Detailed description of an FPD topic

1. FLUID CONTROLAND SOFT TISSUE
MANAGEMENT
DR. AMRIT ASSI
PG 2ND YEAR
DEPT. OF PROSTHODONTICS

2. COMPLETE CONTROL OF THE ENVIRONMENT OF THE OPERATIVE
SITE IS ESSENTIAL DURING RESTORATIVE DENTAL PROCEDURES
FOR:
1.PATIENT’S COMFORT.
2.OPERATOR’S SAFETY
3.OPERATOR’S ACCESS
4.CLEAR VISIBILITY

3. FLUID CONTROL:
• NEED FOR REMOVAL OF FLUIDS VARIES DEPENDING ON THE TASK BEING
PERFORMED.
• DURING THE PREPARATION OF TEETH:
NECESSARY TO REMOVE LARGE VOLUMES OF WATER PRODUCED BY
HANDPIECE SPRAY AND TO CONTROL THE TONGUE TO PREVENT
ACCIDENTAL INJURY
• WHEN AN IMPRESSION IS MADE / RESTORATION IS CEMENTED:
THERE IS A MUCH SMALLER VOLUME OF FLUID TO BE REMOVED, BUT A
MUCH GREATER DEGREE OF DRYNESS IS REQUIRED

4. RUBBER DAM:

5. • MOST EFFECTIVE OF ALL ISOLATION DEVICES USED IN RESTORATIVE
DENTISTRY.
• TEETH WITH OLD OR QUESTIONABLE ENDODONTIC TREATMENTS
SHOULD BE ISOLATED IN THIS MANNER FOR POST AND CORE
PREPARATION, PATTERN FABRICATION, AND CEMENTATION.
• USED DURING TOOTH PREPARATION FOR INLAYS AND ONLAYS (IF THE
OCCLUSAL REDUCTION IS DONE BEFORE DAM IS PLACED), AND IT CAN BE
READILY USED FOR MAKING IMPRESSIONS AND CEMENTING THE SAME
TYPES OF RESTORATION.
• WHEN USED WITH ELASTOMERIC IMPRESSION MATERIALS, THE DAM
MUST BE LUBRICATED, AND THE CLAMP MUST BE REMOVED OR AVOIDED.
IT SHOULD NOT BE USED WITH POLYVINYL SILOXANE IMPRESSION
MATERIAL BECAUSE RUBBER DAM WILL INHIBIT ITS POLYMERIZATION.

6. HIGH-VOLUME VACUUM:
CAN CLEAR 400L OF WATER IN A MINUTE !!!

7. • EXTREMELY USEFUL DURING THE PREPARATION PHASE AND IS MOST EFFECTIVELY
USED WITH AN ASSISTANT.
• MAKES AN EXCELLENT LIP RETRACTOR WHILE THE OPERATOR USES A MIRROR TO
RETRACT AND PROTECT THE TONGUE.
• NOT PRACTICAL DURING THE IMPRESSION OR CEMENTATION PHASES

8. SALIVA EJECTOR:
SIMPLE SALIVA EJECTOR CAN BE USED EFFECTIVELY IN SOME
SITUATIONS BY THE DENTIST WORKING WITHOUT AN ASSISTANT

9. • MOST USEFULAS AN ADJUNCT TO HIGH-VOLUME EVACUATION, BUT IT CAN
BE USED ALONE FOR THE MAXILLARYARCH.
• PLACED IN THE CORNER OF THE MOUTH OPPOSITE THE QUADRANT BEING
TREATED, AND THE PATIENT’S HEAD IS TURNED TOWARD IT.
• CAN ALSO BE USED VERY EFFECTIVELY ON THE MAXILLARYARCH FOR
IMPRESSIONS AND CEMENTATION SIMPLY BY ADDING COTTON ROLLS IN
THE VESTIBULE FACIAL TO THE TEETH BEING ISOLATED.
• IT CAN BE USED ON THE MANDIBULAR ARCH WHILE A COTTON ROLL
HOLDER POSITIONS COTTON ROLLS FACIALAND LINGUAL TO THE TEETH.
• TONGUE CONTROLAND FLUID REMOVAL IN THIS APPLICATION MAY BE
LESS THAN IDEAL

10. THE SALIVA EJECTOR CAN BE USED FOR EVACUATION WHEN THE
MAXILLARY ARCH IS BEING TREATED

11. SVEDOPTER

12. • FOR ISOLATION AND EVACUATION OF THE MANDIBULAR TEETH.
• IT HAS A METAL SALIVA EJECTOR WITH ATTACHED TONGUE DEFLECTOR WHICH IS AN
EXCELLENT DEFLECTOR.
• CAN BE USED WITHOUT COTTON ROLLS DURING THE PREPARATION PHASE, WITH A
MOUTH MIRROR AS A LIP RETRACTOR.

