MOISTURE CONTROLMOISTURE CONTROL
& SOFT TISSUE& SOFT TISSUE
MANAGEMENT INMANAGEMENT IN
FIXEDFIXED
PROSTHODONTICSPROSTHODON...
Table of contents:Table of contents:
 INTRODUCTIONINTRODUCTION
   REVIEW OF LITERATUREREVIEW OF LITERATURE
   FLUID CON...
 High volume suction devicesHigh volume suction devices
 SvedopterSvedopter
 CHEMICAL MEARURES-CHEMICAL MEARURES-
 Ant...
 GINGIVAL RETRACTIONGINGIVAL RETRACTION
 VARIOUS METHODS OF GINGIVALVARIOUS METHODS OF GINGIVAL
RETRACTION-RETRACTION-
...
 SUMMARYSUMMARY
 REFERENCESREFERENCES
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INTRODUCTIONINTRODUCTION
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Complete control of the environment ofComplete control of the environment of
the operative site is essential duringthe ope...
The pt’s mouth is a challengingThe pt’s mouth is a challenging
environment in which to make an accurateenvironment in whic...
When the preparation margins extendWhen the preparation margins extend
subgingivally,the adjacent gingival tissuessubgingi...
DEFINITIONS-DEFINITIONS-
 Gingival crevice: [ GPT 8]Gingival crevice: [ GPT 8]
a shallow fissure between the marginala sh...
 Gingival displacement / gingival retraction:Gingival displacement / gingival retraction:
[GPT-8 ][GPT-8 ]
the deflection...
Review of literatureReview of literature
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James Harrison 1961,11;514James Harrison 1961,11;514
 Effect of retraction material on the gingivalEffect of retraction m...
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 Labial & buccal sulcus were retracted forLabial & buccal sulcus were retracted for
5,10 & 30 mins.5,10 & 30 mins.
 They...
Felix Woycheshin JPDFelix Woycheshin JPD
1964,14;7691964,14;769
 Evaluation of drugs used for gingivalEvaluation of drugs...
Anthony LaForgia JPDAnthony LaForgia JPD
1967,17,3791967,17,379
 Cordless tissue retraction for fixedCordless tissue retr...
 These methods make impregnatedThese methods make impregnated
retraction cords unnecessary & avoid theirretraction cords ...
Henry Lampert JPDHenry Lampert JPD
1970,23,1641970,23,164
 Combined electrosurgery & gingivalCombined electrosurgery & gi...
 The author concludes that this techniqueThe author concludes that this technique
allows for making accurate impressions ...
Thomas Barker JPDThomas Barker JPD
1970,23,6551970,23,655
 Tooth isolation without rubber dam-Tooth isolation without rub...
J.Lee Singer JPD 1976,36,588J.Lee Singer JPD 1976,36,588
 Simplified copper tube impression for fullSimplified copper tub...
Pelzner et al JPD 1978,39,287Pelzner et al JPD 1978,39,287
 Human blood pressure & pulse rateHuman blood pressure & pulse...
 He concluded that pulse rate of ptHe concluded that pulse rate of pt
depended more on the level of anxiety &depended mor...
Robert Tupac et al JPDRobert Tupac et al JPD
1981,46,5091981,46,509
 A comparison of cord gingivalA comparison of cord gi...
 They concluded that there was noThey concluded that there was no
significant difference between the cordsignificant diff...
Edwin Wilson et al JPDEdwin Wilson et al JPD
1984,52,6631984,52,663
 Effect of Methantheline bromide &Effect of Methanthe...
 Clonidine hydrochloride was sufficientlyClonidine hydrochloride was sufficiently
effective in salivary reduction after f...
T.Donovan et al JPDT.Donovan et al JPD
1985,53,5251985,53,525
 Review & survey of medicaments usedReview & survey of medi...
 Equally effective agents such as alum,Equally effective agents such as alum,
aluminum sulphate & aluminum chloridealumin...
Rustam DeVitre et al JPDRustam DeVitre et al JPD
1986,54,1791986,54,179
 Biometric comparison of bur &Biometric compariso...
 They concluded that the bur methodThey concluded that the bur method
resulted in less tissue loss at each timeresulted i...
Luciano de Camargo et al JPDLuciano de Camargo et al JPD
1993,70,1141993,70,114
 Inhibition of polymerization of polyviny...
Marco Ferrari et al JPD 1996,Marco Ferrari et al JPD 1996,
75;24275;242
 Tissue management with a new gingivalTissue mana...
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Martin Land et al JPDMartin Land et al JPD
1996,76,4771996,76,477
 Smear layer instability caused bySmear layer instabili...
 Greatest smear layer removal wasGreatest smear layer removal was
observed by 21.3% aluminium chloride,8%observed by 21.3...
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Haim Baharav et al I JP 1997,Haim Baharav et al I JP 1997,
10,24810,248
 The effect of displacement time onThe effect of ...
 At both th mesiodistal & transitional lineAt both th mesiodistal & transitional line
angle, tissue displaced for 2 mins ...
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k.M.Martin et alk.M.Martin et al J. Dent 1997;
25: 347
 The protein content of dental rubber
dams-
 The purpose of this ...
 The results of this study confirm that all
the rubber dams tested contained
significant amounts of protein.
 The molecu...
Asbjorn Jokstad JPDAsbjorn Jokstad JPD
1999,81,2581999,81,258
 Clinical trial of gingival retraction cord-Clinical trial ...
 Knitted cords ranked better than twinedKnitted cords ranked better than twined
cords.Cords containing epinephrine wereco...
K. L. Chen, International
Endodontic Journal, 37, 507–511,
2004
 This report presents a technique to
simultaneously isola...
Jian Feng et alJian Feng et al J Prosthodont
2006;15:108
 The Effect of Gingival Retraction
Procedures on Periodontal Ind...
 It also provides the first evidence that
gingival retraction results in an elevation of
the proinflammatory cytokine, TN...
MOISTUR CONTROLMOISTUR CONTROL
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 The need for removal of fluid varies uponThe need for removal of fluid varies upon
the task being performed.During theth...
 Several types of attachments can be usedSeveral types of attachments can be used
with low volume [ saliva ejector] or hi...
Moisture control measures:Moisture control measures:
1.1. MechanicalMechanical
2.2. ChemicalChemical
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Mechanical:Mechanical:
1.1. Cotton- rollsCotton- rolls
pelletspellets
2.2. Moisture absorbent devices-Moisture absorbent d...
4.4. Low volume suction devices-Low volume suction devices-
I) suction tips/ saliva ejectors:I) suction tips/ saliva eject...
5. High volume evacuators5. High volume evacuators
6. Svedoptor/ Speejector: consists of 4-parts6. Svedoptor/ Speejector: ...
CHEMICALCHEMICAL
 Anti sailogogues:Anti sailogogues:
i) Anticholinergics-i) Anticholinergics-
1.1. AtropineAtropine
2.2. ...
ii) anti-hypertensives –ii) anti-hypertensives –
1.1. Clonidine hydrochlorideClonidine hydrochloride
iii) Local anesthetic...
COTTON ROLLSCOTTON ROLLS
 ABSORBANTS such as cotton roll areABSORBANTS such as cotton roll are
helpful for short period o...
 Especially in conjuction withEspecially in conjuction with
anaesthesia ,cotton rolls provideanaesthesia ,cotton rolls pr...
 Commercially available ones are-Commercially available ones are-
- star cotton rollsstar cotton rolls
- Roeka cotton rol...
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-retracts cheek effectively-retracts cheek effectively
-keeps its shape and does not fall apart when-keeps its shape and d...
 Sizes-Sizes-
- 000 -1.5 gm000 -1.5 gm
- 00 -4 gm00 -4 gm
- 0 -4 gm0 -4 gm
- 1 -10 gm1 -10 gm
- 2 -10 gm2 -10 gm
www.indi...
Cotton roll holder-Cotton roll holder-
 Several commercial devices areSeveral commercial devices are
available for holdin...
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 The maxillary teeth are isolated by placingThe maxillary teeth are isolated by placing
a medium size cotton roll in the ...
 The mandibular teeth are isolated byThe mandibular teeth are isolated by
placing one medium sized cotton roll inplacing ...
Absorbant devices-Absorbant devices-
-Dry tips-Dry tips
-Dry angles-Dry angles
-Reflective shields-Reflective shields
Thes...
Dry tips*Dry tips*
[moisture absorbing cards][moisture absorbing cards]
 Keeps the parotid gland in check forKeeps the pa...
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Dry Angles*Dry Angles*
 Available in 2 sizesAvailable in 2 sizes
- SmallSmall
- LargeLarge
**((Dental Health ProductsDent...
Reflective sheilds*Reflective sheilds*
 Heart-shaped pads abate moisture during
common dental procedures. Shields have
a ...
 When removing absorbent cards/celluloseWhen removing absorbent cards/cellulose
wafers it may be necessary to moistenwafe...
Tooth isolation with cotton padTooth isolation with cotton pad
& reflective blotting paper*& reflective blotting paper*
 ...
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Rubber Dam:Rubber Dam:
 In 1864 S.C Barnum, a NY dentistIn 1864 S.C Barnum, a NY dentist
introduced the rubber dam.introd...
AdvantagesAdvantages
 Dry clean Operating field-Dry clean Operating field-
teeth prepared & restored using a rubberteeth ...
 Access & visibility-Access & visibility-
-provides maximum access &-provides maximum access &
visibility.Gingival tissue...
 Improved properties of dental materials-Improved properties of dental materials-
RD prevents moisture contamination ofRD...
 Operating efficiency-Operating efficiency-
use of RD allows for increased efficiencyuse of RD allows for increased effic...
Disadvantages-Disadvantages-
 Time consumingTime consuming
 Certain conditions preclude theCertain conditions preclude t...
Armamentarium-Armamentarium-
 Rubber dam materialRubber dam material
-latex-latex
-non- latex-non- latex
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Rubber Dam HolderRubber Dam Holder
 Two types:Two types:
- Young’s U metal frameYoung’s U metal frame
- Plastic framePlas...
Hygenic®
Framed Non-Latex Flexi Dam
•• Convenient built-in-frame – saves timeConvenient built-in-frame – saves time
• High...
Derma Frame*Derma Frame*
 Derma Frame is a pliable metal rubberDerma Frame is a pliable metal rubber
dam frame. DermaFram...
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Rubber Dam retainer-Rubber Dam retainer-
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Rubber dam punchRubber dam punch
 Is a precision instrument having a rotatingIs a precision instrument having a rotating
...
Rubber Dam retainer forceps-Rubber Dam retainer forceps-
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Rubber dam napkin-Rubber dam napkin-
 Placed between the rubber dam & thePlaced between the rubber dam & the
skinskin
 A...
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Rubber Dam templatesRubber Dam templates
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hygenic ivory
Satin steel
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Hole sizesHole sizes
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Hole Position:Hole Position:
 The following guidelines should beThe following guidelines should be
followed-followed-
 W...
 When operating on premolar punch holesWhen operating on premolar punch holes
to include at least two teeth distallyto in...
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Placement-Placement-
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Use of a molar clamp to isolate two
adjacent single-rooted teeth: a clinical
aid*
*International Endodontic Journal, 37, 5...
 Clinically, it is common to find severely
broken-down (decoronated) teeth
following removal of poorly fitting crowns
and...
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 Technique:
 Select an appropriate molar clamp:
1. The mesial–distal clamp jaw distance
should be equal to the mesial–di...
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Rubber dam isolation of FPD*Rubber dam isolation of FPD*
 Cut the dam to slip over the entire FPDCut the dam to slip over...
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MOISTURE CONTROLMOISTURE CONTROL
& SOFT TISSUE& SOFT TISSUE
MANAGEMENT INMANAGEMENT IN
FIXEDFIXED
PROSTHODONTICSPROSTHODON...
High volume evacuators-High volume evacuators-
 When a high speed hand piece is usedWhen a high speed hand piece is used
...
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 It serves as an excellent lip/ cheekIt serves as an excellent lip/ cheek
retractor while the operator uses a mirrorretra...
 Its use is not practical during theIts use is not practical during the
impression or cementation phase.impression or cem...
Saliva EjectorSaliva Ejector
 Or low volume suction tips remove salivaOr low volume suction tips remove saliva
that colle...
I) suction tips/ saliva ejectors:I) suction tips/ saliva ejectors:
a) disposable saliva ejectorsa) disposable saliva eject...
 Commercially available disposable salivaCommercially available disposable saliva
ejectors-ejectors-
- pearson saliva eje...
Hygoformic Disposable*-Hygoformic Disposable*-
 *Pulpdent Corp.*Pulpdent Corp.
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 The coil eliminates the sharp edges andThe coil eliminates the sharp edges and
hard blunt tip which irritate soft tissue...
Accessories:Accessories:
 Super Sof-Ti Saliva Ejector TipsSuper Sof-Ti Saliva Ejector Tips
 are made of soft, indestruct...
 SUCTION TIP SLEEVES (PDI)
 Fully autoclavable.
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Reusable saliva ejectorsReusable saliva ejectors
 Commercially available:Commercially available:
- otis saliva ejector [ ...
 The ejector is placed in the corner of theThe ejector is placed in the corner of the
mouth opposite the quadrant beingmo...
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Svedopter/ Speejector*Svedopter/ Speejector*
 is handy & combines the functions of ais handy & combines the functions of ...
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 Commercially available-Commercially available-
 Svedopter [ E C Moore Co ]Svedopter [ E C Moore Co ]
 Speejector[ Pulp...
 By adding facial & lingual cotton rollsBy adding facial & lingual cotton rolls
excellent control & isolation is provided...
 The svedopter is most effective when it isThe svedopter is most effective when it is
used with the pt in a nearly uprigh...
Drawbacks-Drawbacks-
 Access to lingual surface of mand teethAccess to lingual surface of mand teeth
limitedlimited
 Mig...
