Fluid control and soft tissue management / general dentistry courses

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Fluid control and soft tissue management / general dentistry courses

  1. 1. FLUID CONTROLFLUID CONTROL ANDAND SOFT TISSUE MANAGEMENTSOFT TISSUE MANAGEMENT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. contentscontents 1)1) IntroductionIntroduction 2) Fluid control2) Fluid control Rubber damRubber dam High volume vacuumHigh volume vacuum Saliva ejectorSaliva ejector SvedopterSvedopter AntisialagoguesAntisialagogues 3) Finish line exposure3) Finish line exposure MechanicalMechanical ChemicomechanicalChemicomechanical Surgical methodSurgical method 4)Recent advances4)Recent advances 5) Review of literature5) Review of literature 6) Conclusion6) Conclusion 7) References7) References www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. IntroductionIntroduction  Restorative procedures in the mouthRestorative procedures in the mouth cannot be executed efficiently unless thecannot be executed efficiently unless the moisture is controlled.moisture is controlled.  The moisture control includes theThe moisture control includes the exclusion of sulcular fluid ,saliva ,gingivalexclusion of sulcular fluid ,saliva ,gingival bleeding from the operating field.bleeding from the operating field. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. Fluid control of the environment of the operating site is essential during restorative dental procedures for the reasons of:  Patient comfort, safety.  Operator’s access, clear visibility. Gingiva must be displaced for:  Complete impression.  Completion of preparation. www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. During preparation of teeth, it is required to remove large volumes of water and to control tongue to prevent accidental injury. At Impression stage and Cementation stage, there is much smaller volume of fluid need to be removed, but much greater degree of dryness is required. FLUID CONTROL AND SOFT TISSUE MANAGEMENT- VARIES DEPENDING ON THE TASK www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. Methods of fluid controlMethods of fluid control  They can be broadly classified into :They can be broadly classified into :  Mechanical methodsMechanical methods  Chemical methodsChemical methods  Other methodsOther methods www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. Mechanical methods of fluid controlMechanical methods of fluid control  Most commonly used mechanicalMost commonly used mechanical methods for fluid control are :methods for fluid control are :  Rubber damRubber dam  High volume vacuumHigh volume vacuum  Saliva ejectorsSaliva ejectors  svedoptersvedopter www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. RUBBER DAMRUBBER DAM RUBBER DAMRUBBER DAM  In 1864 S.C. Barnum aIn 1864 S.C. Barnum a New York city dentistNew York city dentist introduced the rubberintroduced the rubber dam into dentistrydam into dentistry  The dam eliminatesThe dam eliminates saliva from the operatingsaliva from the operating site and retracts the softsite and retracts the soft tissuestissues www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. AdvantagesAdvantages  Dry clean fieldDry clean field  Improved access and visibilityImproved access and visibility  Potentially improved properties of thePotentially improved properties of the dental materialsdental materials  Protection of patient and dentistProtection of patient and dentist  Operating efficiencyOperating efficiency www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. DisadvantagesDisadvantages  Time consumption and patient objectionTime consumption and patient objection  Cannot be used with polyvinyl siloxaneCannot be used with polyvinyl siloxane impression material because the rubberimpression material because the rubber dam will inhibit its polymerization.dam will inhibit its polymerization. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. HIGH-VOLUMEHIGH-VOLUME VACUUMVACUUM  Extremely useful during the preparationExtremely useful during the preparation phase.phase.  Most effectively utilized with an assistant.Most effectively utilized with an assistant.  Can be utilized as a lip and tongue retractor.Can be utilized as a lip and tongue retractor. Useful during the tooth preparationUseful during the tooth preparation  Preferred for suctioning water and debris fromPreferred for suctioning water and debris from the mouththe mouth  Can be used as a lip retractorCan be used as a lip retractor Not practical during impression phasewww.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. SALIVA EJECTORSALIVA EJECTOR  Can be utilized effectively by dentist himself .Can be utilized effectively by dentist himself .  Placed in the corner of the mouth opposite the quadrantPlaced in the corner of the mouth opposite the quadrant being operated, and the patient’s head is turned towardsbeing operated, and the patient’s head is turned towards it.it.  Tongue control may be less than ideal, however.Tongue control may be less than ideal, however. Saliva Ejector www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. SVEDOPTERSVEDOPTER  It’s a metal saliva ejector withIt’s a metal saliva ejector with attached tongue deflector.attached tongue deflector.  Used in preparation phase,Used in preparation phase, especially mandibular teeth.especially mandibular teeth.  By adding cotton rolls,By adding cotton rolls, excellent tongue control andexcellent tongue control and isolation is provided.isolation is provided.  