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Fixed > Soft Tissue Management and Fluid Control > Flashcards

Soft Tissue Management and Fluid Control Flashcards

1
Q

What is fluid control?

A

Controlling water and saliva during tooth preparation

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2
Q

What is wrong with too much water?

A

you can’t see and patient is drowning

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3
Q

What is wrong with too little water?

A

you can heat tooth and cause pulpal necrosis

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4
Q

What is gingival control?

A

Saliva and crevicular fluid management is crucial for making a quality impression and for proper cementation

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5
Q

What is soft tissue management?

A

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

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6
Q

What are the uses for a rubber dam?

A

-Caries removal, removing old restorations
-Placing a Core
-During Post and Core procedures
-Root Canal Treatment
-When tissue retraction is difficult (hypertrophied tissue or a pseudopocket)

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7
Q

What is the gold standard for isolation and moisture control?

A

rubber dam

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8
Q

____________ provides necessary isolation for resin cement procedures.

A

Rubber Dam

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9
Q

Primary way to manage fluid during
preparations is with…

A

high-speed suction

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10
Q

What are other products to manage fluid?

A
  • Cotton roll isolation
  • Releaf hands free suction device
  • Nu-Bird. Suction and mirror in one device
  • Dry Angle cheek guards
  • Dentopop
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11
Q

What does an Isovac/Isolite do?

A

-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

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12
Q

What are the types of medications that can reduce saliva?

A

-GI Anticholinergics (Robinul / Pro-Banthine)
—Decreases stomach acid and other secretions including saliva
—Contraindicated in patients with heart disease/glaucoma/asthma
-Clonidine (anti-hypertensive drug)
—Safer than anticholinergics but have side effects like sedation, blurred vision, allergic reactions
—Caution for hypertensive patients

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13
Q

___________ health is critical in the preparation and design process of a crown or bridge.

A

Periodontal

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14
Q

Poorly contoured restorations are responsible for inflammatory reactions:

A

-Roughness and porosity of materials
-Inaccessibility for patient OH
-Lack of patient OH
-Defective crown margins
-Invasion of biological widt

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15
Q

What are different types of periodontal health management?

A

-Use the provisional to re-create or maintain proper gingival contours.
-SRP may be needed to remove foreign substances and kickstart the healing process.
-Pre-placement of retraction cord and careful final marginal preparation
-Chlorhexidine 0.12% for two weeks prior to crown preparation can be useful in more significant inflammation situations.

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16
Q

What is the biologic width?

A

2.0 mm
-Gingival Sulcus
-Junctional Epithelium
-Connective Tissue Attachment

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17
Q

What is the radiographic evaluation of the biologic width?

A

-PA/BW
– Determine if crown lengthening is advisable or needed to avoid impinging on Biological width.

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18
Q

Crown Finish line ideally no deeper than…

A

half the depth of the sulcus
-Usually 0.5 – 1.0mm sub gingival

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19
Q

What type of gingiva is more susceptible to damage and recession due to a crown?

A

Thin, scalloped gingiva

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20
Q

What type of gingiva is less susceptible to damage and recession due to a crown?

A

Thick, flat gingiva

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21
Q

Why is gingival control so critical to restorative treatment?

A

Rapid marginal recession may occur as soon as 2 weeks

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22
Q

What can cause marginal recession of the gingiva?

A

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

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23
Q

What is the purpose of tissue retraction?

A

-To Displace the Gingiva for margin exposure
-As a cutting guide during tooth preparation
- Displacement of gingival tissue for impression
- Control of crevicular fluids

24
Q

What does placement of retraction cord prior to preparation do?

A

-Improves visibility
-Reduces tissue trauma
-Acts as a guide for margin placement

25
Q

Cord causes _______ displacement of tissues to visualize the margin placement

A

vertical

26
Q

What does packing cord allow for?

A

-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

27
Q

What are the techniques for gingival control?

A

*Mechanical
—Rubber dam
—Retraction cord
—Cordless materials (pastes, gels, compounds)
*Chemo-mechanical
—Retraction cord AND chemicals for hemostasis
*Surgical
—Electrosugery
—Laser
—Scalpel

28
Q

What are the different types of retraction cord?

A

Braided, twisted, knitted

29
Q

What is the size range for retraction cord?

A

000 - #3

30
Q

Hemostatic medicaments control…

A

crevicular fluids and seepage

31
Q

Non-impregnated cord can be soaked in _____ controlling agents prior to placement.

A

heme
- like epinephrine

32
Q

What are the advantages of retraction cord soaked in epinephrine?