Better positionBetter position
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Linguafix [ disposable]Linguafix [ disposable]
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Throat sheildsThroat sheilds
 IndicationsIndications
- when small instruments are used withoutwhen small instruments are ...
 A gauze sponge (2 x 2 inch) unfolded &A gauze sponge (2 x 2 inch) unfolded &
spread over tongue & posterior part ofsprea...
AntisialagoguesAntisialagogues
 For the pt’s who saliavate excessivelyFor the pt’s who saliavate excessively
some other m...
ii) anti-hypertensives –ii) anti-hypertensives –
1.1. Clonidine hydrochlorideClonidine hydrochloride
iii) Local anesthetic...
Anticholinergics -Anticholinergics -
 They block the parasympatheticThey block the parasympathetic
innervation & thereby ...
Sal-tropine*Sal-tropine*
 Doseage- 0.4 mgDoseage- 0.4 mg
* Hope Pharma* Hope Pharma
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Methanthiline bromide*-Methanthiline bromide*-
( Banthine )( Banthine )
 Originally developed for prptic ulcers.Originall...
 Dosage- [Banthine] 50 mg 1hr beforeDosage- [Banthine] 50 mg 1hr before
treatmenttreatment
 [Probanthine]* 15 mg 1 hr be...
Clonidine Hydrochloride*Clonidine Hydrochloride*
 Is an antihypertensiveIs an antihypertensive
 Side effects-Side effect...
 Doseage- 0.2 mg 1 hr before theDoseage- 0.2 mg 1 hr before the
treatment.treatment.
 Effect –upto 2 hr after administra...
Gingival RetractionGingival Retraction
 Indirect restorations including cast goldIndirect restorations including cast gol...
 In these instances the clinician must makeIn these instances the clinician must make
impressions that adequately capture...
 The goal of this procedure is to reversiblyThe goal of this procedure is to reversibly
displace the gingival tissues in ...
Gingival retraction -Gingival retraction -
 Can be broadly classified as:*Can be broadly classified as:*
1.1. MechanicalM...
Mechanical methods-Mechanical methods-
 Cord less retraction:*Cord less retraction:*
1.1. Copper band or tubeCopper band ...
 Other technique:Other technique:
1.1. Plain retraction cordPlain retraction cord
2.2. Cotton threadCotton thread
3.3. Un...
Copper tube & modellingCopper tube & modelling
compound-compound-
* JPD 1976,36,588* JPD 1976,36,588
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Ruel J et al JPD 1980,44,508Ruel J et al JPD 1980,44,508
 Metal band with modelling compound wasMetal band with modelling...
Copper tube & rubber baseCopper tube & rubber base
impression material-impression material-
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Relining a primary impression*-Relining a primary impression*-
 A diagnostic impression is made &A diagnostic impression ...
 A primary impression is made of theA primary impression is made of the
completed preparation with heavy bodycompleted pr...
 The surplus rubber is removed 7 the trayThe surplus rubber is removed 7 the tray
is trimmed with burs so that impresioni...
 Incisal & occlusal portions of theIncisal & occlusal portions of the
impression are perforated to createimpression are p...
 Medium body rubber base material isMedium body rubber base material is
mixed & loaded in the tray &placed intomixed & lo...
Extending an acrylic resin trayExtending an acrylic resin tray
with resin beading:*with resin beading:*
 A sat of the ent...
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 The teeth are prepared.The teeth are prepared.
 The resin tray or coping is filled with coldThe resin tray or coping is...
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 The impression is removed & the surplusThe impression is removed & the surplus
is cut & perforations are made.is cut & p...
Aluminium shell*-Aluminium shell*-
 They should be one or two size larger.They should be one or two size larger.
* K E Th...
 The shell are trimmed after teeth areThe shell are trimmed after teeth are
prepared & buccal surfaces are identified.pre...
 A thin coat of adhesive is applied &A thin coat of adhesive is applied &
primary impression is made with heavyprimary im...
Temporary crown with GP -*Temporary crown with GP -*
 Filled with gutta percha or temporaryFilled with gutta percha or te...
Disadvantages-Disadvantages-
 Non reversible tissue displacementNon reversible tissue displacement
 Gingival attachment ...
Cotton twill & ZnOE-Cotton twill & ZnOE-
 Cotton twills the size of floss are rolled in aCotton twills the size of floss ...
Advantages-Advantages-
1.1. Most conservative in terms of tissueMost conservative in terms of tissue
tolerancetolerance
2....
RETRACTION CORDSRETRACTION CORDS
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Classification:Classification:
 Broadly classified as-Broadly classified as-
1.1. ImpregnatedImpregnated
2.2. Non-impregn...
 Depending on configuration:Depending on configuration:
1.1. TwistedTwisted
2.2. KnittedKnitted
3.3. BraidedBraided
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Configuration-Configuration-
 Twisted cords:Allow the dentist to customise theTwisted cords:Allow the dentist to customis...
 Depending on wettability-Depending on wettability-
1.1. DryDry
2.2. Wet [ coated with a gel sol]Wet [ coated with a gel ...
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 Depending on surface finish-Depending on surface finish-
1.1. WaxedWaxed
2.2. unwaxedunwaxed
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 Depending on the thickness they areDepending on the thickness they are
color coded-color coded-
1.1. Black-000(extra sma...
Ideal Requirements-Ideal Requirements-
 Should be dark in colorShould be dark in color
 Should be effective for its inte...
 Should be available in different diametersShould be available in different diameters
 Should not stick to the soft tiss...
Commercially available ones-Commercially available ones-
 Sulpak braided cords; Sultan dental.Sulpak braided cords; Sulta...
 Hemodent cords, Premier dental.Hemodent cords, Premier dental.
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UniBraid ;Dux dental
 UniBraid is pre-cut and individually packaged inUniBraid is pre-cut and individually packaged in
tw...
Gingi braid; Dux dentalGingi braid; Dux dental
 Sizes: O (smallest) - 3 (largest).Sizes: O (smallest) - 3 (largest).
 Av...
Gingigel ; Dux dentalGingigel ; Dux dental
 GingiGel is saturated and coated with 20%GingiGel is saturated and coated wit...
GingiYarn; Dux dentalGingiYarn; Dux dental
 features a soft and absorbent twisted yarn that isfeatures a soft and absorbe...
Chemical medicaments-Chemical medicaments-
 A variety of medicaments are available forA variety of medicaments are availa...
Criteria*-Criteria*-
 Effectiveness-use of medicament mustEffectiveness-use of medicament must
result in sufficient lat &...
 Should not produce potential harmful sideShould not produce potential harmful side
effects-effects-
consideration should...
Medicaments-Medicaments-
 EpinephrineEpinephrine
 Alumilium chlorideAlumilium chloride
 Aluminium sulfateAluminium sulf...
 Zinc chlorideZinc chloride
 TetrahydrozolineTetrahydrozoline
 oxymetazolineoxymetazoline
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 These materials are typically dispensed inThese materials are typically dispensed in
aqueous or glycol/ aqueous buffered...
Aluminium sulfate-Aluminium sulfate-
 Conc used: 25% & 100%Conc used: 25% & 100%
 Both aluminium sulfate & chloride areB...
advantages :advantages :
- minimal tissue lossminimal tissue loss
- Extended working timeExtended working time
Disadvantag...
Van R dental productsVan R dental products
 Astringloid Hemogin-LAstringloid Hemogin-L
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Aluminium Chloride-Aluminium Chloride-
 Conc used- 5% & 25%Conc used- 5% & 25%
 Recommended time- 10 minRecommended time...
Hemodent,Premier dentalHemodent,Premier dental
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Styptin,VanR dental Pe KopaStyptin,VanR dental Pe Kopa
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Zinc Chloride-Zinc Chloride-
 Conc – 8% & 40%Conc – 8% & 40%
 Class- cautery agentClass- cautery agent
 High conc of Zn...
 Adv- good tissue displacement.Adv- good tissue displacement.
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Tannic acid-Tannic acid-
 Conc- 20% & 100%Conc- 20% & 100%
 Recommended time- 10 minRecommended time- 10 min
 Adv- good...
Negatol -Negatol -
 Conc-10% & 100%Conc-10% & 100%
 Class- chemical cautery agentClass- chemical cautery agent
 Adv- go...
Monsel’s soln-Monsel’s soln-
 Is ferric subsulfateIs ferric subsulfate
 Conc 72%Conc 72%
 Recommended time-3 minRecomme...
Ferric sulfate-Ferric sulfate-
 Conc –13.3%,15% & 20%Conc –13.3%,15% & 20%
 Recommended time- 1-3 minRecommended time- 1...
 Disadv-Disadv-
- not compatible with epinephrinenot compatible with epinephrine
- Transient tissue discolorationTransien...
Hemostatic, Premier dentalHemostatic, Premier dental
 15.5% conc15.5% conc
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Viscostat clear viscostat- wintermintViscostat clear viscostat- wintermint
Ultradent;utahUltradent;utah
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Epinephrine-Epinephrine-
 Conc- 0.1% & 8%Conc- 0.1% & 8%
 Adv-Adv-
- good displacementgood displacement
- Min tissue los...
 Is a potent myocardial stimulant.it causesIs a potent myocardial stimulant.it causes
vasoconstriction in many vascular b...
 Max dose in healthy adult- 0.2 mgMax dose in healthy adult- 0.2 mg
 ““ in cardiac pt’s -0.04 mgin cardiac pt’s -0.04 mg...
 Epinephrine syndrome*-Epinephrine syndrome*-
 Includes tachycardia, increasedIncludes tachycardia, increased
respiratio...
Newer medicaments-Newer medicaments-
 0.5% tetratrydrozoline [ visine; Pfizer inc]0.5% tetratrydrozoline [ visine; Pfizer...
 0.5 oxymetazoline [ Afrine spray; Schering0.5 oxymetazoline [ Afrine spray; Schering
corp]corp]
 pH- 6.3,therefore kind...
Placement procedure-*Placement procedure-*
*Shillinburg,Fundamentals of fixed prosthodontics
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 If a twisted or wound cord is used, grasspIf a twisted or wound cord is used, grassp
the ends between thumb & forefinger...
 Be careful not to touch any of the cordBe careful not to touch any of the cord
other than the ends, which will be cut of...
 Cords impregnated with epinephrine orCords impregnated with epinephrine or
aluminum sulfate are twice as effectivealumin...
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 By placing the instrument initially flatBy placing the instrument initially flat
against the enamel & then engaging thea...
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 The overlapping must always occur in theThe overlapping must always occur in the
interproximal area where the bulk of th...
Single cord technique-*Single cord technique-*
 Indications-Indications-
- making impressions of one to threemaking impre...
 Tooth preparation is accomplished & theTooth preparation is accomplished & the
cervical margins are dropped to thecervic...
 A length of gingival retraction of cord isA length of gingival retraction of cord is
selected to specifically match the ...
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 The cord is soaked in medicament ofThe cord is soaked in medicament of
choice [ Hemodent]choice [ Hemodent]
 Excess med...
Double cord technique-*Double cord technique-*
 Indications-Indications-
- making impresssions for multiple teethmaking i...
 A small dia cord [ deknetal 2/0 surgical silkA small dia cord [ deknetal 2/0 surgical silk
is placed in the sulcusis pla...
 The end of the cord should be cut so thatThe end of the cord should be cut so that
they exactly abut against one another...
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 After waiting 8-10 mins the second cord isAfter waiting 8-10 mins the second cord is
soaked in water & removed.soaked in...
Infusion technique-*Infusion technique-*
 After careful preperation of the cervicalAfter careful preperation of the cervi...
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 The 20 % material is preffered because itThe 20 % material is preffered because it
is less acidic than 15% soln & does n...
 When hemostasis is achieved,a knittedWhen hemostasis is achieved,a knitted
retraction cord is packed in sulcus.retractio...
Every tooth technique-*Every tooth technique-*
 Indication-Indication-
- with teeth in root proximity placingwith teeth i...
 In this tech retraction cord is placedIn this tech retraction cord is placed
around the most distal prepared tooth.aroun...
Selective double cordSelective double cord
technique-technique-
 Recommended when spontaneousRecommended when spontaneous...
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MEROCELMEROCEL
 Is a synthetic sponge like material that isIs a synthetic sponge like material that is
specifically exdtr...
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Advantages-Advantages-
 Chemically pureChemically pure
 Easily shapedEasily shaped
 Remarkably effective for absorption...
 Example-Example-
 Merocel [ Medtronic solan]Merocel [ Medtronic solan]
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Procedure*-Procedure*-
* JPD 1996,75,242* JPD 1996,75,242www.indiandentalacademy.comwww.indiandentalacademy.com
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MOISTURE CONTROLMOISTURE CONTROL
& SOFT TISSUE& SOFT TISSUE
MANAGEMENT INMANAGEMENT IN
FIXEDFIXED
PROSTHODONTICSPROSTHODON...
Newer Materials-Newer Materials-
 Expasyl [ Kerr dental]Expasyl [ Kerr dental]
 Magic foam [ coltene –whaledent]Magic fo...
Gingi-Trax retraction systemGingi-Trax retraction system
[for single preparations][for single preparations]
www.indiandent...
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Retraction technique for multipleRetraction technique for multiple
preperations-preperations-
www.indiandentalacademy.comw...
Rotary curettage [ gingettage]Rotary curettage [ gingettage]
 Was described by Amsterdam in 1954.Was described by Amsterd...
 Prerequisite:Prerequisite:
 Must be done only on healthy,Must be done only on healthy,
inflammation-free tissue to avoi...
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 Less change in gingival height with rotaryLess change in gingival height with rotary
curettage than with lateral gingiva...
 There was no significant differenceThere was no significant difference
between the cord gingival displacement &between t...
Electrosurgical –Electrosurgical –
[ subgingival tissue troughing][ subgingival tissue troughing]
 Electrosurgery:[ accor...