Effective when usedEffective when used with the patient sittingwith the patient sitting upright .upright . Mandibular tori- preclude its use. Can trigger gag reflex.www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Chemical methods of fluid controlChemical methods of fluid control  Commonly used chemical methods forCommonly used chemical methods for fluid control are :fluid control are : - Anti – sialogogues- Anti – sialogogues - Local Anaesthetics- Local Anaesthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. ANTISIALAGOGUESANTISIALAGOGUES  For patients who salivates excessively.  Methantheline bromide. 50mg tablet 1 hour before appointment  Propantheline bromide 15mg tablet 1 hour before appointment  Onset of action- 5-10min.  Duration of action- 11 /2 hours CONTRAINDICATION:- Hypersensitivity, glaucoma, asthma, obstructive conditions of GIT or urinary tracts, or congestive heart failure. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. Other methods include :Other methods include : Absorbants and throat shieldAbsorbants and throat shield  Cotton roll isolation and cellulose wafersCotton roll isolation and cellulose wafers  Absorbents, such as cotton rolls and cellulose wafers, canAbsorbents, such as cotton rolls and cellulose wafers, can also provide isolation.These are alternative in cases wherealso provide isolation.These are alternative in cases where rubber dam application may not be possible.rubber dam application may not be possible.  Especially along with profound anesthesia absorbentsEspecially along with profound anesthesia absorbents provide acceptable dryness for procedures such asprovide acceptable dryness for procedures such as impression making and cementation.impression making and cementation.  Throat shields are indicated when small instruments areThroat shields are indicated when small instruments are being used or indirect restoration placed. This is to preventbeing used or indirect restoration placed. This is to prevent aspiration or swallowing of restoration.aspiration or swallowing of restoration. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. Anti salivary drugsAnti salivary drugs  The use of drugs in restorative dentistry toThe use of drugs in restorative dentistry to control salivation is rarely indicated andcontrol salivation is rarely indicated and generally limited togenerally limited to AtropineAtropine..  Is with any drug the operator should be familiarIs with any drug the operator should be familiar with its indications contra indications and sidewith its indications contra indications and side effects.effects.  It is important to remember that atropine isIt is important to remember that atropine is contra indicated for nursing mothers and forcontra indicated for nursing mothers and for patients with glaucoma .patients with glaucoma . www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18.  Some anti histaminics like Hi receptorSome anti histaminics like Hi receptor antagonists also cause dryness of mouthantagonists also cause dryness of mouth due to anti cholinergic action but theydue to anti cholinergic action but they inhibit the action of local anesthesia so areinhibit the action of local anesthesia so are contraindicated.contraindicated. www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Finish line exposureFinish line exposure  Marginal fit of the restoration is necessary inMarginal fit of the restoration is necessary in preventing recurrent caries and gingival irritationpreventing recurrent caries and gingival irritation  Equigingival and subgingival finish lines shouldEquigingival and subgingival finish lines should be temporarily exposed to insure reproduction ofbe temporarily exposed to insure reproduction of the entire finish line in the impressionthe entire finish line in the impression  To expose a finish line one of the followingTo expose a finish line one of the following techniques could be used.techniques could be used. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. FINISH LINE EXPOSUREFINISH LINE EXPOSURE METHODS : Mechanical Chemical Surgical www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. MECHANICAL :MECHANICAL :  Copper bandCopper band  Rubber damRubber dam  Plain cotton cordPlain cotton cord www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Copper bandCopper band  Can be used to carry the impression material and alsoCan be used to carry the impression material and also gingival retraction.gingival retraction. TechniqueTechnique  One end of the tube is festoonedOne end of the tube is festooned  Tube filled with modeling compoundTube filled with modeling compound  Seated along the path of insertion of tooth preparationSeated along the path of insertion of tooth preparation www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. Rubber damRubber dam  The retraction produced with the rubber damThe retraction produced with the rubber dam compresses the tissue.compresses the tissue.  Used when a limited amount of teeth in oneUsed when a limited amount of teeth in one quadrant are being restored and in situations inquadrant are being restored and in situations in which the preparations don’t have to bewhich the preparations don’t have to be extended subgingivally.extended subgingivally. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25.  Rubber dam material :Rubber dam material :  It is available in rolls or sheets.It is available in rolls or sheets.  The advantage of material in rolls is that it canThe advantage of material in rolls is that it can be cut to the desired shape.be cut to the desired shape.  The sheets may be 5x5 inch or 6x6 for pedo.The sheets may be 5x5 inch or 6x6 for pedo. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26.  Sterile dam material is also available packed as individualSterile dam material is also available packed as individual sheets.sheets.  It has a shiny and dull side.It has a shiny and dull side.  