13. • BY ADDING FACIAL AND LINGUAL COTTON ROLLS, EXCELLENT TONGUE
CONTROL AND ISOLATION IS PROVIDED FOR IMPRESSION TAKING OR
CEMENTATION.

14. SVEDOPTER IS MOST EFFECTIVE WHEN IT IS USED WITH THE PATIENT IN A
NEARLY UPRIGHT POSITION BECAUSE IN THIS POSITION, WATER AND
OTHER FLUIDS COLLECT ON THE FLOOR OF THE MOUTH, WHERE THEY
ARE PULLED OFF BY THE VACUUM.

15. DRAWBACKS OF SVEDOPTER:
• ACCESS TO THE LINGUAL SURFACES OF THE MANDIBULAR TEETH IS LIMITED.
• BECAUSE THE DEVICE IS MADE OF METAL CARE MUST BE EXERCISED TO
AVOID BRUISING THE TENDER TISSUE IN THE FLOOR OF THE MOUTH BY
OVERZEALOUSLY CINCHING DOWN THE CLAMP THAT FITS UNDER THE CHIN.
• PRESENCE OF MANDIBULAR TORI USUALLY PRECLUDES ITS USE.
• SELECTION OF AN OVERSIZED REFLECTOR SHOULD BE AVOIDED BECAUSE IT
COULD CUT INTO THE PALATE ABOVE OR TRIGGER THE GAG REFLEX.
• FOR BETTER POSITIONING, THE ANTERIOR PART OF THE SVEDOPTER
SHOULD BE PLACED IN THE INCISOR REGION, WITH THE TUBING UNDER
THE PATIENT’S ARM

16. THE TUBING FOR THE SVEDOPTER IS PLACED UNDER THE
PATIENT’S ARM TO PREVENT ANY JERKING ON THE ATTACHMENT
WHILE IT IS IN THE MOUTH

17. ANTISIALAGOGUES
• THERE ARE NO DRUGS THAT HAVE THE SPECIFIC PURPOSE OF DECREASING SALIVARY
FLOW TO FACILITATE DENTAL IMPRESSIONS (BRITTON ML, PERSONAL
COMMUNICATION, 2009).
• GLYCOPYRROLATE, A SYNTHETIC ANTICHOLINERGIC MEDICATION, IS USED IN ITS
INJECTABLE FORM (ROBINUL, BAXTER) TO REDUCE SALIVARY SECRETIONS BEFORE
SURGERY.
• GLYCOPYRROLATE IN ITS ORAL FORM, IS INDICATED FOR ADJUNCTIVE TREATMENT
OF PEPTIC ULCERS.
• DRY MOUTH IS A SIDE EFFECT.
• IT IS PRUDENT TO CONSULT YOUR PATIENT’S PHYSICIAN BEFORE USING THE
MEDICATION FOR AN “OFFLABEL” PURPOSE

18. • A 1-MG TABLET OF ROBINUL, TAKEN 30 MINUTES BEFORE THE
IMPRESSION (ITS HALF-LIFE IS REPORTED TO BE 0.6 TO 1.2 HOURS) MAY
BE CONSIDERED.
• IF EXPERIENCE PROVES THAT THIS IS INADEQUATE, A 2-MG TABLET
(ROBINUL FORTE, SHIONOGI PHARMA) IS AVAILABLE.
• THIS MEDICATION MAY PRODUCE DROWSINESS AND BLURRED VISION,
SO A DESIGNATED DRIVER SHOULD ACCOMPANY THE PATIENT (ITS
DURATION OF ACTION IS REPORTED TO BE UP TO 7 HOURS).
• THERE IS A RISK OF HEAT PROSTRATION IF THE PATIENT IS EXPOSED TO
HIGH AMBIENT TEMPERATURES

19. • CAUTION SHOULD BE EXERCISED IN THE ELDERLY AND IN PATIENTS WITH:
1. AUTONOMIC NEUROPATHY
2. HEPATIC/ RENAL DISEASE
3. ULCERATIVE COLITIS
4. HYPERTHYROIDISM
5. CORONARY HEART DISEASE
6. CONGESTIVE HEART FAILURE
7. TACHYARRHYTHMIAS, TACHYCARDIA, HYPERTENSION
8. PROSTATIC HYPERTROPHY
9. HIATAL HERNIAASSOCIATED WITH REFLUX ESOPHAGITIS