 UsesUses--
 CuttingCutting
 coagulationcoagulation
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 Principle-Principle-
 Tissues are naturally resistant to highTissues are naturally resistant to high
frequency waveform...
Electrosurgical unit -Electrosurgical unit -
 The units vary in power from 25 watts toThe units vary in power from 25 wat...
Electrosurgical unit -Electrosurgical unit -
 Current genetrator- Ellman Dento-surgCurrent genetrator- Ellman Dento-surg
...
Active electrode-Active electrode-
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Passive electrode-Passive electrode-
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waveformswaveforms
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Procedure-Procedure-
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15-20 deg
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Oringer’s solution-Oringer’s solution-
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Lasers -Lasers -
 The term laser is an acronym. TheThe term laser is an acronym. The
term LASER stands for-Lightterm LASE...
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 The 320micro m & especially the 200-The 320micro m & especially the 200-
micro m fidre diode is used along the Nd:micro ...
 Pulse rate used – 10 pulse/ secPulse rate used – 10 pulse/ sec
 To coagulate the bleeding points- 10-20To coagulate the...
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Argon laserArgon laser
 Argon laser provide excellent hemostasisArgon laser provide excellent hemostasis
& efficient coag...
Thank you
For more details please visit
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Moisture control & soft tissue manipulation / fixed orthodontics courses

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  1. 1. MOISTURE CONTROLMOISTURE CONTROL & SOFT TISSUE& SOFT TISSUE MANAGEMENT INMANAGEMENT IN FIXEDFIXED PROSTHODONTICSPROSTHODONTICS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. Table of contents:Table of contents:  INTRODUCTIONINTRODUCTION    REVIEW OF LITERATUREREVIEW OF LITERATURE    FLUID CONTROL MEASURES-FLUID CONTROL MEASURES-    Cotton rollsCotton rolls  Moisture absorbent devices-Moisture absorbent devices-  Rubber damRubber dam  Low volume suction devicesLow volume suction devices www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3.  High volume suction devicesHigh volume suction devices  SvedopterSvedopter  CHEMICAL MEARURES-CHEMICAL MEARURES-  AnticholinergicsAnticholinergics  AntihypertensivesAntihypertensives  Local anaestheticsLocal anaesthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4.  GINGIVAL RETRACTIONGINGIVAL RETRACTION  VARIOUS METHODS OF GINGIVALVARIOUS METHODS OF GINGIVAL RETRACTION-RETRACTION-  MechanicalMechanical  Mechano-chemicalMechano-chemical  GingitageGingitage  ElectrosurgicalElectrosurgical  laserlaser www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5.  SUMMARYSUMMARY  REFERENCESREFERENCES www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. INTRODUCTIONINTRODUCTION www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. Complete control of the environment ofComplete control of the environment of the operative site is essential duringthe operative site is essential during restorative dental procedures.restorative dental procedures. Because its neither possible norBecause its neither possible nor desirable to make patterns for fixeddesirable to make patterns for fixed prosthesis directly in the mouth, anprosthesis directly in the mouth, an impression of teeth & surroundingimpression of teeth & surrounding structures is necessary to obtain a cast.structures is necessary to obtain a cast. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. The pt’s mouth is a challengingThe pt’s mouth is a challenging environment in which to make an accurateenvironment in which to make an accurate impression.Moisture control is probablyimpression.Moisture control is probably one of the most important aspects ofone of the most important aspects of successful impression making.successful impression making. Except for Polyethers, all the elastomericExcept for Polyethers, all the elastomeric impression materials are hydrophobic &impression materials are hydrophobic & any moisture will result in voids.any moisture will result in voids. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. When the preparation margins extendWhen the preparation margins extend subgingivally,the adjacent gingival tissuessubgingivally,the adjacent gingival tissues must be displaced laterally to allow accessmust be displaced laterally to allow access & to provide adequate thickness of& to provide adequate thickness of impression material.This may requireimpression material.This may require enlarging the gingival sulcus throughenlarging the gingival sulcus through mechanical, chemical or surgical means &mechanical, chemical or surgical means & must be done without jeopardizingmust be done without jeopardizing periodontal health.periodontal health. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. DEFINITIONS-DEFINITIONS-  Gingival crevice: [ GPT 8]Gingival crevice: [ GPT 8] a shallow fissure between the marginala shallow fissure between the marginal gingiva & the enamel or cementum.It isgingiva & the enamel or cementum.It is bounded by the tooth surface on onebounded by the tooth surface on one side , the crevicular epithelium on theside , the crevicular epithelium on the other, & the coronal end of the junctionalother, & the coronal end of the junctional epithelium at its most apical point- calledepithelium at its most apical point- called also gingival sulcus.also gingival sulcus. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  Gingival displacement / gingival retraction:Gingival displacement / gingival retraction: [GPT-8 ][GPT-8 ] the deflection of the marginal away from athe deflection of the marginal away from a tooth.tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. Review of literatureReview of literature www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. James Harrison 1961,11;514James Harrison 1961,11;514  Effect of retraction material on the gingivalEffect of retraction material on the gingival sulcus epithelium-sulcus epithelium-  In this histological study dogs were usedIn this histological study dogs were used as experimental animals. The retractionas experimental animals. The retraction materials were untreated strings & stringsmaterials were untreated strings & strings saturated with 1) 1:1000 epinephrine 2)saturated with 1) 1:1000 epinephrine 2) 8% epinephrine 3) 100% alum 4) 8% zinc8% epinephrine 3) 100% alum 4) 8% zinc chloride 5) 40% zinc chloridechloride 5) 40% zinc chloride www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15.  Labial & buccal sulcus were retracted forLabial & buccal sulcus were retracted for 5,10 & 30 mins.5,10 & 30 mins.  They concluded that mechanical &They concluded that mechanical & chemical retraction material do injure thechemical retraction material do injure the gingival sulcus. The injuries excludinggingival sulcus. The injuries excluding those caused by Zn chloride healed in 7 tothose caused by Zn chloride healed in 7 to 10 days.10 days.  Strings saturated with 8 & 40 % ZnStrings saturated with 8 & 40 % Zn chloride is not recommended for use.chloride is not recommended for use. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. Felix Woycheshin JPDFelix Woycheshin JPD 1964,14;7691964,14;769  Evaluation of drugs used for gingivalEvaluation of drugs used for gingival retractionretraction--  He concluded that most of the materialsHe concluded that most of the materials used for retraction are effective inused for retraction are effective in shrinking tissuesshrinking tissues  Zinc chloride is caustic & high conc willZinc chloride is caustic & high conc will cauterize the tissuecauterize the tissue  Negatan is highly acidic & decalcifies theNegatan is highly acidic & decalcifies the tooth.tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. Anthony LaForgia JPDAnthony LaForgia JPD 1967,17,3791967,17,379  Cordless tissue retraction for fixedCordless tissue retraction for fixed prosthesisprosthesis--  New techniques for making impressions ofNew techniques for making impressions of subgingival prepared margins have beensubgingival prepared margins have been described.described.  They are –They are –  Relining a primary impression, beading aRelining a primary impression, beading a cold cure resin tray & making a impressioncold cure resin tray & making a impression in an aluminium shellin an aluminium shell www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18.  These methods make impregnatedThese methods make impregnated retraction cords unnecessary & avoid theirretraction cords unnecessary & avoid their disadvantages.disadvantages. www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Henry Lampert JPDHenry Lampert JPD 1970,23,1641970,23,164  Combined electrosurgery & gingivalCombined electrosurgery & gingival retractionretraction--  This article describes a method forThis article describes a method for retraction which allows ample workingretraction which allows ample working time & the making of excellent impressiontime & the making of excellent impression in a field free from capillary seepage.in a field free from capillary seepage. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20.  The author concludes that this techniqueThe author concludes that this technique allows for making accurate impressions ofallows for making accurate impressions of multiple prepared teethmultiple prepared teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. Thomas Barker JPDThomas Barker JPD 1970,23,6551970,23,655  Tooth isolation without rubber dam-Tooth isolation without rubber dam-  This article acquaints the dentist withThis article acquaints the dentist with means of isolating a tooth other thanmeans of isolating a tooth other than rubber dam using Bibulous paper, blottingrubber dam using Bibulous paper, blotting lint lined with foil & cotton rolls.lint lined with foil & cotton rolls.  The report was intended in simulatingThe report was intended in simulating interest in ways of isolating teeth wheninterest in ways of isolating teeth when rubber dam cannot be used.rubber dam cannot be used. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. J.Lee Singer JPD 1976,36,588J.Lee Singer JPD 1976,36,588  Simplified copper tube impression for fullSimplified copper tube impression for full crown coveragecrown coverage--  Using modelling compound.Using modelling compound.  He concludes that with this method needHe concludes that with this method need for retraction is eliminated & an accuratefor retraction is eliminated & an accurate selection & fitting of the tube can beselection & fitting of the tube can be carried with a min of time.carried with a min of time. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. Pelzner et al JPD 1978,39,287Pelzner et al JPD 1978,39,287  Human blood pressure & pulse rateHuman blood pressure & pulse rate response to Epinephrine retraction cord-response to Epinephrine retraction cord-  This study was done to evaluate the CVSThis study was done to evaluate the CVS effect ,clinical reliability of epinephrineeffect ,clinical reliability of epinephrine impregnated retraction cords.impregnated retraction cords. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24.  He concluded that pulse rate of ptHe concluded that pulse rate of pt depended more on the level of anxiety &depended more on the level of anxiety & stress than on the level of epinephrine.stress than on the level of epinephrine.  BP is raised by placement of EpinephrineBP is raised by placement of Epinephrine retraction cord upon an exposed vascularretraction cord upon an exposed vascular bed.bed.  4% epinephrine causes less elevation of4% epinephrine causes less elevation of BP than 8%.BP than 8%. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. Robert Tupac et al JPDRobert Tupac et al JPD 1981,46,5091981,46,509  A comparison of cord gingivalA comparison of cord gingival displacement with the gingitage technique-displacement with the gingitage technique-  15 adult dogs were divided into three15 adult dogs were divided into three groups representing 0, 7 & 21 day healinggroups representing 0, 7 & 21 day healing periods.Randomly selected cuspid teethperiods.Randomly selected cuspid teeth were used.were used. www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26.  They concluded that there was noThey concluded that there was no significant difference between the cordsignificant difference between the cord displacement & gingitage technique.displacement & gingitage technique. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. Edwin Wilson et al JPDEdwin Wilson et al JPD 1984,52,6631984,52,663  Effect of Methantheline bromide &Effect of Methantheline bromide & clonidine hydrochloride on salivaryclonidine hydrochloride on salivary secretion-secretion-  Methantheline bromide [ 50mg] &Methantheline bromide [ 50mg] & clonidine hydrochloride[ 0.1 to 0.2 mg]clonidine hydrochloride[ 0.1 to 0.2 mg] both reduced salivary output.both reduced salivary output.  Both were equally effective in theBoth were equally effective in the reduction of salivation 60,90 & 120 minreduction of salivation 60,90 & 120 min after medication.after medication. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28.  Clonidine hydrochloride was sufficientlyClonidine hydrochloride was sufficiently effective in salivary reduction after fastingeffective in salivary reduction after fasting & post pandial.& post pandial. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. T.Donovan et al JPDT.Donovan et al JPD 1985,53,5251985,53,525  Review & survey of medicaments usedReview & survey of medicaments used with gingival retraction cords-with gingival retraction cords-  Data from survey of 495 dentists indicatedData from survey of 495 dentists indicated that most use mechano- chemical methodthat most use mechano- chemical method of retraction & 79.3% use cord containingof retraction & 79.3% use cord containing epinephrine.epinephrine. www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30.  Equally effective agents such as alum,Equally effective agents such as alum, aluminum sulphate & aluminum chloridealuminum sulphate & aluminum chloride exert no systemic effects.exert no systemic effects.  Therefore there is little indication for theTherefore there is little indication for the use of epinephrine retraction cord.use of epinephrine retraction cord. www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Rustam DeVitre et al JPDRustam DeVitre et al JPD 1986,54,1791986,54,179  Biometric comparison of bur &Biometric comparison of bur & electrosurgical retraction methodelectrosurgical retraction method  Twenty pts in need of maxillary anteriorTwenty pts in need of maxillary anterior full-crown restoration were divided in2full-crown restoration were divided in2 groupsgroups - group A: retraction with electrosurgery &group A: retraction with electrosurgery & 10% alum cord10% alum cord - Group B: retraction with a no.12 fluted burGroup B: retraction with a no.12 fluted bur & 10% alum cord.