The thickness available are :The thickness available are : Thin - .006 inch .15mmThin - .006 inch .15mm Medium - .008 inch .2mmMedium - .008 inch .2mm Heavy - .010 inch .25mmHeavy - .010 inch .25mm Extra heavy - .012 inch .3mmExtra heavy - .012 inch .3mm special heavy - .014 inch .35mmspecial heavy - .014 inch .35mm www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27.  The thicker dam is available to retract the tissueThe thicker dam is available to retract the tissue its more resistant to tearing and speciallyits more resistant to tearing and specially recommended for class v cavities in conjunctionrecommended for class v cavities in conjunction with a cervical retainers.with a cervical retainers.  The thinner materials have the advantage ofThe thinner materials have the advantage of passing through the contacts easier which ispassing through the contacts easier which is particularly helpful when they are tight.particularly helpful when they are tight. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28.  Rubber Dam Accessories :Rubber Dam Accessories : Rubber Dam frames, forceps, punchesRubber Dam frames, forceps, punches and clamp boards.and clamp boards. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. Retraction cords :Retraction cords :  Three varieties areThree varieties are generally available -generally available -  Loose twistedLoose twisted  BraidedBraided  KnittedKnitted www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. CHEMICOMECHANICAL(Retraction Cord)CHEMICOMECHANICAL(Retraction Cord) Combination of chemical action with pressure packingCombination of chemical action with pressure packing PREVIOUSLY USED  Sulfuric acid  Trichloracetic acid  Negatol  Zinc chloride RECENTLY USED  Epinephrine (8%)  Aluminum chloride  Alum  Aluminum sulfate  Ferric sulfatewww.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. REQUIREMENT FOR A GINGIVAL RETRACTION MATERIAL 1. Effectiveness in gingival displacement. 2. Effectiveness in gingival hemostasis. 3. Absence of irreversible damage to gingiva. 4. Should not produce untoward systemic effects. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. RETRACTION OF GINGIVAL TISSUERETRACTION OF GINGIVAL TISSUE  Gingival retraction and gingival displacement areGingival retraction and gingival displacement are important phases in restorative dentistry.important phases in restorative dentistry.  Any preparation with a sub gingival margin can not beAny preparation with a sub gingival margin can not be successfully and accurately recorded without proper andsuccessfully and accurately recorded without proper and adequate tissue retraction.adequate tissue retraction.  This can be done by enlarging the gingival sulcusThis can be done by enlarging the gingival sulcus through mechanical , chemical , or surgical means,through mechanical , chemical , or surgical means, which must be done without jeopardizing periodontalwhich must be done without jeopardizing periodontal health.health. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33.  completion of the preparationcompletion of the preparation  to make a complete impressionto make a complete impression  cementation of the restorationcementation of the restoration Gingival retraction permits :Gingival retraction permits : www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. IMPORTANCE OF FINISH LINEIMPORTANCE OF FINISH LINE EXPOSUREEXPOSURE  The finish line must be reproduced in theThe finish line must be reproduced in the impression. The marginal integrity is veryimpression. The marginal integrity is very important in preventing recurrent caries andimportant in preventing recurrent caries and gingival inflammation.gingival inflammation.  So, the finish line must be exposed temporarilySo, the finish line must be exposed temporarily exposed to reproduce the entire preparation.exposed to reproduce the entire preparation. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. CHEMICOMECHANICAL METHODS OFCHEMICOMECHANICAL METHODS OF GINGIVAL RETRACTIONGINGIVAL RETRACTION A method of combining a chemical withA method of combining a chemical with pressure packing, which leads topressure packing, which leads to enlargement of the gingival sulcus asenlargement of the gingival sulcus as well as control of fluids seeping from thewell as control of fluids seeping from the sulcus.sulcus. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Chemicals UsedChemicals Used The following chemicals are generally local vasoconstrictors which produce transient gingival shrinkage.  8 % Racemic epinephrine.  Aluminium chloride.  Alum. (Aluminium potassium sulphate)  Aluminium sulphate.  Ferric sulphate. www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37.  It should produce effective gingival displacement and haemostasis.  It should not produce any irreversible damage to the gingiva.  It should not have any systemic side effects. Ideal Requirements for Chemicals Used with Gingival Retraction Cord www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. Contraindications for EpinephrineContraindications for Epinephrine  CVS diseaseCVS disease  HypertensionHypertension  DiabetesDiabetes  HyperthyroidismHyperthyroidism  Known hypersensitivity to epinephrine.Known hypersensitivity to epinephrine. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. TECHNIQUETECHNIQUE  The operating area should be dry. Fluid controlThe operating area should be dry. Fluid control should be done with an evacuating device and theshould be done with an evacuating device and the quadrant containing the prepared tooth is isolatedquadrant containing the prepared tooth is isolated with cotton rolls.with cotton rolls.  