20. ABSOLUTE CONTRAINDICATIONS INCLUDE:
1. HYPERSENSITIVITY OR ALLERGY TO GLYCOPYRROLATE
2. GLAUCOMA
3. OBSTRUCTIVE UROPATHY
4. OBSTRUCTIVE DISEASE OF THE GASTROINTESTINAL TRACT
5. PARALYTIC ILEUS
6. INTESTINAL ATONY OF THE ELDERLY OR DEBILITATED PATIENT
7. UNSTABLE CARDIOVASCULAR STATUS IN ACUTE HEMORRHAGE
8. SEVERE ULCERATIVE COLITIS
9. TOXIC MEGACOLON COMPLICATING ULCERATIVE COLITIS
10. MYASTHENIA GRAVIS

21. • ANOTHER DRUG THAT HAS BEEN SHOWN TO BE EFFECTIVE AS AN
ANTISIALAGOGUE IS CLONIDINE HYDROCHLORIDE.
• WILSON ET AL DEMONSTRATED THAT A 0.2-MG DOSE OF THIS DRUG IS
EFFECTIVE IN DIMINISHING SALIVARY FLOW.
• CLONIDINE HYDROCHLORIDE IS AN ANTIHYPERTENSIVE AGENT,
AND IT SHOULD BE USED CAUTIOUSLY IN PATIENTS WHO ARE
RECEIVING OTHER ANTIHYPERTENSIVE MEDICATION.
• PRINCIPAL SIDE EFFECT, BESIDES A DRY MOUTH, IS DROWSINESS,
WHICH IS NOT ALTOGETHER UNDESIRABLE IN A PATIENT
UNDERGOING A LENGTHY RESTORATIVE DENTAL APPOINTMENT.
• THE DOSE OF 0.2 MG SHOULD BE ADMINISTERED AN HOUR BEFORE
THE APPOINTMENT, AND A DESIGNATED DRIVER SHOULD ACCOMPANY
THE PATIENT

23. FINISH LINE EXPOSURE
• IT IS ESSENTIAL THAT GINGIVAL TISSUE BE HEALTHY AND FREE OF INFLAMMATION
BEFORE CAST RESTORATIONS ARE BEGUN.
• STARTING TOOTH PREPARATIONS IN THE FACE OF UNTREATED GINGIVITIS MAKES THE
TASK MORE DIFFICULT AND SERIOUSLY COMPROMISES THE CHANCES FOR SUCCESS.
• THE MARGINAL FIT OF A RESTORATION IS ESSENTIAL IN PREVENTING RECURRENT
CARIES AND GINGIVAL IRRITATION, THE FINISH LINE OF THE TOOTH PREPARATION
MUST BE REPRODUCED IN THE IMPRESSION.
• OBTAINING A COMPLETE IMPRESSION IS COMPLICATED WHEN SOME OR ALL OF THE
PREPARATION FINISH LINE LIES AT OR APICAL TO THE CREST OF THE FREE GINGIVA.
• IN THESE SITUATIONS, THE PREPARATION FINISH LINE MUST BE TEMPORARILY
EXPOSED TO ENSURE REPRODUCTION OF THE ENTIRE PREPARATION

24. DISPLACEMENT OF GINGIVAL TISSUES:
• TISSUE DISPLACEMENT IS COMMONLY NEEDED TO OBTAIN ADEQUATE ACCESS TO THE
PREPARED TOOTH AND TO EXPOSE ALL NECESSARY SURFACES, BOTH PREPARED AND
NOT PREPARED.
• THIS CAN BE ACHIEVED BY:
1.MECHANICAL
2.CHEMICOMECHANICAL
3.SURGICAL

25. MECHANICAL:
• MECHANICAL DISPLACEMENT IS MOST EFFECTIVELY ACHIEVED BY
PLACEMENT OF A CORD (GENERALLY IMPREGNATED WITH A CHEMICAL
AGENT).
• ALTERNATIVELY, FOAM OR PASTE SYSTEMS CAN BE USED, OFTEN IN
CONJUNCTION WITH DIRECTED PRESSURE.
• CHEMICALS SUCH AS ALUMINUM SULFATE OR EPINEPHRINE CAUSE
LOCALIZED SOFT TISSUE SHRINKAGE.
• SURGICAL TISSUE REMOVAL CAN BE ACCOMPLISHED THROUGH CURETTAGE,
EXCISION WITH A SCALPEL, ELECTROSURGERY, OR LASER