& 10% alum cord. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32.  They concluded that the bur methodThey concluded that the bur method resulted in less tissue loss at each timeresulted in less tissue loss at each time interval tested.interval tested. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. Luciano de Camargo et al JPDLuciano de Camargo et al JPD 1993,70,1141993,70,114  Inhibition of polymerization of polyvinylInhibition of polymerization of polyvinyl siloxane by medicaments used on gingivalsiloxane by medicaments used on gingival retraction cords-retraction cords-  Following conclusions appear valid-Following conclusions appear valid- - latex rubber can inhibit the set oflatex rubber can inhibit the set of polyvinylsiloxane.polyvinylsiloxane. - None of the medicaments tested had anyNone of the medicaments tested had any inhibitory effect whatsoever.inhibitory effect whatsoever. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Marco Ferrari et al JPD 1996,Marco Ferrari et al JPD 1996, 75;24275;242  Tissue management with a new gingivalTissue management with a new gingival retraction material-retraction material-  A new material [ Merocel] was evaluatedA new material [ Merocel] was evaluated in a clinical trial with 10 selectedin a clinical trial with 10 selected abutments.abutments.  The material was evaluated by SEMThe material was evaluated by SEM also.This priliminary study suggested thatalso.This priliminary study suggested that Merocel strip was a predictable retractionMerocel strip was a predictable retraction material.material. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Martin Land et al JPDMartin Land et al JPD 1996,76,4771996,76,477  Smear layer instability caused bySmear layer instability caused by hemostatic agents-hemostatic agents-  Standardized dentinal smear layer wereStandardized dentinal smear layer were exposed to eight astringent solutions forexposed to eight astringent solutions for 30,120,300 sec.30,120,300 sec. www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37.  Greatest smear layer removal wasGreatest smear layer removal was observed by 21.3% aluminium chloride,8%observed by 21.3% aluminium chloride,8% epinephrine& 15.5% ferric sulfate & leastepinephrine& 15.5% ferric sulfate & least with pH neutral Tetrahydrozoline &with pH neutral Tetrahydrozoline & oxymetazoline.oxymetazoline. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Haim Baharav et al I JP 1997,Haim Baharav et al I JP 1997, 10,24810,248  The effect of displacement time onThe effect of displacement time on gingival crevicular width.gingival crevicular width.  Medicated cords[ hemodent onMedicated cords[ hemodent on ultrapak#1] were placed in gingival sulcusultrapak#1] were placed in gingival sulcus for 2,4,6 & 8 mins.for 2,4,6 & 8 mins.  Following cord removal closure of sulcusFollowing cord removal closure of sulcus was recorded with miniature videowas recorded with miniature video camera.camera. www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  At both th mesiodistal & transitional lineAt both th mesiodistal & transitional line angle, tissue displaced for 2 mins resultedangle, tissue displaced for 2 mins resulted in gingival crevice significantly smallerin gingival crevice significantly smaller than those when displacement time wasthan those when displacement time was 4,6 & 8 mins.4,6 & 8 mins. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. k.M.Martin et alk.M.Martin et al J. Dent 1997; 25: 347  The protein content of dental rubber dams-  The purpose of this study was to analyse the protein content of 17 commonly used rubber dams and to determine if they contained known allergenic proteins. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43.  The results of this study confirm that all the rubber dams tested contained significant amounts of protein.  The molecular weights of these proteins correspond with those of known allergens, and they could, therefore, be a cause of hypersensitivity reactions to dental rubber dams. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. Asbjorn Jokstad JPDAsbjorn Jokstad JPD 1999,81,2581999,81,258  Clinical trial of gingival retraction cord-Clinical trial of gingival retraction cord-  This study aimed to determine whetherThis study aimed to determine whether clinicians were able to identify differencesclinicians were able to identify differences in clinical performance among 3 types ofin clinical performance among 3 types of gingival retraction cordsgingival retraction cords www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45.  Knitted cords ranked better than twinedKnitted cords ranked better than twined cords.Cords containing epinephrine werecords.Cords containing epinephrine were found no better clinically than aluminumfound no better clinically than aluminum sulfate cord.sulfate cord. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. K. L. Chen, International Endodontic Journal, 37, 507–511, 2004  This report presents a technique to simultaneously isolate two adjacent single- rooted teeth that are difficult to isolate by conventional methods. Its advantages are efficiency, reduction of radiation exposure, better access, good visibility and isolation. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. Jian Feng et alJian Feng et al J Prosthodont 2006;15:108  The Effect of Gingival Retraction Procedures on Periodontal Indices and Crevicular Fluid Cytokine Levels: A Pilot Study  This pilot study supports the previous research that gingival retraction causes an acute injury that heals clinically in 2 weeks as is indicated by the GI. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48.  It also provides the first evidence that gingival retraction results in an elevation of the proinflammatory cytokine, TNF-α, in GCF. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. MOISTUR CONTROLMOISTUR CONTROL www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50.  The need for removal of fluid varies uponThe need for removal of fluid varies upon the task being performed.During thethe task being performed.During the preparation of teeth, it is necessary topreparation of teeth, it is necessary to remove large volumes of water producedremove large volumes of water produced by a handpiece spray & to control theby a handpiece spray & to control the tongue to prevent accidental injury.Whentongue to prevent accidental injury.When an impression is made or arestoration isan impression is made or arestoration is cemented, there is much smaller volumecemented, there is much smaller volume of fluid to be removed,but a much greaterof fluid to be removed,but a much greater degree of dryness is required.degree of dryness is required. www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51.  Several types of attachments can be usedSeveral types of attachments can be used with low volume [ saliva ejector] or highwith low volume [ saliva ejector] or high volume vacuum outlets to remove fluids.volume vacuum outlets to remove fluids. Some combine the function of fluidSome combine the function of fluid removal with isolation.removal with isolation. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. Moisture control measures:Moisture control measures: 1.1. MechanicalMechanical 2.2. ChemicalChemical www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Mechanical:Mechanical: 1.1. Cotton- rollsCotton- rolls pelletspellets 2.2. Moisture absorbent devices-Moisture absorbent devices- -dry tips-dry tips -dry angles-dry angles -reflective sheilds-reflective sheilds 3.3. Rubber damRubber dam -Latex-Latex -Non latex-Non latex www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. 4.4. Low volume suction devices-Low volume suction devices- I) suction tips/ saliva ejectors:I) suction tips/ saliva ejectors: a) disposable saliva ejectorsa) disposable saliva ejectors - transparent [ plastic]- transparent [ plastic] - multi coloured [ plastic]- multi coloured [ plastic] - flexible silicon- flexible silicon - hygoformic saliva ejector- hygoformic saliva ejector b) reusable saliva ejectorsb) reusable saliva ejectors - steel with cushion tips- steel with cushion tips www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. 5. High volume evacuators5. High volume evacuators 6. Svedoptor/ Speejector: consists of 4-parts6. Svedoptor/ Speejector: consists of 4-parts - saliva ejector- saliva ejector - mouth mirror- mouth mirror - reflector- reflector - tongue guard- tongue guard www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. CHEMICALCHEMICAL  Anti sailogogues:Anti sailogogues: i) Anticholinergics-i) Anticholinergics- 1.1. AtropineAtropine 2.2. DycyclomineDycyclomine 3.3. MethanthilineMethanthiline 4.4. Propantheline bromidePropantheline bromide www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. ii) anti-hypertensives –ii) anti-hypertensives – 1.1. Clonidine hydrochlorideClonidine hydrochloride iii) Local anestheticsiii) Local anesthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. COTTON ROLLSCOTTON ROLLS  ABSORBANTS such as cotton roll areABSORBANTS such as cotton roll are helpful for short period of isolationhelpful for short period of isolation  Absorbants are isolation alternatives whenAbsorbants are isolation alternatives when rubber dam application is impractical orrubber dam application is impractical or impossible.impossible. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59.  Especially in conjuction withEspecially in conjuction with anaesthesia ,cotton rolls provideanaesthesia ,cotton rolls provide acceptable dryness for procedures suchacceptable dryness for procedures such as impression taking & cementation.as impression taking & cementation.  Using a saliva ejector in conjuction withUsing a saliva ejector in conjuction with absorbants will further abate salivary flowabsorbants will further abate salivary flow www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60.  Commercially available ones are-Commercially available ones are- - star cotton rollsstar cotton rolls - Roeka cotton rolls [ coltene -whaledent]Roeka cotton rolls [ coltene -whaledent] - Roeka cotton pellets[ coltene-whaledent]Roeka cotton pellets[ coltene-whaledent] www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. -retracts cheek effectively-retracts cheek effectively -keeps its shape and does not fall apart when-keeps its shape and does not fall apart when full of salivafull of saliva -absorbs moisture throughout treatment-absorbs moisture throughout treatment  Sizes:Sizes:  11  22  33  44 www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63.  Sizes-Sizes- - 000 -1.5 gm000 -1.5 gm - 00 -4 gm00 -4 gm - 0 -4 gm0 -4 gm - 1 -10 gm1 -10 gm - 2 -10 gm2 -10 gm www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Cotton roll holder-Cotton roll holder-  Several commercial devices areSeveral commercial devices are available for holding cotton rolls in place.available for holding cotton rolls in place.  Adv-Adv- 1.1. Cheek and tongue are slightly retractedCheek and tongue are slightly retracted 2.2. Enhancing visibilityEnhancing visibility www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66.  The maxillary teeth are isolated by placingThe maxillary teeth are isolated by placing a medium size cotton roll in the adj buccala medium size cotton roll in the adj buccal vestibule.vestibule. www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67.  The mandibular teeth are isolated byThe mandibular teeth are isolated by placing one medium sized cotton roll inplacing one medium sized cotton roll in vestibule & larger one between teeth &vestibule & larger one between teeth & tongue.tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Absorbant devices-Absorbant devices- -Dry tips-Dry tips -Dry angles-Dry angles -Reflective shields-Reflective shields These are used to retract the cheek &These are used to retract the cheek & provide absorbencyprovide absorbency www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Dry tips*Dry tips* [moisture absorbing cards][moisture absorbing cards]  Keeps the parotid gland in check forKeeps the parotid gland in check for 15 minutes. Outlasts cotton rolls and15 minutes. Outlasts cotton rolls and other absorbents. Dry-Tips absorb atother absorbents. Dry-Tips absorb at least 30x their weight in moisture.least 30x their weight in moisture. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. Dry Angles*Dry Angles*  Available in 2 sizesAvailable in 2 sizes - SmallSmall - LargeLarge **((Dental Health ProductsDental Health Products)) www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. Reflective sheilds*Reflective sheilds*  Heart-shaped pads abate moisture during common dental procedures. Shields have a mirror-like film on exposed side, improving visibility in the oral cavity. *(Richmond) www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73.  When removing absorbent cards/celluloseWhen removing absorbent cards/cellulose wafers it may be necessary to moistenwafers it may be necessary to moisten them with the water gun to preventthem with the water gun to prevent inadvertent removal of epithelium frominadvertent removal of epithelium from cheek.cheek. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. Tooth isolation with cotton padTooth isolation with cotton pad & reflective blotting paper*& reflective blotting paper*  This procedure will exclude the salivaThis procedure will exclude the saliva coming from Stenson’s duct & salivarycoming from Stenson’s duct & salivary glands in muco-buccal fold area.glands in muco-buccal fold area. * JPD 1970,23;655* JPD 1970,23;655 www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. Rubber Dam:Rubber Dam:  In 1864 S.C Barnum, a NY dentistIn 1864 S.C Barnum, a NY dentist introduced the rubber dam.introduced the rubber dam.  purpose:purpose:  To define the operating field by isolatingTo define the operating field by isolating one or more teeth from the oralone or more teeth from the oral environment.environment. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. AdvantagesAdvantages  Dry clean Operating field-Dry clean Operating field- teeth prepared & restored using a rubberteeth prepared & restored using a rubber dam are less prone to post –operdam are less prone to post –oper problems related to contamination fromproblems related to contamination from oral fluids.oral fluids. www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79.  