Next, the retraction cord is drawn from theNext, the retraction cord is drawn from the dispenser bottle with sterile cotton pliers and adispenser bottle with sterile cotton pliers and a piece of approximately 5 cm (2 inch) long is cut off.piece of approximately 5 cm (2 inch) long is cut off. www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  The cord is twisted to make it tight and smallThe cord is twisted to make it tight and small  The retraction cord should be dipped in 25%The retraction cord should be dipped in 25% AlCl3 solution in a dampen dish.AlCl3 solution in a dampen dish.  Haemorrhage can be controlled by usingHaemorrhage can be controlled by using haemostatic agents.haemostatic agents.  The retraction cord is looped around the toothThe retraction cord is looped around the tooth and held tightly with the thumb and forefinger.and held tightly with the thumb and forefinger. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41.  The cord is packed into theThe cord is packed into the gingival sulcus starting fromgingival sulcus starting from the mesial surface of thethe mesial surface of the tooth. The cord should betooth. The cord should be stabilized near the distal endstabilized near the distal end of the tooth.of the tooth.  The cord can be packed withThe cord can be packed with special instruments likespecial instruments like Fischer Packing instrumentFischer Packing instrument oror a DEa DE plastic instrument IPPA.plastic instrument IPPA. www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42.  Force should be applied in aForce should be applied in a mesial direction during cordmesial direction during cord placement so that the packedplacement so that the packed preceding segment does not getpreceding segment does not get dislodged .dislodged .  Occasionally it may beOccasionally it may be necessary to hold the cord withnecessary to hold the cord with one instrument while packingone instrument while packing with another .with another .  The instrument used forThe instrument used for packing should be angledpacking should be angled slightly towards the root toslightly towards the root to facilitate the sub-gingivalfacilitate the sub-gingival placement of the cordplacement of the cord www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43.  The instrument is inclined at an angle towards theThe instrument is inclined at an angle towards the tooth surface. If it is held parallel to the long axistooth surface. If it is held parallel to the long axis of the tooth, the retraction cord will be pushedof the tooth, the retraction cord will be pushed against the wall of the gingival crevice, and willagainst the wall of the gingival crevice, and will rebounce.rebounce. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44.  Excess cord is cut off near the inter-proximalExcess cord is cut off near the inter-proximal area such that a slight overlap of the cordarea such that a slight overlap of the cord occurs in this region .If the overlap occurs onoccurs in this region .If the overlap occurs on the facial and lingual sur-faces, the gingivalthe facial and lingual sur-faces, the gingival finish line in that area may not be replicatedfinish line in that area may not be replicated properly in the impression.properly in the impression. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45.  Atleast 2-3 mm of cord is left protruding out-sideAtleast 2-3 mm of cord is left protruding out-side the sulcus so that it can be grasped for easythe sulcus so that it can be grasped for easy removal.removal.  After 10 minutes, the cord should be removedAfter 10 minutes, the cord should be removed slowly in order to avoid bleeding.slowly in order to avoid bleeding.  If active bleeding persists, a cord soaked in ferricIf active bleeding persists, a cord soaked in ferric sulphate should be placed in the sulcus andsulphate should be placed in the sulcus and removed after 3 minutesremoved after 3 minutes.. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46.  The impression should be made only afterThe impression should be made only after cessation of bleeding.cessation of bleeding.  The retraction cord must be slightly moist beforeThe retraction cord must be slightly moist before removal. Removing dry cord from the creviceremoval. Removing dry cord from the crevice can injure the delicate epithelial lining of thecan injure the delicate epithelial lining of the gingivagingiva.. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. Placement of the cord in the sulcus A) Correct B) Incorrect www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Usage of ferric Sulphate SolutionUsage of ferric Sulphate Solution  Cord removal is done after made damp.Cord removal is done after made damp.  After 3 minutes, remove the cord.After 3 minutes, remove the cord.  Then 1 cc special syringe is loaded withThen 1 cc special syringe is loaded with the stringent chemical and a specialthe stringent chemical and a special fibrous tip is used to rub or burnish cutfibrous tip is used to rub or burnish cut sulcular tissue until all bleeding stops.sulcular tissue until all bleeding stops. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. SurgicalSurgical There are basically three modalitiesThere are basically three modalities practiced by the dentistspracticed by the dentists I.I. Rotary curettage/gingettageRotary curettage/gingettage II.II. ElectrosurgeryElectrosurgery III.III. LaserLaser www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Rotary CurettageRotary Curettage ((Amsterdam 1954)Amsterdam 1954)  It is a troughing technique.It is a troughing technique.  