Tissue Management Prostho long quiz

Question 1

exclusion of sulcular fluid, saliva and gingival bleeding from operating field

Answer 1

moisture control

Question 2

prevention of aspiration or swallowing of fluid sprayed from the handpiece and restorative debris
*objectives are isolation, retractions and accessibility

Answer 2

moisture control

Question 3

objectives of isolation

Answer 3

• obtain a dry clean operating field
• improve properties of dental materials
• protect the patient and operator
• improve the dentists operating efficiency

Question 4

methods of fluid control

Answer 4

• mechanical (saliva ejector, high vol evacuator), absorbant(cotton rolls, cellulose wafers)
• rubber dam-should not be used w/ polysiloxane impression materials for it to inhibit polymerization
• chemical-use of antisialogogues drugs and local anest

Question 5

group of drugs used to control salivary flow
-are gastrointestinal anti-cholinergic drugs that inhibit the action of myoepithelial cells in salivary glands producing dry mouth

Answer 5

anti-sialogogues

Question 6

woven cord impregnated w/ chemicals

• electrosurgery
• combination of chemical in cord and electrosurgery
• curettage with stone while doing prep of Finish line

Answer 6

Gum Retraction Technique

Question 7

the shallow groove around tooth bounded on one side by surface of tooth and on the other by the epith lining of free margin of gingiva.

Answer 7

gingival crevice

Question 8

-‘V’ shaped w/ its base at the most coronal level of the epithelial attachment to the tooth root

Answer 8

gingival crevice

Question 9

what is the dentist’s goal?

Answer 9

to accomplish the required procedure w/ a minimal degree of unintended alteration of the gingival tissue

Question 10

what is the purpose of tissue retraction?

Answer 10

• exposure and inspection of subgingival and equigingival finish line
• control of bleeding
• accessibility to finishing line

Question 11

what are some points to consider during tissue retraction?

Answer 11

• location of cord should be within gingival crevice at or just below the finish line
• avoidance of any trauma

Question 12

what is the process of chemico-mechanical? (soaked retraction cord)

Answer 12

1. combine mech (pressure packing) w/ chemical leadin to enlargement of gingival sulcus and fluid control
   * retraction cords are soaked in chemicals w/c promotes gingival contraction to provide better gingival retraction than plain cord

Question 13

ideal requirments of chemicals used

Answer 13

• should produce effective gingival displacement
• should promote hemostasis
• should not produce irreversible damage to gingiva
• no systemic side effects

Question 14

drugs used for cord retraction

Answer 14

• epinephrine
• alum astringent
• ferric sulfate(15%)
• ferric chloride(22%)

Question 15

Contraindications of epinephrine

Answer 15

• cardiovasc diseases
• diabetes
• hyperthyroidism
• known hypersensitivity to epinephrine
• causes tachycardia (if placed in lacerated tissue)

Question 16

signs of epinephrine reaction

Answer 16

• increase in cardiac rate
• increase in force of cardiac contractions
• increase in respiration
• patient will usually appear nervous
• px may seem frightened
• px may be confused about what is happening
• at a later time, px may feel depressed about the visit

Question 17

Significance and Treatment of Epinephrine Reaction

Answer 17

-No significance, only an exaggerated physiologic reaction to the drug and not life threatening.

Question 18

how to treat the epinephrine reaction?

-Patient w/ No cardiac Insufficiency

Answer 18

Calm the patient by showing to them that you are aware of the situation

• remove the cord
• stay with them
• take pulse and blood pressure at intervals
• terminate appointment after

Question 19

Patient w/ cardiac insufficiency or hypertension

significance

Answer 19

could be lifethreatening if cardiac reserve is exceeded by the effects of the epinephrine which is rare

Question 20

how to treat patient w/ cardiac insufficiency or hypertension

Answer 20

assume that the patient is experiencing a cardiac crisis and follow procedure for a medical emergency