Access & visibility-Access & visibility- -provides maximum access &-provides maximum access & visibility.Gingival tissues are retractedvisibility.Gingival tissues are retracted mildly for better access.mildly for better access. - dam also retracts lip, cheek &- dam also retracts lip, cheek & tongue.Black rubber dam provide darktongue.Black rubber dam provide dark non reflective background.non reflective background. www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80.  Improved properties of dental materials-Improved properties of dental materials- RD prevents moisture contamination ofRD prevents moisture contamination of restorative materials.restorative materials.  Protection of Pt & operator-Protection of Pt & operator- the dam protects the pt from aspirating orthe dam protects the pt from aspirating or swallowing small instruments.Also offersswallowing small instruments.Also offers soft tissue protection.soft tissue protection. www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81.  Operating efficiency-Operating efficiency- use of RD allows for increased efficiencyuse of RD allows for increased efficiency & productivity.The time involved in letting& productivity.The time involved in letting the pt rinse & expectorate is eliminated.the pt rinse & expectorate is eliminated. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. Disadvantages-Disadvantages-  Time consumingTime consuming  Certain conditions preclude theCertain conditions preclude the application of RD-application of RD- i)i) Partially erupted toothPartially erupted tooth ii)ii) Some 3Some 3rdrd molarmolar iii)iii) Extremely malposed teethExtremely malposed teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Armamentarium-Armamentarium-  Rubber dam materialRubber dam material -latex-latex -non- latex-non- latex www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. Rubber Dam HolderRubber Dam Holder  Two types:Two types: - Young’s U metal frameYoung’s U metal frame - Plastic framePlastic frame www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. Hygenic® Framed Non-Latex Flexi Dam •• Convenient built-in-frame – saves timeConvenient built-in-frame – saves time • Highly elastic Flexi Dam material – tear• Highly elastic Flexi Dam material – tear resistant and easy placementresistant and easy placement • Latex free – allergy free• Latex free – allergy free • Odourless – patient comfort• Odourless – patient comfort www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. Derma Frame*Derma Frame*  Derma Frame is a pliable metal rubberDerma Frame is a pliable metal rubber dam frame. DermaFrame can be bent todam frame. DermaFrame can be bent to improve patient comfort while still retainingimprove patient comfort while still retaining the dam in place.the dam in place.  DermaFrame can also be bent to the sideDermaFrame can also be bent to the side to facilitate taking radiographs withoutto facilitate taking radiographs without removing the dam or frame.removing the dam or frame. *Ultradent*Ultradent www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. Rubber Dam retainer-Rubber Dam retainer- www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. Rubber dam punchRubber dam punch  Is a precision instrument having a rotatingIs a precision instrument having a rotating metal table with 6 holes of varying sizes &metal table with 6 holes of varying sizes & a tapered pointed plungera tapered pointed plunger www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. Rubber Dam retainer forceps-Rubber Dam retainer forceps- www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. Rubber dam napkin-Rubber dam napkin-  Placed between the rubber dam & thePlaced between the rubber dam & the skinskin  AdvantagesAdvantages i)i) Prevents skin contact & allergicPrevents skin contact & allergic reactionsreactions ii)ii) Absorbs saliva at the corners of mouthAbsorbs saliva at the corners of mouth iii)iii) Act as cushionAct as cushion www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. Rubber Dam templatesRubber Dam templates www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. hygenic ivory Satin steel www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. Hole sizesHole sizes www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. Hole Position:Hole Position:  The following guidelines should beThe following guidelines should be followed-followed-  When operating on maxillary ant isolateWhen operating on maxillary ant isolate from 1from 1stst premolar to 1premolar to 1stst premolar.premolar.  When operating on posterior teeth isolateWhen operating on posterior teeth isolate anteriorly to include lateral incisor onanteriorly to include lateral incisor on opposite side.opposite side. www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98.  When operating on premolar punch holesWhen operating on premolar punch holes to include at least two teeth distallyto include at least two teeth distally  The distance between holes is equal toThe distance between holes is equal to distance from centre of one tooth to centredistance from centre of one tooth to centre of adjacent tooth at gingival level.of adjacent tooth at gingival level. www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. www.indiandentalacademy.comwww.indiandentalacademy.com
  101. 101. Placement-Placement- www.indiandentalacademy.comwww.indiandentalacademy.com
  102. 102. www.indiandentalacademy.comwww.indiandentalacademy.com
  103. 103. www.indiandentalacademy.comwww.indiandentalacademy.com
  104. 104. www.indiandentalacademy.comwww.indiandentalacademy.com
  105. 105. Use of a molar clamp to isolate two adjacent single-rooted teeth: a clinical aid* *International Endodontic Journal, 37, 507, 2004. www.indiandentalacademy.comwww.indiandentalacademy.com
  106. 106.  Clinically, it is common to find severely broken-down (decoronated) teeth following removal of poorly fitting crowns and bridges, making it difficult for a clamp to be retained www.indiandentalacademy.comwww.indiandentalacademy.com
  107. 107. www.indiandentalacademy.comwww.indiandentalacademy.com
  108. 108.  Technique:  Select an appropriate molar clamp: 1. The mesial–distal clamp jaw distance should be equal to the mesial–distal spacing of the two roots. 2. The buccal–lingual jaw distance of the clamp should be smaller than the dimension of the roots to provide adequate retention. www.indiandentalacademy.comwww.indiandentalacademy.com
  109. 109. www.indiandentalacademy.comwww.indiandentalacademy.com
  110. 110. Rubber dam isolation of FPD*Rubber dam isolation of FPD*  Cut the dam to slip over the entire FPDCut the dam to slip over the entire FPD  Suture the interproximal areas of cutSuture the interproximal areas of cut rubber to close rubber dam under therubber to close rubber dam under the pontic.pontic. *JPD 1993’69;237*JPD 1993’69;237www.indiandentalacademy.comwww.indiandentalacademy.com
  111. 111. www.indiandentalacademy.comwww.indiandentalacademy.com
  112. 112. MOISTURE CONTROLMOISTURE CONTROL & SOFT TISSUE& SOFT TISSUE MANAGEMENT INMANAGEMENT IN FIXEDFIXED PROSTHODONTICSPROSTHODONTICS www.indiandentalacademy.comwww.indiandentalacademy.com
  113. 113. High volume evacuators-High volume evacuators-  When a high speed hand piece is usedWhen a high speed hand piece is used ,high volume evacuators are preferred fpr,high volume evacuators are preferred fpr suctioning because saliva ejectors removesuctioning because saliva ejectors remove water slowly & have little capicity ofwater slowly & have little capicity of picking up solidspicking up solids  They can easily suck 150 ml of water in 1They can easily suck 150 ml of water in 1 sec.sec. www.indiandentalacademy.comwww.indiandentalacademy.com
  114. 114. www.indiandentalacademy.comwww.indiandentalacademy.com
  115. 115.  It serves as an excellent lip/ cheekIt serves as an excellent lip/ cheek retractor while the operator uses a mirrorretractor while the operator uses a mirror to retract the tongue.to retract the tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  116. 116.  Its use is not practical during theIts use is not practical during the impression or cementation phase.impression or cementation phase. www.indiandentalacademy.comwww.indiandentalacademy.com
  117. 117. Saliva EjectorSaliva Ejector  Or low volume suction tips remove salivaOr low volume suction tips remove saliva that collects on the floor of the mouth.that collects on the floor of the mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  118. 118. I) suction tips/ saliva ejectors:I) suction tips/ saliva ejectors: a) disposable saliva ejectorsa) disposable saliva ejectors - transparent [ plastic]- transparent [ plastic] - multi coloured [ plastic]- multi coloured [ plastic] - flexible silicon- flexible silicon - hygoformic saliva ejector- hygoformic saliva ejector b) reusable saliva ejectorsb) reusable saliva ejectors - steel with cushion tips- steel with cushion tips www.indiandentalacademy.comwww.indiandentalacademy.com
  119. 119.  Commercially available disposable salivaCommercially available disposable saliva ejectors-ejectors- - pearson saliva ejectorpearson saliva ejector - PQ “PQ “ - Crosstec “Crosstec “ - Monojet “Monojet “ www.indiandentalacademy.comwww.indiandentalacademy.com
  120. 120. Hygoformic Disposable*-Hygoformic Disposable*-  *Pulpdent Corp.*Pulpdent Corp. www.indiandentalacademy.comwww.indiandentalacademy.com
  121. 121.  The coil eliminates the sharp edges andThe coil eliminates the sharp edges and hard blunt tip which irritate soft tissue andhard blunt tip which irritate soft tissue and are common in other disposable salivaare common in other disposable saliva ejectors.ejectors.  The aspirating holes are placed to avoidThe aspirating holes are placed to avoid contact with the tongue and tissues andcontact with the tongue and tissues and will not become blocked. The coil design iswill not become blocked. The coil design is adjustable in seconds to the shape & sizeadjustable in seconds to the shape & size required for each patient.required for each patient. www.indiandentalacademy.comwww.indiandentalacademy.com
  122. 122. Accessories:Accessories:  Super Sof-Ti Saliva Ejector TipsSuper Sof-Ti Saliva Ejector Tips  are made of soft, indestructible medical grade silicone. They rest gently on the oral tissue. There are no hard edges. www.indiandentalacademy.comwww.indiandentalacademy.com
  123. 123.  SUCTION TIP SLEEVES (PDI)  Fully autoclavable. www.indiandentalacademy.comwww.indiandentalacademy.com
  124. 124. Reusable saliva ejectorsReusable saliva ejectors  Commercially available:Commercially available: - otis saliva ejector [ otis]otis saliva ejector [ otis] - Super soft-ti [pulpdent]Super soft-ti [pulpdent] www.indiandentalacademy.comwww.indiandentalacademy.com
  125. 125.  The ejector is placed in the corner of theThe ejector is placed in the corner of the mouth opposite the quadrant beingmouth opposite the quadrant being operated & the pt’s head is turned towardsoperated & the pt’s head is turned towards it .it .  It can also be used effectively on theIt can also be used effectively on the maxillary arch by simply adding cotton rollmaxillary arch by simply adding cotton roll in the vestibule facial to the teeth.in the vestibule facial to the teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  126. 126. www.indiandentalacademy.comwww.indiandentalacademy.com
  127. 127. Svedopter/ Speejector*Svedopter/ Speejector*  is handy & combines the functions of ais handy & combines the functions of a saliva ejector with that of a mouth mirror, asaliva ejector with that of a mouth mirror, a light reflector and a tongue guard.light reflector and a tongue guard.  Each Speejecter comes withEach Speejecter comes with interchangeable small, medium and largeinterchangeable small, medium and large reflectors to fit all mouth sizes.reflectors to fit all mouth sizes. www.indiandentalacademy.comwww.indiandentalacademy.com
  128. 128. www.indiandentalacademy.comwww.indiandentalacademy.com
  129. 129.  Commercially available-Commercially available-  Svedopter [ E C Moore Co ]Svedopter [ E C Moore Co ]  Speejector[ Pulpdent ]Speejector[ Pulpdent ] www.indiandentalacademy.comwww.indiandentalacademy.com
  130. 130.  By adding facial & lingual cotton rollsBy adding facial & lingual cotton rolls excellent control & isolation is provided.excellent control & isolation is provided. www.indiandentalacademy.comwww.indiandentalacademy.com
  131. 131.  The svedopter is most effective when it isThe svedopter is most effective when it is used with the pt in a nearly uprightused with the pt in a nearly upright position.position. www.indiandentalacademy.comwww.indiandentalacademy.com
  132. 132. Drawbacks-Drawbacks-  Access to lingual surface of mand teethAccess to lingual surface of mand teeth limitedlimited  Might bruise soft tissue of the floor if chinMight bruise soft tissue of the floor if chin clamp is overzealously tightenedclamp is overzealously tightened  Presence of mandibular tori precludes itsPresence of mandibular tori precludes its useuse  Selection of oversized reflector should beSelection of oversized reflector should be avoided ;as might produce gagging.avoided ;as might produce gagging. www.indiandentalacademy.comwww.indiandentalacademy.com
  133. 133. Better positionBetter position www.indiandentalacademy.comwww.indiandentalacademy.com
  134. 134. Linguafix [ disposable]Linguafix [ disposable] www.indiandentalacademy.comwww.indiandentalacademy.com
  135. 135. Throat sheildsThroat sheilds  IndicationsIndications - when small instruments are used withoutwhen small instruments are used without rubber damrubber dam - When treating teeth in the maxillary arch.When treating teeth in the maxillary arch. - Indirect restorationsIndirect restorations www.indiandentalacademy.comwww.indiandentalacademy.com
  136. 136.  A gauze sponge (2 x 2 inch) unfolded &A gauze sponge (2 x 2 inch) unfolded & spread over tongue & posterior part ofspread over tongue & posterior part of mouth is helpful in recovering a restorationmouth is helpful in recovering a restoration should it be dropped.should it be dropped. www.indiandentalacademy.comwww.indiandentalacademy.com
  137. 137. AntisialagoguesAntisialagogues  For the pt’s who saliavate excessivelyFor the pt’s who saliavate excessively some other measures may besome other measures may be necessary.necessary. i) Anticholinergics-i) Anticholinergics- 1.1. AtropineAtropine 2.2. DycyclomineDycyclomine 3.3. MethanthilineMethanthiline 4.4. Propantheline bromidePropantheline bromide www.indiandentalacademy.comwww.indiandentalacademy.com