Purpose is to produce limited removal ofPurpose is to produce limited removal of epithelial tissue in the sulcus while aepithelial tissue in the sulcus while a chamfer finish line is being created in thechamfer finish line is being created in the tooth structure.tooth structure.  Must be done only on healthy,Must be done only on healthy, inflammation free tissue to avoid tissueinflammation free tissue to avoid tissue shrinkage that occurs when diseasedshrinkage that occurs when diseased tissue heals.tissue heals. www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. A shoulder is formed at the level of the gingival crest prior to rotary curettage. A Torpedo tipped diamond bur simultaneously forms a chamfer finish line and removes the epithelial lining of the gingival sulcus. A cord is placed in the troughed sulcus for hemostasis www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. DISADVANTAGESDISADVANTAGES  Poor tactile sensation when usingPoor tactile sensation when using diamonds on sulcular walls can producediamonds on sulcular walls can produce deepening of the sulcus.deepening of the sulcus.  Have the potential for destruction ofHave the potential for destruction of periodontium if used incorrectly, makingperiodontium if used incorrectly, making this a method that is best used only bythis a method that is best used only by experienced dentists.experienced dentists. www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. ElectrosurgeryElectrosurgery  Employed in situations where gingiva cannot be handledEmployed in situations where gingiva cannot be handled with retraction cord alone.with retraction cord alone.  Ex – Areas of inflammation and granulation tissueEx – Areas of inflammation and granulation tissue around a tooth, as a result of overhangs or previousaround a tooth, as a result of overhangs or previous restoration or caries itselfrestoration or caries itself  Generally recommended for enlargement of gingivalGenerally recommended for enlargement of gingival sulcus and control of haemorrhagesulcus and control of haemorrhage  Employs a high frequency electrical current of 1.0 MHzEmploys a high frequency electrical current of 1.0 MHz (Million Cycles per second) or more to produce(Million Cycles per second) or more to produce controlled tissue destructioncontrolled tissue destruction www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. Typical electrosurgery unit with active electrode (A) and ground electrode (G). Five commonly used electrodes –  a) Coagulating  b) Diamond loop  c) Round loop  d) Small straight  e) Small loop www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Types of current :Types of current : 1.1. Unrectified damped currentUnrectified damped current 2.2. Partially rectified damped currentPartially rectified damped current 3.3. Fully rectified currentFully rectified current 4.4. Fully rectified filtered currentFully rectified filtered current www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Electro surgery – Mode of Action 1)Unit generates heat in a way similar to1)Unit generates heat in a way similar to microwave heating oven or a diathermymicrowave heating oven or a diathermy machine.machine. 2)Current flows from a small cutting electrode2)Current flows from a small cutting electrode which produces a high current density and rapidwhich produces a high current density and rapid temperature rise at its point of contact.temperature rise at its point of contact. 3)Cells directly adjacent to the electrode are3)Cells directly adjacent to the electrode are volatilized at this temperature.volatilized at this temperature. www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Electrosurgery - ContraindicationsElectrosurgery - Contraindications 1)Patients with Cardiac Pacemakers.1)Patients with Cardiac Pacemakers. 2)Should not be used in the presence of2)Should not be used in the presence of inflammable agents(Since generates sparks)inflammable agents(Since generates sparks) –– Hence use of topical anesthetic such as ethylHence use of topical anesthetic such as ethyl chloride and other flammable aerosols should bechloride and other flammable aerosols should be strictly avoided when electro surgery is used.strictly avoided when electro surgery is used. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. Electro surgery TechniqueElectro surgery Technique 1)Anesthesia is verified in the site1)Anesthesia is verified in the site of surgery.of surgery. 2)Aromatic oil (Peppermint) is2)Aromatic oil (Peppermint) is placed on the vermillion of theplaced on the vermillion of the upper lip to (For maskingupper lip to (For masking unpleasant smell arising duringunpleasant smell arising during tissue cutting.tissue cutting. 3)Connections of the unit are3)Connections of the unit are checked.checked. 4)Cutting electrode should be4)Cutting electrode should be applied with light pressure onlyapplied with light pressure only www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. 5)Strokes should be quick and deft.5)Strokes should be quick and deft. 6)Electrode should be kept moving and no stroke6)Electrode should be kept moving and no stroke should be repeated immediately, smoothlyshould be repeated immediately, smoothly without tissue charring.without tissue charring. 7)Moist tissue will cut best.7)Moist tissue will cut best. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. 8)High volume vacuum Plastic8)High volume vacuum Plastic tip used – to avoid burnstip used – to avoid burns when contact is made withwhen contact is made with electrode) is used to draw offelectrode) is used to draw off unpleasant odors generated.unpleasant odors generated. 9)Wooden tongue depressor is9)Wooden tongue depressor is used rather than normalused rather than normal mouth mirror.mouth mirror. 