A

-Can be kind to tissues
-Sulcus not overly harmed and left clean
-No additional tissue loss

33
Q

What is the disadvantage of retraction cord soaked in epinephrine?

A

Extra epinephrine systemically for patient

34
Q

What is an astringent?

A

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

35
Q

What are examples of an astringent?

A
  • Buffered Aluminum Chloride (20% Hemodent)
  • Ferric Sulfate (15%) Astringedent
36
Q

What are the advantages of Buffered Aluminum Chloride (20% Hemodent) astringents?

A

-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

37
Q

What is the disadvantage of Buffered Aluminum Chloride (20% Hemodent) astringents?

A

-Nasty taste

38
Q

What are the advantages of Ferric Sulfate (15%) astringent?

A

-Stypic (clotting agent)
-Applied to cut tissue for best hemostasis

39
Q

What are the disadvantages of Ferric Sulfate (15%) astringents?

A

-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

40
Q

For proper exposure of your finish line (margin) cord aims to:

A

-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

41
Q

What is the single cord technique?

A

-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

42
Q

What is the double cord technique?

A

-#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

43
Q

___________ technique is considered the gold standard for impression taking

A

Double Cord

44
Q

What is the procedure for tissue retraction?

A
  • Use of Local is mandatory
  • Moisture control is mandatory
  • Place cord near crevice
  • Place looped cord around tooth with cotton forceps
  • Start in deepest part of sulcus (usually interproximal)
  • Use blunt instrument
  • Use gentle pressure to avoid stripping attachment
  • Placement is parallel to the roo
45
Q

Note angle toward tooth at approximately ___ degrees when placing cord

A

45

46
Q

What are the common problems with cord placement?

A
  • Insufficient tissue retraction leading to impression material being too thin.
  • Cord could be too small vertically or horizontally
  • Retraction cord too small = Bottleneck of tissue
  • Top of cord needs to be fully visible with no tissue overlap at the top of the sulcus.
47
Q

What are the steps to cord placement?

A

Step 1:
- determine # of cords to use
- cut cord into anticipated length plus a little extra
Step 2:
- place cord segments into hemostatic solution. In clinic, we use small clear cups for this.
- recommend Hemodent as primary astringent.
- after soaking cord, dab off excess leaving cord still wet just prior to placement in the mouth.
- if you know your patient’s gingiva will be bleeding, some Astringedent can be drawn into a syringe and placed on your cart.
Step 3:
- Pack smaller (#000 or #00) cord (now moistened with Hemodent) into the sulcus with smooth blade instrument.
- Cut off excess length.
- The margin should be visible ABOVE the cord
Step 4:
- Pack larger (#0 or larger) cord (now moistened with Hemodent) into the sulcus with smooth blade instrument.
- Do not cut off excess length. Leave some cord hanging out to grab later.
- The margin should be visible ABOVE the cord.
Step 5:
- Allow cord to sit and be isolated (dry and heme free) for 3-5 minutes.
- Remove top cord
- Air dry the tooth and crevicular area
- Place light body material into sulcus circumferentially
- Blow the impression material down into sulcus with LOTS of air. (Circular motion around the tooth multiple times with lots of air)
- Start again to place light body impression material
- Place impression tray with medium, hard, or rigid impression material
- Remove any remaining smaller cord prior to temporizing

48
Q

Why should you not remove a dry cord?

A

This tears the gingiva creating bleeding and an inflammatory reaction.

49
Q

What happens if you leave a cord in a patient’s mouth?

A

create pain and inflammation!

50
Q

Has cord been placed gently and does not overflow the sulcus BUT you still have bleeding from your preparation or patients gingival is unhealthy?

A
  • Rub Astringedent on tissue until bleeding stops.
  • Remove dark debris from Astringedent by using Hemodent and cotton pellet.
  • Dry thoroughly
  • Check for bleeding and repeat if necessary.
51
Q

__________ will inhibit the setting of your PVS impression material. A
thorough wash and dry may allow you to get an adequate impression.

A

Astringedent

52
Q

What are the types of retraction pastes?

A

Traxodent (Expasyl, Dryz)
-15% aluminum Chloride
Magic Foam Cord (PVS)
-Material Expands in sulcus
-Does not have a hemostatic agent

53
Q

If using a retraction paste, best to combine with a…

A

single small cord and add pressure with a cotton cap

54
Q

What is electrosurge?

A

-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

55
Q

What are the surgical options for gingival management?

A
  • electrosurge
  • laser
  • rotary
56
Q

What is the laser method for removing gingiva?

A
  • 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
57
Q

What is the rotary method for removing gingiva?

A
  • 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.

Fixed (19 decks)

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