healing
20
Q

What is the aim of the rotary curettage method of soft tissue retraction

A

The limited removal of the sulcular epithelium with rotary instruments while preparing the marginal finish line

21
Q

What is the advantage of the rotary curettage method of soft tissue retraction

A

quick

22
Q

What are the disadvantage of the rotary curettage method of soft tissue retraction

A
  • Trauma and haemorrhage with poor healing
  • Increased risk of periodontal destruction

This method is also shit and is rarely used

23
Q

What is the aim of the retraction paste method of soft tissue retraction

A

Gingival retraction pastes can be used to create space between the prepared tooth and the sulcus

24
Q

What are some of the properties of the retraction pastes used in soft tissue retraction

A
  • Some are medicated e.g. with Aluminium Chloride

- Material is viscous and maintains rigidity, displacing the gingivae away from the tooth without causing trauma

25
Q

What is the method of retraction paste application

A
  • Express the paste around the preparation, directly into the sulcus
  • Leave for 2 minutes, then wash away with water, dry the tooth and take the impression
26
Q

What are the advantages of the retraction paste method of soft tissue retraction

A
  • Quicker and seems easier than using retraction cord with astringent
27
Q

What are the disadvantages of the retraction paste method of soft tissue retraction

A
  • Can be technique sensitive with a suboptimal result
28
Q

Describe the process of applying the impregnated retraction cord in soft tissue retraction

A
  • Obtain good moisture control
  • Choose appropriate size retraction cord and cut to rough length of tooth circumference
  • Place cord in dappens pout with astringent solution for 3 mins
  • Remove cord and place on tissue (tastes terrible)
  • Loop cord around tooth using flat plastic push cord into gingival crevice
  • Leave for about 4 mins, then wash well and remove cord
  • Rinse and dry sulcus and preparation
  • Syringe impression material into the sulcus and all the way around the tooth and take impression
29
Q

How do you obtain good moisture control in the impregnated retraction cord method

A
  • Suction and salivary ejector

- Cotton wool rolls

30
Q

How long should you place the retraction cord in the astringent solution for at least

A

3 mins

31
Q

Why should you place the impregnated retraction cord onto a tissue after its been in the astringent solution

A

removes excess as it tastes horrible

32
Q

What is the difference between the impregnated retraction cord method where you take the cord out and the method where you leave it in

A
  • After packing into the sulcus you should ensure that there is no excess cord left above the gingival margin so the impression material can cover the entire margin and just beyond it
  • Leave the retraction cord in the sulcus while taking the impression
33
Q

When can you remove the impregnated retraction cord in the method where you leave it in the sulcus

A
  • Can come out when you remove the impression
  • If not you can leave it in situ whilst cementing the temp crown
  • When temp bond sets you can then remove the retraction cord and most of the excess temp cement will also come out with it
34
Q

Why might you want to choose the method of leaving the impregnated retraction cord in the sulcus

A
  • Even though haemolytic agents are used, removal of the cord can cause trauma or remove the blood clot, causing haemorrhage and problems obtaining an accurate impression, this technique avoids this risk
35
Q

Describe the method for the 2 cord impregnated retraction cord method

A
  • Two impregnated cords are packed into the sulcus
  • Smaller cord is placed first and remains in the sulcus during the impression stage
  • Larger cord is placed on top in the same stages as other methods
36
Q

What are the aims of the 2 impregnated cord method of soft tissue retraction

A
  • the smaller cord reduces the risk of gingival cuff recoiling and displacing partially set impression material
37
Q

What are the disadvantages of the 2 impregnated cord method of soft tissue retraction

A

Increased inflammation and tissue damage

38
Q

What is the aim of the electrosurgery method of soft tissue retraction

A
  • Controlled tissue destruction from a current flowing from a small cutting electrode that produces a high current and temperature at the point of contact with the tissue
39
Q

When is the electrosurgery method of soft tissue retraction used

A
  • When the situation doesnt allow or isn’t desirable to only use a retraction cord alone e.g. when the tissue has proliferated over the preparation finish lines
  • Widening of the gingival sulcus, coagulation, gingivectomy
40
Q

What are the contraindications for the electrosurgery method of soft tissue retraction

A
  • Don’t used with cardiac pacemakers (can interfere with their function)
  • Don’t use with topical anaesthetics or flammable aerosols
41
Q

Describe the steps that are taken in the electrosurgery method of soft tissue retraction

A
  • Ensure anaesthesia
  • Check unit, grounding, settings and connections
  • Good general moisture control
  • Practice strokes (unit off)
  • Turn on unit, use high volume suction and cut by applying light pressure in smooth sweeping strokes (7mm/sec)
  • Tip shouldn’t be stationary at any point, don’t drag the tissue
  • Clean debris on the tip (gauze) - careful of heat
  • Leave adequate time intervals between cutting strokes (10 seconds) to allow tissue to cool down or you risk necrosis of tissue and underlying alveolar bone
  • Give post op
42
Q

What needs to be avoided in the mouth when doing the electrosurgery method of soft tissue retraction

A
  • Metal restorations
  • Metal instruments
  • Contact with bone

Fixed Prosthodontics (11 decks)

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