10)Frequently fragments are10)Frequently fragments are cleaned from tip with ancleaned from tip with an alcohol soaked sponge.alcohol soaked sponge. www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. Gingival Sulcus EnlargementGingival Sulcus Enlargement  Small ,straight or j shapedSmall ,straight or j shaped electrode is selected for thiselectrode is selected for this purpose.purpose. Cuts for gingival crevice enlargement are made with a small straight electrode. Facial, mesial , lingual and distal. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. Debris are cleaned from the enlarged sulcus with hydrogen peroxide on a cotton pellet www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Removal of Edentulous CuffRemoval of Edentulous Cuff  Remnants of interdentalRemnants of interdental papilla adjacent to anpapilla adjacent to an edentulous space will formedentulous space will form a hypertrophic roll or cuff –a hypertrophic roll or cuff – hence fabricating a pontichence fabricating a pontic with cleanable embrasureswith cleanable embrasures and strong connectors.and strong connectors.  A Large Loop electrode isA Large Loop electrode is used for removing large rollused for removing large roll of hypertrophied tissue.of hypertrophied tissue. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Crown Lengthening procedureCrown Lengthening procedure If there is a sufficiently wide band of attached gingivaIf there is a sufficiently wide band of attached gingiva surrounding a tooth, its removal can besurrounding a tooth, its removal can be accomplished with a gingivectomy using a diamondaccomplished with a gingivectomy using a diamond electrode.electrode. Periodontal dressing is placed after surgery.Periodontal dressing is placed after surgery. Lengthened tooth offers better retention for any crownLengthened tooth offers better retention for any crown placed on it ,with the margin placement in an areaplaced on it ,with the margin placement in an area of the tooth more accessible for cleaning.of the tooth more accessible for cleaning. www.indiandentalacademy.comwww.indiandentalacademy.com
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  66. 66. Recent AdvancementsRecent Advancements LASERS :LASERS : currently lasers are gaining popularity incurrently lasers are gaining popularity in various fields of dentistry.various fields of dentistry. Types of lasers used in dentistry areTypes of lasers used in dentistry are 1.Co21.Co2 2.Nd-YAG(neodymium-yittrium-aluminium-garnet)2.Nd-YAG(neodymium-yittrium-aluminium-garnet) 3.Argon3.Argon 4.Diode4.Diode 5.Erbium5.Erbium www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67.  For gingival tissue retraction and excision Nd-For gingival tissue retraction and excision Nd- YAG are recommended.YAG are recommended.  Lasers work through photo albation andLasers work through photo albation and produces completely blood less incisionproduces completely blood less incision controlled tissue removal and rapid pain freecontrolled tissue removal and rapid pain free healing.healing.  There is no need for anesthesia.but theThere is no need for anesthesia.but the technique is slower than scalpel surgery and thetechnique is slower than scalpel surgery and the equipment is expensive.equipment is expensive. www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68.  CoCo22 laserslasers :: • 9000-11000nm. They work on a non-contact9000-11000nm. They work on a non-contact mode. They can be used in a defocused ormode. They can be used in a defocused or focused mode.focused mode. • The focused mode has lens, which can focusThe focused mode has lens, which can focus the beam to sizes of 0.1mm to 0.35mm.the beam to sizes of 0.1mm to 0.35mm. • They are used for frenectomies or removal ofThey are used for frenectomies or removal of soft tissue hyperplasia. The Co2 is a viablesoft tissue hyperplasia. The Co2 is a viable alternative to scalpel in soft tissue surgery.alternative to scalpel in soft tissue surgery. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69.  Nd-YAG lasers (1064-1300 mm):Nd-YAG lasers (1064-1300 mm): • Due to its near infra red range, it can be deliveredDue to its near infra red range, it can be delivered through a pure optical fibre.through a pure optical fibre. • They can be delivered by both contact and non-contactThey can be delivered by both contact and non-contact systems. They use the helium- neon (red) laser forsystems. They use the helium- neon (red) laser for aiming the beam.aiming the beam. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. ● Expa-sylExpa-syl :: ● Is an innovative system for access to the gingival margin, itIs an innovative system for access to the gingival margin, it contains a paste that opens the sulcus physicallycontains a paste that opens the sulcus physically displacing the tissues and leaving the field dry, ready fordisplacing the tissues and leaving the field dry, ready for impression making or cementation.impression making or cementation. ● The paste has to be placed in sulcus for minutes andThe paste has to be placed in sulcus for minutes and rinsed.rinsed. ● When used for final impression .Expa-syl will hold itsWhen used for final impression .Expa-syl will hold its rigidity while in the sulcus to create space between therigidity while in the sulcus to create space between the tooth and the tissue, much like retraction cord does; unliketooth and the tissue, much like retraction cord does; unlike cord you need little or no pressure to apply expo-syl ,whichcord you need little or no pressure to apply expo-syl ,which greatly minimizes the risk of rupturing the epithelialgreatly minimizes the risk of rupturing the epithelial attachmentattachment www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71.  