26. CORD HAS BEEN PLACED INTRASULCULARLY AS CLOSE TO THE LEVEL
OF THE PREPARED MARGIN AS POSSIBLE TO DISPLACE TISSUE
LATERALLY
RETRACTION
CORD

27. DISPLACEMENT CORD:
• IF A DRY FIELD HAS BEEN ACHIEVED, THE SULCUS CAN BE ENLARGED SOMEWHAT BY
PLACEMENT OF A NONIMPREGNATED CORD THAT IS LEFT IN PLACE FOR A SUFFICIENT
LENGTH OF TIME.
• CORD IS PUSHED INTO THE SULCUS AND MECHANICALLY STRETCHES THE
CIRCUMFERENTIAL PERIODONTAL FIBERS.
• PLACEMENT IS OFTEN EASIER IF A BRAIDED CORD, OR A KNITTED CORD IS USED.
• ARGER SIZES OF BRAIDED CORD SHOULD BE AVOIDED BECAUSE THEY HAVE A
TENDENCY TO DOUBLE UP AND CAN BECOME TOO THICK FOR ATRAUMATIC
INTRASULCULAR PLACEMENT.
• IN AREAS WHERE EXTREME NARROWNESS OF THE SULCI PRECLUDES PLACEMENT OF
THE SMALLER SIZES OF TWISTED OR BRAIDED CORD, WOOL-LIKE CORDS THAT CAN BE
FLATTENED ARE PREFERABLE FOR INITIAL DISPLACEMENT OF TISSUE

28. • SULCI CAN BE ENLARGED BETTER WITH A CHEMICALLY IMPREGNATED CORD OR A
CORD DIPPED IN AN ASTRINGENT.
• THESE MATERIALS CONTAIN ALUMINUM OR IRON SALTS AND CAUSE A TRANSIENT
ISCHEMIA, SHRINKING THE GINGIVAL TISSUE

29. • IN ADDITION, MEDICAMENTS HELP CONTROL SEEPAGE OF GINGIVAL
FLUID.
• ALUMINUM CHLORIDE, FERRIC SULFATE ARE SUITABLE BECAUSE
THEY CAUSE MINIMAL TISSUE DAMAGE.
• AS AN ALTERNATIVE:
a) A SYMPATHOMIMETIC AMINE–CONTAINING EYE WASH
(TETRAHYDROZOLINE HCL [VISINE], 0.05%)
b) NASAL DECONGESTANT (OXYMETAZOLINE [AFRIN], 0.05%)

30. • MANY OF THE CHEMICALS USED FOR THEIR ASTRINGENT EFFECT ARE STABLE ONLY
AT NARROW RANGES OF LOW PH LEVELS.
• LOW PH LEVELS HAVE RAISED CONCERN ABOUT THE EFFECT OF ACIDIC SOLUTIONS
ON TOOTH STRUCTURE.

31. • TISSUE DISPLACEMENT IS TIME DEPENDENT; BECAUSE SEVERAL
MINUTES MUST ELAPSE BEFORE ADEQUATE DISPLACEMENT HAS BEEN
ACCOMPLISHED.
• THE SULCUS CLOSES QUICKLY (LESS THAN 30 SECONDS); THEREFORE,
THE IMPRESSION MUST BE MADE IMMEDIATELY.
• A 1999 SURVEY REVEALED THAT 54% OF PROSTHODONTISTS PREFER
SOAKING DISPLACEMENT CORD IN BUFFERED ALCL3 WHEREAS MORE
THAN 35% ROUTINELY USE FE2(SO4)3 OR ALCL3

32. STEP-BY-STEP PROCEDURE
• ISOLATE THE PREPARED TEETH WITH COTTON ROLLS, PLACE SALIVA EVACUATORS
AND ANY OTHER AIDS AS REQUIRED, AND DRY THE FIELD WITH AIR.
• CUT A LENGTH OF CORD SUFFICIENT TO ENCIRCLE THE TOOTH.