  138. 138. ii) anti-hypertensives –ii) anti-hypertensives – 1.1. Clonidine hydrochlorideClonidine hydrochloride iii) Local anestheticsiii) Local anesthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  139. 139. Anticholinergics -Anticholinergics -  They block the parasympatheticThey block the parasympathetic innervation & thereby reduceinnervation & thereby reduce secretions,including saliva.secretions,including saliva.  Contraindications-Contraindications- - individuals with glaucoma- may causeindividuals with glaucoma- may cause blindness.blindness. - Heart diseaseHeart disease - AsthmaAsthma - Lactating femalesLactating females www.indiandentalacademy.comwww.indiandentalacademy.com
  140. 140. Sal-tropine*Sal-tropine*  Doseage- 0.4 mgDoseage- 0.4 mg * Hope Pharma* Hope Pharma www.indiandentalacademy.comwww.indiandentalacademy.com
  141. 141. Methanthiline bromide*-Methanthiline bromide*- ( Banthine )( Banthine )  Originally developed for prptic ulcers.Originally developed for prptic ulcers.  Side-effects-Side-effects- - blurring of vision due to dialation of pupilsblurring of vision due to dialation of pupils - Loss of accomodationLoss of accomodation - TachycardiaTachycardia - ConstipationConstipation - Urinary retention & dry skinUrinary retention & dry skin * JPD 1984,52;663* JPD 1984,52;663www.indiandentalacademy.comwww.indiandentalacademy.com
  142. 142.  Dosage- [Banthine] 50 mg 1hr beforeDosage- [Banthine] 50 mg 1hr before treatmenttreatment  [Probanthine]* 15 mg 1 hr before[Probanthine]* 15 mg 1 hr before treatmenttreatment *Schiapparelli Searle[ chichago]*Schiapparelli Searle[ chichago] www.indiandentalacademy.comwww.indiandentalacademy.com
  143. 143. Clonidine Hydrochloride*Clonidine Hydrochloride*  Is an antihypertensiveIs an antihypertensive  Side effects-Side effects-  Dry mouth & drowsinessDry mouth & drowsiness *Catapres,Boehringer Ingelheim Pharm.*Catapres,Boehringer Ingelheim Pharm. www.indiandentalacademy.comwww.indiandentalacademy.com
  144. 144.  Doseage- 0.2 mg 1 hr before theDoseage- 0.2 mg 1 hr before the treatment.treatment.  Effect –upto 2 hr after administration.Effect –upto 2 hr after administration. www.indiandentalacademy.comwww.indiandentalacademy.com
  145. 145. Gingival RetractionGingival Retraction  Indirect restorations including cast goldIndirect restorations including cast gold inlays, onlays, partial veeneer & completeinlays, onlays, partial veeneer & complete crowns , metal ceramic & all ceramiccrowns , metal ceramic & all ceramic crowns are routinely used to restorecrowns are routinely used to restore defective teeth.defective teeth.  These restorations frequently haveThese restorations frequently have cervical margins that are intentionallycervical margins that are intentionally placed in the gingival sulcus for esthetic orplaced in the gingival sulcus for esthetic or functional reasons.functional reasons. www.indiandentalacademy.comwww.indiandentalacademy.com
  146. 146.  In these instances the clinician must makeIn these instances the clinician must make impressions that adequately capture theimpressions that adequately capture the prepared finish lines.prepared finish lines.  There is evidence that inadequateThere is evidence that inadequate impressions are forwarded to theimpressions are forwarded to the laboratory.the primary reason for this islaboratory.the primary reason for this is deficient “gingival displacement”deficient “gingival displacement” technique.technique. www.indiandentalacademy.comwww.indiandentalacademy.com
  147. 147.  The goal of this procedure is to reversiblyThe goal of this procedure is to reversibly displace the gingival tissues in a lateraldisplace the gingival tissues in a lateral direction so that the bulk of low- viscositydirection so that the bulk of low- viscosity impression material can be introduced intoimpression material can be introduced into the widened sulcus & capture the marginthe widened sulcus & capture the margin detail.detail.  The critical sulcular width in this regardThe critical sulcular width in this regard seems to be 0.2 mm*.seems to be 0.2 mm*. *DCNA 2004,48;433*DCNA 2004,48;433 www.indiandentalacademy.comwww.indiandentalacademy.com
  148. 148. Gingival retraction -Gingival retraction -  Can be broadly classified as:*Can be broadly classified as:* 1.1. MechanicalMechanical 2.2. ChemicomechanicalChemicomechanical 3.3. Rotary curettageRotary curettage 4.4. ElectrosurgicalElectrosurgical *Shillinburg*Shillinburg JPD 1986,55,175JPD 1986,55,175www.indiandentalacademy.comwww.indiandentalacademy.com
  149. 149. Mechanical methods-Mechanical methods-  Cord less retraction:*Cord less retraction:* 1.1. Copper band or tubeCopper band or tube 2.2. Relining a primary impressionRelining a primary impression 3.3. Beading a cold –cure resin trayBeading a cold –cure resin tray 4.4. Aluminium shell impressionAluminium shell impression 5.5. Temporary metal crown filled with gutta-Temporary metal crown filled with gutta- perchapercha 6.6. Cotton twill with ZnOECotton twill with ZnOE ** JPD 1967,17,379 ; 1986,55,175JPD 1967,17,379 ; 1986,55,175 www.indiandentalacademy.comwww.indiandentalacademy.com
  150. 150.  Other technique:Other technique: 1.1. Plain retraction cordPlain retraction cord 2.2. Cotton threadCotton thread 3.3. Untreated surgical silkUntreated surgical silk 4.4. Leather ringLeather ring 5.5. MerocelMerocel 6.6. ExpasylExpasyl www.indiandentalacademy.comwww.indiandentalacademy.com
  151. 151. Copper tube & modellingCopper tube & modelling compound-compound- * JPD 1976,36,588* JPD 1976,36,588 www.indiandentalacademy.comwww.indiandentalacademy.com
  152. 152. www.indiandentalacademy.comwww.indiandentalacademy.com
  153. 153. www.indiandentalacademy.comwww.indiandentalacademy.com
  154. 154. Ruel J et al JPD 1980,44,508Ruel J et al JPD 1980,44,508  Metal band with modelling compound wasMetal band with modelling compound was better than either surgical or retractionbetter than either surgical or retraction cord [ with or without chemical]cord [ with or without chemical] www.indiandentalacademy.comwww.indiandentalacademy.com
  155. 155. Copper tube & rubber baseCopper tube & rubber base impression material-impression material- www.indiandentalacademy.comwww.indiandentalacademy.com
  156. 156. www.indiandentalacademy.comwww.indiandentalacademy.com
  157. 157. www.indiandentalacademy.comwww.indiandentalacademy.com
  158. 158. www.indiandentalacademy.comwww.indiandentalacademy.com
  159. 159. www.indiandentalacademy.comwww.indiandentalacademy.com
  160. 160. Relining a primary impression*-Relining a primary impression*-  A diagnostic impression is made &A diagnostic impression is made & diagnostic cast is poured.diagnostic cast is poured.  Wax up of the missing teeth is done.Wax up of the missing teeth is done.  A wet asbestos spacer is adapted on theA wet asbestos spacer is adapted on the teeth to be prepared & the waxed up teethteeth to be prepared & the waxed up teeth ..  An acrylic resin tray is made.An acrylic resin tray is made. * JPD 1967,17,379* JPD 1967,17,379 www.indiandentalacademy.comwww.indiandentalacademy.com
  161. 161.  A primary impression is made of theA primary impression is made of the completed preparation with heavy bodycompleted preparation with heavy body rubber base impression material.rubber base impression material. www.indiandentalacademy.comwww.indiandentalacademy.com
  162. 162.  The surplus rubber is removed 7 the trayThe surplus rubber is removed 7 the tray is trimmed with burs so that impresionis trimmed with burs so that impresion margin will be most superior part of themargin will be most superior part of the tray.tray. www.indiandentalacademy.comwww.indiandentalacademy.com
  163. 163.  Incisal & occlusal portions of theIncisal & occlusal portions of the impression are perforated to createimpression are perforated to create escape vents for the final impressionescape vents for the final impression material.material. www.indiandentalacademy.comwww.indiandentalacademy.com
  164. 164.  Medium body rubber base material isMedium body rubber base material is mixed & loaded in the tray &placed intomixed & loaded in the tray &placed into position for 8 mins before removal.position for 8 mins before removal.  The margin of the primary impressionThe margin of the primary impression move the free gingiva away from the finalmove the free gingiva away from the final impression material.impression material. www.indiandentalacademy.comwww.indiandentalacademy.com
  165. 165. Extending an acrylic resin trayExtending an acrylic resin tray with resin beading:*with resin beading:*  A sat of the entire arch is made & all theA sat of the entire arch is made & all the missing teeth are waxed up.missing teeth are waxed up.  Cast is coated with silicon mold releaseCast is coated with silicon mold release spray.this will permit an impression to bespray.this will permit an impression to be made in an irreversible hydrocoloid.made in an irreversible hydrocoloid.  An acrylic resin tray for the abutmentAn acrylic resin tray for the abutment teeth.teeth. * JPD 1967,17,379* JPD 1967,17,379 www.indiandentalacademy.comwww.indiandentalacademy.com
  166. 166. www.indiandentalacademy.comwww.indiandentalacademy.com
  167. 167.  The teeth are prepared.The teeth are prepared.  The resin tray or coping is filled with coldThe resin tray or coping is filled with cold cure resin.when the sheen of this addedcure resin.when the sheen of this added resin becomes dull,an impresion of theresin becomes dull,an impresion of the abutment teeth is made.abutment teeth is made.  It is removed & reinserted several times.It is removed & reinserted several times. www.indiandentalacademy.comwww.indiandentalacademy.com
  168. 168. www.indiandentalacademy.comwww.indiandentalacademy.com
  169. 169. www.indiandentalacademy.comwww.indiandentalacademy.com
  170. 170.  The impression is removed & the surplusThe impression is removed & the surplus is cut & perforations are made.is cut & perforations are made.  Tray is filled with regular body impressionTray is filled with regular body impression material & placed in position for 8 min.material & placed in position for 8 min.  An overall impression is made in a stockAn overall impression is made in a stock tray with regular body.tray with regular body. www.indiandentalacademy.comwww.indiandentalacademy.com
  171. 171. Aluminium shell*-Aluminium shell*-  They should be one or two size larger.They should be one or two size larger. * K E Thayer; Fixed Prosthodontics* K E Thayer; Fixed Prosthodonticswww.indiandentalacademy.comwww.indiandentalacademy.com
  172. 172.  The shell are trimmed after teeth areThe shell are trimmed after teeth are prepared & buccal surfaces are identified.prepared & buccal surfaces are identified.  The cervical margin of the shell should beThe cervical margin of the shell should be positioned apical to preparation marginpositioned apical to preparation margin www.indiandentalacademy.comwww.indiandentalacademy.com
  173. 173.  A thin coat of adhesive is applied &A thin coat of adhesive is applied & primary impression is made with heavyprimary impression is made with heavy body rubber base material.body rubber base material. www.indiandentalacademy.comwww.indiandentalacademy.com
  174. 174. Temporary crown with GP -*Temporary crown with GP -*  Filled with gutta percha or temporaryFilled with gutta percha or temporary stopping material.stopping material.  It is lined with excess of material & placedIt is lined with excess of material & placed on prepared tooth & excess of guttaon prepared tooth & excess of gutta percha is rounded with a hot instrumentpercha is rounded with a hot instrument where it protrudes into the crevice.where it protrudes into the crevice.  It is left for 24 hrs in the mouth.It is left for 24 hrs in the mouth. * JPD 1986,55,175* JPD 1986,55,175 www.indiandentalacademy.comwww.indiandentalacademy.com
  175. 175. Disadvantages-Disadvantages-  Non reversible tissue displacementNon reversible tissue displacement  Gingival attachment relocationGingival attachment relocation  Sensitivity of neck of the tooth.Sensitivity of neck of the tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
  176. 176. Cotton twill & ZnOE-Cotton twill & ZnOE-  Cotton twills the size of floss are rolled in aCotton twills the size of floss are rolled in a creamy mixture of ZnOE.creamy mixture of ZnOE.  Several twills are placed into sulcus &Several twills are placed into sulcus & covered with fast setting cement.covered with fast setting cement.  Left in place for min of 48 hrs.Left in place for min of 48 hrs. www.indiandentalacademy.comwww.indiandentalacademy.com
  177. 177. Advantages-Advantages- 1.1. Most conservative in terms of tissueMost conservative in terms of tissue tolerancetolerance 2.2. Extended working timeExtended working time Indication-Indication- 1.1. Deep cervically involved teeth.Deep cervically involved teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  178. 178. RETRACTION CORDSRETRACTION CORDS www.indiandentalacademy.comwww.indiandentalacademy.com
  179. 179. Classification:Classification:  Broadly classified as-Broadly classified as- 1.1. ImpregnatedImpregnated 2.2. Non-impregnatedNon-impregnated www.indiandentalacademy.comwww.indiandentalacademy.com
  180. 180.  Depending on configuration:Depending on configuration: 1.1. TwistedTwisted 2.2. KnittedKnitted 3.3. BraidedBraided www.indiandentalacademy.comwww.indiandentalacademy.com
  181. 181. www.indiandentalacademy.comwww.indiandentalacademy.com
  182. 182. www.indiandentalacademy.comwww.indiandentalacademy.com
  183. 183. www.indiandentalacademy.comwww.indiandentalacademy.com
  184. 184. www.indiandentalacademy.comwww.indiandentalacademy.com
  185. 185. Configuration-Configuration-  Twisted cords:Allow the dentist to customise theTwisted cords:Allow the dentist to customise the cord,because individual strands can be removed.cord,because individual strands can be removed.  Braided cords:Pack easily because packingBraided cords:Pack easily because packing instrument will not pierce the cord or separateinstrument will not pierce the cord or separate the strands.the strands.  Knitted cords :Create pockets within the cord forKnitted cords :Create pockets within the cord for trapping medicaments to deliver them where theytrapping medicaments to deliver them where they are needed within the sulcus.are needed within the sulcus. www.indiandentalacademy.comwww.indiandentalacademy.com
  186. 186.  Depending on wettability-Depending on wettability- 1.1. DryDry 2.2. Wet [ coated with a gel sol]Wet [ coated with a gel sol] www.indiandentalacademy.comwww.indiandentalacademy.com
  187. 187. www.indiandentalacademy.comwww.indiandentalacademy.com
  188. 188. www.indiandentalacademy.comwww.indiandentalacademy.com
  189. 189.  Depending on surface finish-Depending on surface finish- 1.1. WaxedWaxed 2.2. unwaxedunwaxed www.indiandentalacademy.comwww.indiandentalacademy.com