With Expa-syl time can be saved and aWith Expa-syl time can be saved and a comfortable experience provided to the patientcomfortable experience provided to the patient while setting stage for a quality restoration.while setting stage for a quality restoration.  When using before final cementation Expa-sylWhen using before final cementation Expa-syl completely replaces cord.completely replaces cord. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  Advantages :Advantages :  Causes no tissue damageCauses no tissue damage  Preserves epithelial attachmentPreserves epithelial attachment  Dry operating fieldDry operating field  Guarantees, regular, reversible retractionGuarantees, regular, reversible retraction of gums.of gums. www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. Recent advance in rubber damRecent advance in rubber dam  HandiDam :HandiDam :  HandiDam is the mostHandiDam is the most significant innovation insignificant innovation in rubber dam technology torubber dam technology to come along in years.come along in years. Pre-framed, saves timePre-framed, saves time and makes patientsand makes patients happy!happy!  Now available latex-freeNow available latex-free www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Recent advance in salivaRecent advance in saliva ejectorejector Lingua Fix :Lingua Fix :  Unique disposableUnique disposable saliva ejector thatsaliva ejector that isolates and protects theisolates and protects the tongue, evacuates fluidstongue, evacuates fluids while maintaining a drywhile maintaining a dry work area.work area.  Comfortable, no sharpComfortable, no sharp edges or corners. Usefuledges or corners. Useful when the assistant is notwhen the assistant is not present.present. www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. RECENT ADVANCE IN RETRACTIONRECENT ADVANCE IN RETRACTION CORDSCORDS Complete, successful tissue management requires absorbent, Ultrapak Knitted Cord for effective gingival displacement. Twisted and braided cords can't offer ease of packability and tissue displacement comparable to Ultrapak. It's made of 100% cotton that's knitted to form an interlocking chain of thousands of tin tiny loops, making it easy to pack below the gingival margin. www.indiandentalacademy.comwww.indiandentalacademy.com
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  81. 81. RECENT ADVANCE IN CORD PACKERSRECENT ADVANCE IN CORD PACKERS Gingi-Pak (Anterior) Gingi-Pak Packer (Posterior) www.indiandentalacademy.comwww.indiandentalacademy.com
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  83. 83.  SILICONE-HANDLED INSTRUMENTSSILICONE-HANDLED INSTRUMENTS ANTERIOR POSTERIOR www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. Review of literatureReview of literature  Sherman CRSherman CR,, Sherman BRSherman BR Atropine sulfate--aAtropine sulfate--a current review of a useful agent for controllingcurrent review of a useful agent for controlling salivation during dental procedures. Gen Dent.salivation during dental procedures. Gen Dent. 1999 Jan-Feb;47(1):56-60; quiz 62-3.1999 Jan-Feb;47(1):56-60; quiz 62-3.  This article, describe techniques for the controlThis article, describe techniques for the control of saliva during dental procedures; discuss theof saliva during dental procedures; discuss the problems associated with saliva contaminationproblems associated with saliva contamination of an operative field; explain the clinical benefits,of an operative field; explain the clinical benefits, dosing guidelines, and contraindications fordosing guidelines, and contraindications for using atropine sulfate to temporarily reduceusing atropine sulfate to temporarily reduce saliva flow during dental procedures.saliva flow during dental procedures. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85.  Jokstad AJokstad A. Clinical trial of gingival retraction. Clinical trial of gingival retraction cords J Prosthet Dent. 1999 Mar;81(3):258-61.cords J Prosthet Dent. 1999 Mar;81(3):258-61.  A wide spectrum of different gingival retractionA wide spectrum of different gingival retraction cords is used, while the relative clinical efficacy ofcords is used, while the relative clinical efficacy of these cords remains undocumented. This studythese cords remains undocumented. This study aimed to determine whether clinicians were ableaimed to determine whether clinicians were able to identify differences in clinical performanceto identify differences in clinical performance among 3 types of gingival retraction cords.among 3 types of gingival retraction cords.  Cords differed in consistency (knitted or twined)Cords differed in consistency (knitted or twined) and impregnation (8% dl-epinephrine HCl, 0.5and impregnation (8% dl-epinephrine HCl, 0.5 mg/in or 25% aluminum sulfate, 0.5 mg/in).mg/in or 25% aluminum sulfate, 0.5 mg/in). www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86.  The Knitted cords were ranked better thanThe Knitted cords were ranked better than twined cords (P =.03). Cords containingtwined cords (P =.03). Cords containing epinephrine performed no better clinically thanepinephrine performed no better clinically than aluminum sulfate cords (P >.05).aluminum sulfate cords (P >.05).  Finally they concluded that Clinicians wereFinally they concluded that Clinicians were unable to detect any clinical advantages of usingunable to detect any clinical advantages of using epinephrine impregnated gingival retractionepinephrine impregnated gingival retraction cords compared with aluminum sulfate cords.cords compared with aluminum sulfate cords. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87.  