Question 21

What to do in operating technique of retraction cord

Answer 21

• operating area should be dry.
• fluid control w/ evacuating device
• isolate prepared quadrant w/ cotton rolls
• cut about 5cm long retraction cord
• Twist cord to make it tight and small
• (if not pre-soaked), dip cord in chemical
• loop retraction cord tightly around the tooth held by thumb and forefinger
• Pack cord into the sulcus starting from mesial using instrument like Fisher packing instrument or DE plastic instrument (care not to damage gingiva)
• Force should be applied in mesial direction so that packed cord will not be dislodge.
• Packing instrument should be angled slightly toward the tooth/root to facilitate subging placement of cord (if instrument is placed parallel to long axis, cord will be pushed against the wall of gingival crevice will rebound)
• -technique where a portion of the epithelium w/in the sulcus is cut/removed to expose finish line, done only on healthy gingiva

Question 22

a portion of the epithelium w/in the sulcus is cut/removed to expose finish line, done only on healthy gingiva

Answer 22

rotary curettage (gingettage)

Question 23

surgical removal of sulcular epithelium using an electrode

Answer 23

electrosurgery

Question 24

what is the criteria of rotary curettage (gingettage)

Answer 24

• absence of bleeding on probing
• depth of sulcus less than 3mm
• presence of adequate keratinized gingiva

Question 25

technique of rotary currettage

Answer 25

- done simultaneously along w/ finish line prep - torpedo diamond (used to create chamfer) is carefully extended into sulcus (half its depth) to remove portion of sulcular epithelium - handpiece at slow speed - abundant water spray during the procedure - retraction cord impregnated w/ aluminum chloride can be used to control bleeding

Question 26

a high frequency radio transmitter that uses either a vacuum tube or a transistor to deliver a high frequency electrical current of at least 1.0 MHz (one million cycles per second)

Answer 26

electrosurgical retraction

Question 27

what are the indications of electrosurgical retraction?

Answer 27

- in areas of inflamed gingival where impossible to use retraction cord - in cases w/ gingival proliferation around the prep'd finish line.

Question 28

contraindication of electrosurgical retraction

Answer 28

patients w/ cardiac pacemakers

Question 29

advantages of electrosurgical retraction

Answer 29

- quick procedure - produces little or no bleeding - can be done in cases w/ gingival inflammation

Question 30

disadvantages of electrosurgical retraction

Answer 30

- technique sensitive - application of excessive pressure may produce severe tissue damage - difficult to control lateral dissipation of heat (will produce tiss damage) - cannot be done in dry field(should be moist)

Question 31

helps stabilize electrical flow w/in patients body (electrical accidents happen if single electrode is used) -placed under px thigh or at back of px (should not be placed close to bony tubercles as it may generate enough electricity to produce burn)d

Answer 31

ground electrode

Question 32

designs of cutting edge of surgical electrode

Answer 32

-coagulating diamond loop, round loop, small straight probe, small loop

Question 33

basic principles during electrosurgical procedure

Answer 33

- local anesthesia should be given - unpleasant odor in tissue necrosis, so use aromatic oils at vermillion border of lips to mask unpleasant odor - grounding should be dnoe to protect px from electrical accidnets - electrode should be applied w/ very light pressure w/ swift strokes. - pressure should not be applied for it may produce excessive tissue damage - electrode should never be placed stagnant at any one point as it may lead to lateral dissipation of heat producing injury

Question 34

technique for sulcus enlargment

Answer 34

-use small electrode positin parallel to long axis of tooth -run probe at min speed of 7mm/sec to avoid lateral heat dissipation -tissue debris entangled in probe should be cleaned after each stroke run probe in facial, mesial, lingual, distal direction -debris in sulcus should be removed using cotton pellet dipped in hydrogen peroxide

Question 35

- done when clinical crown is short in comparison to the anatomic crown - if a wide band of attached gingiva surround the tooth, crown lengthening is done to increase accessibility. - removal of hyperplastic gingiva (gingivectomy) in order to expose the anatomical crown - done using diamond shaped electrode

Answer 35

-crown lengthening

Question 36

technique of crown lengthening

Answer 36

diamond electrode is run over the tissues such that one of its surfaces follows the incline of tooth - bevel should be done on attached to prevent re-growth - when there is extensive wound, periodontal dressing is given

Question 37

a remnant of a remnant of edentulous papilla, w/c forms as a roll of tissue adjacent to the proximal surface of the teeth adjacent to the edentulous space

Answer 37

edentulous cuff

Question 38

can be removed surgically or electrosurgically | -electrosurgical loop electrode are best used for these procedures

Answer 38

removal of edentulous cuff