  190. 190.  Depending on the thickness they areDepending on the thickness they are color coded-color coded- 1.1. Black-000(extra small)Black-000(extra small) 2.2. Yellow-00(small)Yellow-00(small) 3.3. Purple –0Purple –0 4.4. Blue-1Blue-1 5.5. Green-2Green-2 6.6. Red-3(extra large)Red-3(extra large) www.indiandentalacademy.comwww.indiandentalacademy.com
  191. 191. Ideal Requirements-Ideal Requirements-  Should be dark in colorShould be dark in color  Should be effective for its intended useShould be effective for its intended use  Should be safe, locally & systemicallyShould be safe, locally & systemically  Effects should be spontaneouslyEffects should be spontaneously reversiblereversible  Should be absorbantShould be absorbant www.indiandentalacademy.comwww.indiandentalacademy.com
  192. 192.  Should be available in different diametersShould be available in different diameters  Should not stick to the soft tissuesShould not stick to the soft tissues  Should provide hemostasisShould provide hemostasis  Should not cause chemical injury to theShould not cause chemical injury to the gingival tissue.gingival tissue. www.indiandentalacademy.comwww.indiandentalacademy.com
  193. 193. Commercially available ones-Commercially available ones-  Sulpak braided cords; Sultan dental.Sulpak braided cords; Sultan dental. www.indiandentalacademy.comwww.indiandentalacademy.com
  194. 194.  Hemodent cords, Premier dental.Hemodent cords, Premier dental. www.indiandentalacademy.comwww.indiandentalacademy.com
  195. 195. UniBraid ;Dux dental  UniBraid is pre-cut and individually packaged inUniBraid is pre-cut and individually packaged in two inch lengths (fits any tooth size).two inch lengths (fits any tooth size).  Sizes: 0 (smallest) - 3 (largest).Sizes: 0 (smallest) - 3 (largest). www.indiandentalacademy.comwww.indiandentalacademy.com
  196. 196. Gingi braid; Dux dentalGingi braid; Dux dental  Sizes: O (smallest) - 3 (largest).Sizes: O (smallest) - 3 (largest).  Available in Epinephrine / Alum, or Non-Available in Epinephrine / Alum, or Non- impregnatedimpregnated www.indiandentalacademy.comwww.indiandentalacademy.com
  197. 197. Gingigel ; Dux dentalGingigel ; Dux dental  GingiGel is saturated and coated with 20%GingiGel is saturated and coated with 20% buffered Aluminum Chloride gel. each bottlebuffered Aluminum Chloride gel. each bottle contains six feet (72 in/183 cm).contains six feet (72 in/183 cm).  Sizes: 0 (smallest) - 3 (largest).Sizes: 0 (smallest) - 3 (largest). www.indiandentalacademy.comwww.indiandentalacademy.com
  198. 198. GingiYarn; Dux dentalGingiYarn; Dux dental  features a soft and absorbent twisted yarn that isfeatures a soft and absorbent twisted yarn that is flexible for easy placement .flexible for easy placement .  ideal for use as a soft overpack with GingiBraidideal for use as a soft overpack with GingiBraid  Sizes: 1 (smallest) - 3 (largest). Available inSizes: 1 (smallest) - 3 (largest). Available in Epinephrine / Alum, Alum, or Non-impregnatedEpinephrine / Alum, Alum, or Non-impregnated www.indiandentalacademy.comwww.indiandentalacademy.com
  199. 199. Chemical medicaments-Chemical medicaments-  A variety of medicaments are available forA variety of medicaments are available for use with gingival retraction cords;use with gingival retraction cords; therefore the dentist must choose whichtherefore the dentist must choose which material to use.material to use. www.indiandentalacademy.comwww.indiandentalacademy.com
  200. 200. Criteria*-Criteria*-  Effectiveness-use of medicament mustEffectiveness-use of medicament must result in sufficient lat & verticalresult in sufficient lat & vertical displacement of gingival tissuesdisplacement of gingival tissues concomitant with tissue shrinkage.concomitant with tissue shrinkage.  Control hemorrage & fluid shrinkage.Control hemorrage & fluid shrinkage.  Should not cause tissue damageShould not cause tissue damage * JPD 1985,53,525* JPD 1985,53,525 www.indiandentalacademy.comwww.indiandentalacademy.com
  201. 201.  Should not produce potential harmful sideShould not produce potential harmful side effects-effects- consideration should be given to potentialconsideration should be given to potential reaction from LA, medication for medicalreaction from LA, medication for medical purpose & pt’s vascular status.purpose & pt’s vascular status. www.indiandentalacademy.comwww.indiandentalacademy.com
  202. 202. Medicaments-Medicaments-  EpinephrineEpinephrine  Alumilium chlorideAlumilium chloride  Aluminium sulfateAluminium sulfate  Ferric sulfateFerric sulfate  Monsel’s solutionMonsel’s solution  Negatans solutionNegatans solution  Tannic acidTannic acid www.indiandentalacademy.comwww.indiandentalacademy.com
  203. 203.  Zinc chlorideZinc chloride  TetrahydrozolineTetrahydrozoline  oxymetazolineoxymetazoline www.indiandentalacademy.comwww.indiandentalacademy.com
  204. 204.  These materials are typically dispensed inThese materials are typically dispensed in aqueous or glycol/ aqueous bufferedaqueous or glycol/ aqueous buffered solution.solution. www.indiandentalacademy.comwww.indiandentalacademy.com
  205. 205. Aluminium sulfate-Aluminium sulfate-  Conc used: 25% & 100%Conc used: 25% & 100%  Both aluminium sulfate & chloride areBoth aluminium sulfate & chloride are astringents.astringents.  They act primarily by precipitation ofThey act primarily by precipitation of protien & inhibiting transcapillaryprotien & inhibiting transcapillary movement of plasma protiens.movement of plasma protiens.  They have relatively low cellularThey have relatively low cellular permeability.permeability. www.indiandentalacademy.comwww.indiandentalacademy.com
  206. 206. advantages :advantages : - minimal tissue lossminimal tissue loss - Extended working timeExtended working time Disadvantage:Disadvantage: - less displacement & hemostasis than- less displacement & hemostasis than epinephrine.epinephrine. www.indiandentalacademy.comwww.indiandentalacademy.com
  207. 207. Van R dental productsVan R dental products  Astringloid Hemogin-LAstringloid Hemogin-L www.indiandentalacademy.comwww.indiandentalacademy.com
  208. 208. Aluminium Chloride-Aluminium Chloride-  Conc used- 5% & 25%Conc used- 5% & 25%  Recommended time- 10 minRecommended time- 10 min  Advantage:Advantage: - min tissue lossmin tissue loss - Good hemostasisGood hemostasis disadvantage:disadvantage: - local tissue destruction- local tissue destruction www.indiandentalacademy.comwww.indiandentalacademy.com
  209. 209. Hemodent,Premier dentalHemodent,Premier dental www.indiandentalacademy.comwww.indiandentalacademy.com
  210. 210. Styptin,VanR dental Pe KopaStyptin,VanR dental Pe Kopa www.indiandentalacademy.comwww.indiandentalacademy.com
  211. 211. Zinc Chloride-Zinc Chloride-  Conc – 8% & 40%Conc – 8% & 40%  Class- cautery agentClass- cautery agent  High conc of Zn chloride are caustic &High conc of Zn chloride are caustic & cause permanent injury to soft tissue &cause permanent injury to soft tissue & some times bonesome times bone  Interfere with tissue healing*Interfere with tissue healing* ** JPD, 1961,11,514; ~JPD 1978,39,287JPD, 1961,11,514; ~JPD 1978,39,287 www.indiandentalacademy.comwww.indiandentalacademy.com
  212. 212.  Adv- good tissue displacement.Adv- good tissue displacement. www.indiandentalacademy.comwww.indiandentalacademy.com
  213. 213. Tannic acid-Tannic acid-  Conc- 20% & 100%Conc- 20% & 100%  Recommended time- 10 minRecommended time- 10 min  Adv- good tissue displacementAdv- good tissue displacement  Disadv-Disadv- - less displacement than epinephrineless displacement than epinephrine - Minimal hemostasisMinimal hemostasis www.indiandentalacademy.comwww.indiandentalacademy.com
  214. 214. Negatol -Negatol -  Conc-10% & 100%Conc-10% & 100%  Class- chemical cautery agentClass- chemical cautery agent  Adv- good displacementAdv- good displacement  Disadv-Disadv- - poor tissue responsepoor tissue response - Corrosive to teeth*Corrosive to teeth* - Highly acidicHighly acidic *JPD 1964,14,769*JPD 1964,14,769 www.indiandentalacademy.comwww.indiandentalacademy.com
  215. 215. Monsel’s soln-Monsel’s soln-  Is ferric subsulfateIs ferric subsulfate  Conc 72%Conc 72%  Recommended time-3 minRecommended time-3 min  Adv- good displacementAdv- good displacement  Disadv-Disadv- - messy to use- messy to use - corrosive to teethcorrosive to teeth - Highly acidicHighly acidic www.indiandentalacademy.comwww.indiandentalacademy.com
  216. 216. Ferric sulfate-Ferric sulfate-  Conc –13.3%,15% & 20%Conc –13.3%,15% & 20%  Recommended time- 1-3 minRecommended time- 1-3 min  Adv –Adv – - good tissue responsegood tissue response - Compatible with Al chlorideCompatible with Al chloride - Extended working time-10 to 20 min.Extended working time-10 to 20 min. www.indiandentalacademy.comwww.indiandentalacademy.com
  217. 217.  Disadv-Disadv- - not compatible with epinephrinenot compatible with epinephrine - Transient tissue discolorationTransient tissue discoloration  It coagulates blood so easily that it mustIt coagulates blood so easily that it must be placed directly against the cut tissue.Ifbe placed directly against the cut tissue.If not it becomes tied up with the blood &not it becomes tied up with the blood & floats away, leaving a bleeding surface.floats away, leaving a bleeding surface. www.indiandentalacademy.comwww.indiandentalacademy.com
  218. 218. Hemostatic, Premier dentalHemostatic, Premier dental  15.5% conc15.5% conc www.indiandentalacademy.comwww.indiandentalacademy.com
  219. 219. Viscostat clear viscostat- wintermintViscostat clear viscostat- wintermint Ultradent;utahUltradent;utah www.indiandentalacademy.comwww.indiandentalacademy.com
  220. 220. Epinephrine-Epinephrine-  Conc- 0.1% & 8%Conc- 0.1% & 8%  Adv-Adv- - good displacementgood displacement - Min tissue lossMin tissue loss - Good responseGood response - Good hemostasisGood hemostasis www.indiandentalacademy.comwww.indiandentalacademy.com
  221. 221.  Is a potent myocardial stimulant.it causesIs a potent myocardial stimulant.it causes vasoconstriction in many vascular beds.vasoconstriction in many vascular beds.  Contraindications*-Contraindications*- - impared CVS functionsimpared CVS functions - HyperthyroidismHyperthyroidism - Diabetic pt’sDiabetic pt’s ** JPD 1985,53,527JPD 1985,53,527 www.indiandentalacademy.comwww.indiandentalacademy.com
  222. 222.  Max dose in healthy adult- 0.2 mgMax dose in healthy adult- 0.2 mg  ““ in cardiac pt’s -0.04 mgin cardiac pt’s -0.04 mg  Epinephrine impregnated cords containEpinephrine impregnated cords contain 0.2 to1 mg of epinephrine/ inch cord0.2 to1 mg of epinephrine/ inch cord - this is more than the max dose for healthythis is more than the max dose for healthy ptpt - 6 times the max dose for cardiac pt’s.6 times the max dose for cardiac pt’s. www.indiandentalacademy.comwww.indiandentalacademy.com
  223. 223.  Epinephrine syndrome*-Epinephrine syndrome*-  Includes tachycardia, increasedIncludes tachycardia, increased respiration, increased BP, nervousness,respiration, increased BP, nervousness, fright, post- op depression.fright, post- op depression. * JPD 1986,55,178* JPD 1986,55,178 www.indiandentalacademy.comwww.indiandentalacademy.com
  224. 224. Newer medicaments-Newer medicaments-  0.5% tetratrydrozoline [ visine; Pfizer inc]0.5% tetratrydrozoline [ visine; Pfizer inc]  pH- 6.2pH- 6.2 www.indiandentalacademy.comwww.indiandentalacademy.com
  225. 225.  0.5 oxymetazoline [ Afrine spray; Schering0.5 oxymetazoline [ Afrine spray; Schering corp]corp]  pH- 6.3,therefore kinder to tooth str & softpH- 6.3,therefore kinder to tooth str & soft tissuetissue www.indiandentalacademy.comwww.indiandentalacademy.com
  226. 226. Placement procedure-*Placement procedure-* *Shillinburg,Fundamentals of fixed prosthodontics www.indiandentalacademy.comwww.indiandentalacademy.com
  227. 227.  If a twisted or wound cord is used, grasspIf a twisted or wound cord is used, grassp the ends between thumb & forefinger ofthe ends between thumb & forefinger of each hand.each hand.  Hold the cord taut & twist the ends toHold the cord taut & twist the ends to produce a tightly wound cord of small dia.produce a tightly wound cord of small dia. www.indiandentalacademy.comwww.indiandentalacademy.com
  228. 228.  Be careful not to touch any of the cordBe careful not to touch any of the cord other than the ends, which will be cut offother than the ends, which will be cut off later,with your gloved fingers.later,with your gloved fingers.  The retraction cord should be moistnedThe retraction cord should be moistned with buffered 25% aluminum chloride soln.with buffered 25% aluminum chloride soln. www.indiandentalacademy.comwww.indiandentalacademy.com
  229. 229.  Cords impregnated with epinephrine orCords impregnated with epinephrine or aluminum sulfate are twice as effectivealuminum sulfate are twice as effective when saturated with aluminum chloride*when saturated with aluminum chloride* * JPD 1984,51,326* JPD 1984,51,326 www.indiandentalacademy.comwww.indiandentalacademy.com
  230. 230. www.indiandentalacademy.comwww.indiandentalacademy.com
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  234. 234. www.indiandentalacademy.comwww.indiandentalacademy.com
  235. 235. www.indiandentalacademy.comwww.indiandentalacademy.com
  236. 236.  By placing the instrument initially flatBy placing the instrument initially flat against the enamel & then engaging theagainst the enamel & then engaging the innermost aspect of the cord, a rollinginnermost aspect of the cord, a rolling effect is produced which has the effect ofeffect is produced which has the effect of spinning the cord in the sulcus.*spinning the cord in the sulcus.* ** Gingival displacement methods,RufenachtGingival displacement methods,Rufenacht www.indiandentalacademy.comwww.indiandentalacademy.com
  237. 237. www.indiandentalacademy.comwww.indiandentalacademy.com
  238. 238. www.indiandentalacademy.comwww.indiandentalacademy.com
  239. 239. www.indiandentalacademy.comwww.indiandentalacademy.com
  240. 240.  The overlapping must always occur in theThe overlapping must always occur in the interproximal area where the bulk of theinterproximal area where the bulk of the tissue will tolerate extra bulk of the cord.tissue will tolerate extra bulk of the cord.  According to Rufenacht -overlapping &According to Rufenacht -overlapping & consequent excessive tissue displacementconsequent excessive tissue displacement should be avoided.*should be avoided.* *fundamentals of esthetics*fundamentals of esthetics www.indiandentalacademy.comwww.indiandentalacademy.com
  241. 241. Single cord technique-*Single cord technique-*  Indications-Indications- - making impressions of one to threemaking impressions of one to three prepared teeth with healthy gingivaprepared teeth with healthy gingiva - Probably the most commonly usedProbably the most commonly used technique.technique. ** DCNA 2004,48,433DCNA 2004,48,433www.indiandentalacademy.comwww.indiandentalacademy.com