Terry. E. Donovan, Winston. W. L. Chee Current conceptsTerry. E. Donovan, Winston. W. L. Chee Current concepts in gingival displacement. DCNA 48:433-434,2004.in gingival displacement. DCNA 48:433-434,2004.  They explained three types of mechanical-chemicalThey explained three types of mechanical-chemical techniques for gingival displacement. Namely :techniques for gingival displacement. Namely : 1.Single cord technique1.Single cord technique 2.Double cord technique2.Double cord technique 3.Infusion method3.Infusion method  They also recommended numerous haemostaticThey also recommended numerous haemostatic medicaments that can be advocated for use with gingivalmedicaments that can be advocated for use with gingival retraction cords. This includes aluminium potassiumretraction cords. This includes aluminium potassium sulfate, aluminium sulfate, aluminium chloride andsulfate, aluminium sulfate, aluminium chloride and epinephrine.epinephrine. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88.  The single cord technique was indicatedThe single cord technique was indicated when making impressions of one to threewhen making impressions of one to three prepared teeth with healthy gingivalprepared teeth with healthy gingival tissues.tissues.  The double cord technique was usedThe double cord technique was used when making impressions of multiplewhen making impressions of multiple prepared teeth and when tissue healthprepared teeth and when tissue health was impossible to delay the procedure.was impossible to delay the procedure. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89.  The infusion technique of gingival displacementThe infusion technique of gingival displacement requires careful preparation of cervical marginsrequires careful preparation of cervical margins and hemorrhage should be controlled usingand hemorrhage should be controlled using dento-infuser with a ferric sulfate medicament.dento-infuser with a ferric sulfate medicament.  The infuser was carried circumferentially 360˚The infuser was carried circumferentially 360˚ around the sulcus. After hemostasis, a knittedaround the sulcus. After hemostasis, a knitted retraction cord was soaked in the ferric sulfateretraction cord was soaked in the ferric sulfate solution and packed into the sulcus. The cordsolution and packed into the sulcus. The cord was removed, the sulcus rinsed with water, andwas removed, the sulcus rinsed with water, and the impression made.the impression made. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. conclusionconclusion  In medicine, surgical procedures are done withIn medicine, surgical procedures are done with controller operating field’s surrounded by asepticcontroller operating field’s surrounded by aseptic environment .an attempt should be made inenvironment .an attempt should be made in restorative dentistry to work only on clean teethrestorative dentistry to work only on clean teeth and on a patient who is under control.and on a patient who is under control.  control should mean not only the elimination ofcontrol should mean not only the elimination of moisture but the elimination of humidity as wellmoisture but the elimination of humidity as well utilizing all the above mentioned measuresutilizing all the above mentioned measures.. www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91.  If the restored tooth and the periodontal tissuesIf the restored tooth and the periodontal tissues are to survive in health, proper management ofare to survive in health, proper management of gingival tissue prior to, during and subsequent togingival tissue prior to, during and subsequent to the fabrication of a restoration becomes a matterthe fabrication of a restoration becomes a matter of vital importance particularly in case of subof vital importance particularly in case of sub gingival placement of margins of restoration.gingival placement of margins of restoration.  The choice of method of soft tissue managementThe choice of method of soft tissue management depends on existing clinical condition and choicedepends on existing clinical condition and choice of the operator.of the operator. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. ReferencesReferences  Fundamentals of fixed prosthodontics-H.T.ShillingbergFundamentals of fixed prosthodontics-H.T.Shillingberg  Contemparary fixed prosthodontics-S.F.Roseintiel.Contemparary fixed prosthodontics-S.F.Roseintiel.  Tylman’s theory of practice of fixed prosthodontics.Tylman’s theory of practice of fixed prosthodontics.  Sherman CR, Sherman BR Atropine sulfate--a current review of aSherman CR, Sherman BR Atropine sulfate--a current review of a useful agent for controlling salivation during dental procedures.useful agent for controlling salivation during dental procedures. Gen Dent. 1999 Jan-Feb;47(1):56-60; quiz 62-3.Gen Dent. 1999 Jan-Feb;47(1):56-60; quiz 62-3.  Jokstad A. Clinical trial of gingival retraction cords J ProsthetJokstad A. Clinical trial of gingival retraction cords J Prosthet Dent. 1999 Mar;81(3):258-61.Dent. 1999 Mar;81(3):258-61.  Terry. E. Donovan, Winston. W. L. CheeTerry. E. Donovan, Winston. W. L. Chee Current concepts in gingivalCurrent concepts in gingival displacement. DCNA 48:433-434,2004.displacement. DCNA 48:433-434,2004.  Kellam SA, Smith JR, Scheffel SJ. Epinephrine absorption fromKellam SA, Smith JR, Scheffel SJ. Epinephrine absorption from commercial gingival retraction cords in clinical patients. : Jcommercial gingival retraction cords in clinical patients. : J Prosthet Dent. 1992 Nov;68(5):761-5.Prosthet Dent. 1992 Nov;68(5):761-5. www.indiandentalacademy.comwww.indiandentalacademy.com
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  100. 100. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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