Gingival Tissue Management
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Gingival Tissue Management

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    Gingival Tissue Management Gingival Tissue Management Presentation Transcript

    • GINGIVAL TISSUE MANAGEMENT Dr shabeel pn
      • In the context of general operative treatment procedures , gingival tissue management relates to the various techniques applied in order to displace these tissues from the proposed operating site.
      • Such gingival tissue displacement is often required in order to carry out the principles of cavity design and restoration
    • Indications
      • When the cavity preparation extends into the subgingival area as in class II and class V cavity preparation.
      • Aesthetics, while placing crown it should stay 0.5mm into gingival sulcus.
      • Making impression to get the contour of tooth below cervical margin.
      • Enhancing the retention: If the crown is smaller , restoration is to be placed after increasing crown length after gingival surgery.
      • Gingival overgrowth hindering operative procedure .
      • Control gingival haemorrhage during operative procedure.
    • Methods
      • Physico Mechanical Method
      • Chemico-Mechanical method.
      • Chemical method.
      • Rotary curettage.
      • Electro Surgical Method.
      • Surgical Method.
      • Recent methods.
    • Physico Mechanical Methods
      • This involves mechanically forcing the gingival tissue away from tooth surface, laterally & apically.
      • Used only when there is normal healthy attached gingiva.
      • Retraction attained to a lesser extend
      • Methods
      • Application of heavy,extra heavy& special weight rubber dam (with 212 clamp)
      • Wooden wedges
      • Replacement of rolled cotton twills in the gingival sulcus.
      • Placement of cotton twills impregnated with ZnOE (This pack should remain for minimum of 48 hours and not more than 7 days)
      • Copper bands .
      • Aluminium shell .
      • Temporary acrylic resin copings
      • Gingival cords .
    • Chemico-mechanical method
      • Dry the operating area.
      • Select appropriate size of cord-neither too thin nor too thick.
      • Cut suitable length of cord to fit the entire sulcus.
      • Soak the cord in the chemical.
      • Place cord into the gingival sulcus using plastic instrument or cord packer. Place in the axial area first, then lingual and buccal.
      • Remove after 5-10 minutes by moistening to prevent gingival injury.
    • Chemico-Mechanical
      • They provide predictable amount of gingival retraction.
      • Retraction cord used along with chemicals such as
      • Vasonstrictors- Adrenalin& Nor-adrenalin
      • They lower bleeding
      • But they Increase heart rate & BP
      • Hence Contraindicated heartpatients, Hptn & Diabetics.
      • Astringents or biological fluid coagulants,
      • Alum -100%, Aluminium chloride- 15-25%, Tannic acid-15-25%, Ferric sulphite- 15.5% .
      • These agents coagulate gingival fluid & blood and forms a impervious layer preventing further fluid seepage. There is no systemic effect so commonly used.
      • Tissue coagulants:
      • Zinc chloride 8% and Silver nitrite.
      • They act by coagulate sulcular epithelium and free gingival epithelium and fluid and prevent further seepage.
      • But they cause ulceration & necrosis, Alteration position and contour of the free gingiva.
      • Gingival retraction cords :
      • Available as:
      • Braided
      • Twisted
      • Flattened
      • Knitted.
      • They may be supplied as already impregnated with chemical.
      • A suitable length of cord is tucked into the gingival sulcus using blunt ended instruments around the tooth.
    • Chemical Method
      • This method involves cauterization using various caustic chemicals sulphuric acid. Trichloro acetic acid, Negatol.
      • Most of these chemical are now abondoned, only Trichloro acetic acid is now used.
      • Method:
      • Blade of plastic instrument is dipped in the chemical and then placed in the required gingival margin.
      • It causes haemostasis & control of gingival fluid flow.
      • It is used where minimum retraction is required along with control of blood & fluid flow.
    • Rotary Curretage
      • Also known as GINGITTAGE.
      • Camphor diamond point used with a high speed hand piece to cut the gingival margins.
      • Disadvantage:
      • Uncontrolled procedure. Hence may cause overextention and excessive bleeding.
    • Surgical Method
      • This involves surgical excision of interfering gingival tissue using a sharp scalpel blade or surgical knife.
      • Used in case of gingival hypertrophy, extensive tooth fracture extending sub gingivally.
      • Temporary restoration given for two weeks after this procedure and then only permanent restoration given for proper healing of the site.
    • Electro Surgical Method
      • When other conservative procedures not possible Electro surgical method is used.
      • Principles:
      • It uses alternating current at high frequency concentrated at tiny electrode to perform various action.
      • In this 4 types of action can be produced at the electrode end namely, cutting, coagulation, fulguration & dessication.
      • Cutting : Done precisely using minimum energy and does not induce any bleeding.
      • Coagulation : When greater energy is used there is coagulation of tissues, blood & gingival fluid.
      • Fulguration : using considerable energy. As heat is genetrated there is deeper tissue involvement associated with carbonization.
      • Dessication : This involves massive tissue involvement and is uncontrolled in it’s action.
      • For gingival tissue retraction mostly cutting and rarely coagulation actions are employed.
      • Method
      • Proper isolation of tooth & adjacent tissue without excessively drying the soft tissue.
      • Use fully rectified current with minimal energy output for desired purpose.
      • For cutting use the probe or loop type electrode with light touch & rapid intermittent stroke.
      • Always cut on the inner walls of the gingival sulcus avoiding the gingival crest and epithelial attachment.
      • For coagulation use bulky unipolar electrode with partially rectified current.The electrode should be kept very close to the tissue to control bleeding or oozing.
      • Avoid contact of the electrode with metallic filling to prevent short circuit.
      • Clean the electrode tip with alcohol sponge after each use.
      • Advantages:
      • Rapid atraumatic cutting of the soft tissue
      • Sterilizes the wound immediately.
      • Create a dry field free from haemorrhage.
      • Healing occurs by primary intention, without pain swelling or scar.
    • Recent techniques for gingival retraction
      • Lasers.
      • For gingival retractin Nd- YAG lasers are used.
      • Advantage:
      • Bloodless, painless incision.
      • Controlled tissue removal.
      • Rapid healing.
      • Disadvantage:
      • Slow technique.
      • Expensive
      • Retraction by dilatation of gingival sulcus.
      • 1.Gingifoam:
      • 2 paste system:
      • Base paste: poly dimethyl siloxane.
      • Catalyst paste: Tin
      • On mixing the two paste hydrogen gas is formed resulting in formation of foam this foam cause retraction of gingiva.
      • 2.Paste of aluminium chloride kaolin & water which is delivered using a gun into the gingival sulcus.
    • THE END