  242. 242.  Tooth preparation is accomplished & theTooth preparation is accomplished & the cervical margins are dropped to thecervical margins are dropped to the predetermined intra crevicular position.predetermined intra crevicular position. www.indiandentalacademy.comwww.indiandentalacademy.com
  243. 243.  A length of gingival retraction of cord isA length of gingival retraction of cord is selected to specifically match the anatomyselected to specifically match the anatomy of each individual sulcus.of each individual sulcus.  The largest diameter braided or knittedThe largest diameter braided or knitted cord that fit in the sulcus should be used.cord that fit in the sulcus should be used. www.indiandentalacademy.comwww.indiandentalacademy.com
  244. 244. www.indiandentalacademy.comwww.indiandentalacademy.com
  245. 245.  The cord is soaked in medicament ofThe cord is soaked in medicament of choice [ Hemodent]choice [ Hemodent]  Excess medicament is blotted from theExcess medicament is blotted from the soaked cord with a sterile cotton spongesoaked cord with a sterile cotton sponge www.indiandentalacademy.comwww.indiandentalacademy.com
  246. 246. Double cord technique-*Double cord technique-*  Indications-Indications- - making impresssions for multiple teethmaking impresssions for multiple teeth - When tissue health is compromisedWhen tissue health is compromised * DCNA 2004,48,433* DCNA 2004,48,433 www.indiandentalacademy.comwww.indiandentalacademy.com
  247. 247.  A small dia cord [ deknetal 2/0 surgical silkA small dia cord [ deknetal 2/0 surgical silk is placed in the sulcusis placed in the sulcus www.indiandentalacademy.comwww.indiandentalacademy.com
  248. 248.  The end of the cord should be cut so thatThe end of the cord should be cut so that they exactly abut against one another.they exactly abut against one another.  A second cord soaked in hemostatic agentA second cord soaked in hemostatic agent ,is placed in the sulcus above the small,is placed in the sulcus above the small diameter cord.diameter cord.  The dia of this cord should be the largestThe dia of this cord should be the largest dia that can readily be placed.dia that can readily be placed. www.indiandentalacademy.comwww.indiandentalacademy.com
  249. 249. www.indiandentalacademy.comwww.indiandentalacademy.com
  250. 250.  After waiting 8-10 mins the second cord isAfter waiting 8-10 mins the second cord is soaked in water & removed.soaked in water & removed.  The preparations are dried & theThe preparations are dried & the impressions are made with the primaryimpressions are made with the primary cord in place.cord in place. www.indiandentalacademy.comwww.indiandentalacademy.com
  251. 251. Infusion technique-*Infusion technique-*  After careful preperation of the cervicalAfter careful preperation of the cervical margin in the intra- crevicular position,margin in the intra- crevicular position, hemorrage is controlled using ahemorrage is controlled using a specifically designed dento infuser withspecifically designed dento infuser with ferric sulfate medicament.ferric sulfate medicament. * DCNA 2004,48,433* DCNA 2004,48,433 www.indiandentalacademy.comwww.indiandentalacademy.com
  252. 252. www.indiandentalacademy.comwww.indiandentalacademy.com
  253. 253.  The 20 % material is preffered because itThe 20 % material is preffered because it is less acidic than 15% soln & does notis less acidic than 15% soln & does not remove smear layer.remove smear layer.  The infuser is used in a burnishing motionThe infuser is used in a burnishing motion & is carried circumferentially 360 degree& is carried circumferentially 360 degree around the sulcus.around the sulcus. www.indiandentalacademy.comwww.indiandentalacademy.com
  254. 254.  When hemostasis is achieved,a knittedWhen hemostasis is achieved,a knitted retraction cord is packed in sulcus.retraction cord is packed in sulcus.  Advocate of this technique recommendAdvocate of this technique recommend leaving the cord in place 1-3 min.leaving the cord in place 1-3 min. www.indiandentalacademy.comwww.indiandentalacademy.com
  255. 255. Every tooth technique-*Every tooth technique-*  Indication-Indication- - with teeth in root proximity placingwith teeth in root proximity placing retraction cord simultaneously around allretraction cord simultaneously around all the prepared teeth may result inthe prepared teeth may result in strangulation of the gingival papillae &strangulation of the gingival papillae & eventual loss of papillae.eventual loss of papillae. * DCNA 2004,48,433* DCNA 2004,48,433 www.indiandentalacademy.comwww.indiandentalacademy.com
  256. 256.  In this tech retraction cord is placedIn this tech retraction cord is placed around the most distal prepared tooth.around the most distal prepared tooth.  No cord is placed around tooth mesial toNo cord is placed around tooth mesial to it.Retraction procedures are completed onit.Retraction procedures are completed on alternate teeth.alternate teeth.  Impression is made; gingival displacementImpression is made; gingival displacement is accomplished on other teeth & a 2is accomplished on other teeth & a 2ndnd impression is made.impression is made. www.indiandentalacademy.comwww.indiandentalacademy.com
  257. 257. Selective double cordSelective double cord technique-technique-  Recommended when spontaneousRecommended when spontaneous bleeding of the gingival crevice is likely tobleeding of the gingival crevice is likely to occur during impression.occur during impression.  Typically, the interproximal or lingualTypically, the interproximal or lingual aspects of the crevice are more prone toaspects of the crevice are more prone to localised inflammation,whereas the faciallocalised inflammation,whereas the facial sulcus remains relatively healthier.sulcus remains relatively healthier. www.indiandentalacademy.comwww.indiandentalacademy.com
  258. 258. www.indiandentalacademy.comwww.indiandentalacademy.com
  259. 259. www.indiandentalacademy.comwww.indiandentalacademy.com
  260. 260. MEROCELMEROCEL  Is a synthetic sponge like material that isIs a synthetic sponge like material that is specifically exdtracted from aspecifically exdtracted from a biocompatible polymer –hydroxylatebiocompatible polymer –hydroxylate polyvinyl acetate that creates net likepolyvinyl acetate that creates net like strips without debris or free fragments.strips without debris or free fragments. www.indiandentalacademy.comwww.indiandentalacademy.com
  261. 261. www.indiandentalacademy.comwww.indiandentalacademy.com
  262. 262. Advantages-Advantages-  Chemically pureChemically pure  Easily shapedEasily shaped  Remarkably effective for absorption ofRemarkably effective for absorption of intraoral fluids such as blood, saliva &intraoral fluids such as blood, saliva & crevicular fluid.crevicular fluid.  Soft & adatable to surrounding tisuesSoft & adatable to surrounding tisues  Non abrasive & free of fragmentsNon abrasive & free of fragments www.indiandentalacademy.comwww.indiandentalacademy.com
  263. 263.  Example-Example-  Merocel [ Medtronic solan]Merocel [ Medtronic solan] www.indiandentalacademy.comwww.indiandentalacademy.com
  264. 264. www.indiandentalacademy.comwww.indiandentalacademy.com
  265. 265. Procedure*-Procedure*- * JPD 1996,75,242* JPD 1996,75,242www.indiandentalacademy.comwww.indiandentalacademy.com
  266. 266. www.indiandentalacademy.comwww.indiandentalacademy.com
  267. 267. MOISTURE CONTROLMOISTURE CONTROL & SOFT TISSUE& SOFT TISSUE MANAGEMENT INMANAGEMENT IN FIXEDFIXED PROSTHODONTICSPROSTHODONTICS www.indiandentalacademy.comwww.indiandentalacademy.com
  268. 268. Newer Materials-Newer Materials-  Expasyl [ Kerr dental]Expasyl [ Kerr dental]  Magic foam [ coltene –whaledent]Magic foam [ coltene –whaledent]  Gingi-Trac [ centrix dental]Gingi-Trac [ centrix dental] www.indiandentalacademy.comwww.indiandentalacademy.com
  269. 269. Gingi-Trax retraction systemGingi-Trax retraction system [for single preparations][for single preparations] www.indiandentalacademy.comwww.indiandentalacademy.com
  270. 270. www.indiandentalacademy.comwww.indiandentalacademy.com
  271. 271. Retraction technique for multipleRetraction technique for multiple preperations-preperations- www.indiandentalacademy.comwww.indiandentalacademy.com
  272. 272. Rotary curettage [ gingettage]Rotary curettage [ gingettage]  Was described by Amsterdam in 1954.Was described by Amsterdam in 1954.  Is a “troughing” technique, the purpose ofIs a “troughing” technique, the purpose of which is to produce limited removal ofwhich 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 inchamfer finish line is being created in tooth structure.tooth structure. www.indiandentalacademy.comwww.indiandentalacademy.com
  273. 273.  Prerequisite:Prerequisite:  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.  Absence of bleeding on probingAbsence of bleeding on probing  Sulcus depth less than 3 mmSulcus depth less than 3 mm  Presence of adequate keratinized gingiva.Presence of adequate keratinized gingiva. www.indiandentalacademy.comwww.indiandentalacademy.com
  274. 274. www.indiandentalacademy.comwww.indiandentalacademy.com
  275. 275. www.indiandentalacademy.comwww.indiandentalacademy.com
  276. 276.  Less change in gingival height with rotaryLess change in gingival height with rotary curettage than with lateral gingivalcurettage than with lateral gingival displacement using retraction cord.*displacement using retraction cord.* * JPD 1984,52,380* JPD 1984,52,380 www.indiandentalacademy.comwww.indiandentalacademy.com
  277. 277.  There was no significant differenceThere was no significant difference between the cord gingival displacement &between the cord gingival displacement & the gingitage technique.*the gingitage technique.*  Results of another study demonstrated aResults of another study demonstrated a significant difference between gingitage &significant difference between gingitage & electrosurgical retraction.the bur methodelectrosurgical retraction.the bur method resulted in less tissue loss.resulted in less tissue loss.†† * JPD 1981,46,509;* JPD 1981,46,509; † 1985,53,179† 1985,53,179 www.indiandentalacademy.comwww.indiandentalacademy.com
  278. 278. Electrosurgical –Electrosurgical – [ subgingival tissue troughing][ subgingival tissue troughing]  Electrosurgery:[ according to Can DentElectrosurgery:[ according to Can Dent Asso]Asso]  As intentional passage of high –frequencyAs intentional passage of high –frequency waveforms, or current, through the tissueswaveforms, or current, through the tissues of the body to achieve a controlledof the body to achieve a controlled surgical effect.*surgical effect.* * Quintessence Int 1998; 29;649-54* Quintessence Int 1998; 29;649-54 www.indiandentalacademy.comwww.indiandentalacademy.com
  279. 279.  UsesUses--  CuttingCutting  coagulationcoagulation www.indiandentalacademy.comwww.indiandentalacademy.com
  280. 280.  Principle-Principle-  Tissues are naturally resistant to highTissues are naturally resistant to high frequency waveform, when thesefrequency waveform, when these waveform pass through it, intense cellularwaveform pass through it, intense cellular heat is produced within the tissuesheat is produced within the tissues contacted by the active electrode tip.Thecontacted by the active electrode tip.The heat volatilizes the cell.heat volatilizes the cell. www.indiandentalacademy.comwww.indiandentalacademy.com
  281. 281. Electrosurgical unit -Electrosurgical unit -  The units vary in power from 25 watts toThe units vary in power from 25 watts to 100 watts100 watts  They produce radio waves from 1.3 –4They produce radio waves from 1.3 –4 MHz.MHz. www.indiandentalacademy.comwww.indiandentalacademy.com
  282. 282. Electrosurgical unit -Electrosurgical unit -  Current genetrator- Ellman Dento-surgCurrent genetrator- Ellman Dento-surg 70&9070&90 www.indiandentalacademy.comwww.indiandentalacademy.com
  283. 283. Active electrode-Active electrode- www.indiandentalacademy.comwww.indiandentalacademy.com
  284. 284. Passive electrode-Passive electrode- www.indiandentalacademy.comwww.indiandentalacademy.com
  285. 285. waveformswaveforms www.indiandentalacademy.comwww.indiandentalacademy.com
  286. 286. www.indiandentalacademy.comwww.indiandentalacademy.com
  287. 287. Procedure-Procedure- www.indiandentalacademy.comwww.indiandentalacademy.com
  288. 288. www.indiandentalacademy.comwww.indiandentalacademy.com
  289. 289. www.indiandentalacademy.comwww.indiandentalacademy.com
  290. 290. www.indiandentalacademy.comwww.indiandentalacademy.com
  291. 291. 15-20 deg www.indiandentalacademy.comwww.indiandentalacademy.com
  292. 292. www.indiandentalacademy.comwww.indiandentalacademy.com
  293. 293. Oringer’s solution-Oringer’s solution- www.indiandentalacademy.comwww.indiandentalacademy.com
  294. 294. Lasers -Lasers -  The term laser is an acronym. TheThe term laser is an acronym. The term LASER stands for-Lightterm LASER stands for-Light Amplification by Stimulated EmissionAmplification by Stimulated Emission of Radiation.of Radiation. www.indiandentalacademy.comwww.indiandentalacademy.com
  295. 295. www.indiandentalacademy.comwww.indiandentalacademy.com
  296. 296. www.indiandentalacademy.comwww.indiandentalacademy.com
  297. 297.  The 320micro m & especially the 200-The 320micro m & especially the 200- micro m fidre diode is used along the Nd:micro m fidre diode is used along the Nd: YAG wavelength to deliver subablativeYAG wavelength to deliver subablative power to open the gingival crevice .power to open the gingival crevice . *DCNA 48,2004,971*DCNA 48,2004,971 www.indiandentalacademy.comwww.indiandentalacademy.com
  298. 298.  Pulse rate used – 10 pulse/ secPulse rate used – 10 pulse/ sec  To coagulate the bleeding points- 10-20To coagulate the bleeding points- 10-20 pulse /sec is used.pulse /sec is used.  There is no need for anesthesia.if neededThere is no need for anesthesia.if needed a topical aplication of 20% benzocaine isa topical aplication of 20% benzocaine is enough.enough. www.indiandentalacademy.comwww.indiandentalacademy.com
  299. 299. www.indiandentalacademy.comwww.indiandentalacademy.com
  300. 300. Argon laserArgon laser  Argon laser provide excellent hemostasisArgon laser provide excellent hemostasis & efficient coagulation & vaporisation of& efficient coagulation & vaporisation of oral tissues.oral tissues.  These characteristics are beneficial forThese characteristics are beneficial for retraction & hemostasis of the gingivalretraction & hemostasis of the gingival tissue in preparation for an impressiontissue in preparation for an impression during a crown & bridge procedureduring a crown & bridge procedure www.indiandentalacademy.comwww.indiandentalacademy.com
  301. 301. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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