33. • DIP THE CORD IN ASTRINGENT SOLUTION AND SQUEEZE OUT THE
EXCESS WITH A GAUZE SQUARE.
• AN IMPREGNATED CORD CAN BE PLACED DRY BUT SHOULD BE
SLIGHTLY MOISTENED IN SITU IMMEDIATELY BEFORE REMOVAL FROM
THE SULCUS, TO PREVENT THE THIN SULCULAR EPITHELIUM FROM
STICKING TO IT AND TEARING WHEN IT IS REMOVED.
• A CONVENIENT WAY TO LIMIT THE AMOUNT OF MOISTURE ADDED IS TO
APPLY WATER HELD BETWEEN THE TIPS OF A DENTAL FORCEPS BY
OPENING IT.
• TWIST NONBRAIDED CORDS TIGHTLY FOR EASIER PLACEMENT.
• LOOP THE CORD AROUND THE TOOTH, AND GENTLY PUSH IT INTO THE
SULCUS WITH A SUITABLE INSTRUMENT

35. • IT IS OFTEN EASIEST TO START
INTERPROXIMALLY, BECAUSE
MORE SULCULAR DEPTH IS
AVAILABLE, THAN FACIALLY OR
LINGUALLY.
• INSTRUMENT SHOULD BE ANGLED
SLIGHTLY TOWARD THE TOOTH SO
THAT THE CORD IS PUSHED
DIRECTLY INTO THE SULCUS.
• IT SHOULD ALSO BE ANGLED
SLIGHTLY TOWARD ANY CORD
PREVIOUSLY PACKED; OTHERWISE,
THE LATTER MIGHT BE DISPLACED

36. • TISSUE MUST BE DISPLACED
GENTLY BUT WITH SUFFICIENT
FIRMNESS TO PLACE THE CORD
JUST APICAL TO THE MARGIN.
• OVERPACKING MUST BE
AVOIDED BECAUSE IT COULD
CAUSE TEARING OF THE
GINGIVALATTACHMENT, WHICH
LEADS TO IRREVERSIBLE
RECESSION.
• REPEATED USE OF
DISPLACEMENT CORD IN THE
SULCUS ALSO SHOULD BE
AVOIDED BECAUSE THIS CAN
CAUSE GINGIVAL RECESSION.

37. COMPLICATIONS OF IMPROPER TISSUE DISPLACEMENT:
1.GINGIVAL INFLAMMATION.
2.INFLAMED AND SWOLLEN TISSUES BLEED EASILY.
3.RESULTING MOISTURE PREVENTS PROPER
WETTING OF THE PREPARED SURFACES BY THE
IMPRESSION MATERIAL

38. EVALUATION OF CORD
• SHOULD BE DONE FEW MINUTES AFTER CORD PLACEMENT.
• THE CLINICIAN SHOULD VIEW THE TOOTH PREPARATION FROM THE OCCLUSAL
ASPECT AND BE ABLE TO SEE THE PREPARATION MARGIN CIRCUMFERENTIALLY
AND A WIDTH OF THE UNINTERRUPTED CORD, WITH NO FREE GINGIVAL TISSUE
FOLDED OVER IT OR IN CONTACT WITH THE TOOTH.
• VISIBLE CORD WIDTH SHOULD RARELY EXCEED HALF THE WIDTH OF THE CORD
BEFORE PACKING.
• IF THERE IS ANY DOUBT, THE CLINICIAN CAN ASSESS DISPLACEMENT BY REMOVING
THE CORD.
• THE ENTIRE PREPARATION MARGIN SHOULD BE CLEARLY VISIBLE AND REMAIN
DIRECTLY ACCESSIBLE FOR BETWEEN 30 AND 60 SECONDS

39. • IF ANY TISSUE FOLDS BACK INTO CONTACT WITH THE PREPARATION
SOONER, ADDITIONAL ATTENTION MUST BE GIVEN TO THAT AREA
BECAUSE A SECOND CORD IS INSERTED IMMEDIATELY AFTER THIS
EVALUATION.
• SECOND PLACEMENT OF DISPLACEMENT CORD IS USUALLY FAIRLY
STRAIGHTFORWARD BECAUSE THE PERIODONTAL FIBERS HAVE BEEN
STRETCHED BY THE INITIAL DISPLACEMENT EFFORT.
• IF THE RESULT IS ACCEPTABLE, A SECOND CORD IS TYPICALLY
INSERTED QUICKLY TO MAINTAIN THE DISPLACEMENT WHILE THE
IMPRESSION MATERIAL IS MIXED.
• IF THE SULCULAR ENLARGEMENT IS NOT FAVORABLE, THE TISSUE
HEALTH SHOULD BE REASSESSED, PARTICULARLY IF ADEQUATE
DISPLACEMENT CANNOT BE OBTAINED IN REPEATING THE PREVIOUS
STEPS

40. DOUBLE-CORD TECHNIQUE:

41. • AN INITIAL (THIN) CORD IS TRIMMED AND PLACED SO THAT ITS ENDS
DO NOT OVERLAP.
• A SECOND (THICKER) CORD IS THEN SATURATED WITH ASTRINGENT,
PLACED IN THE NORMAL MANNER, AND REMOVED AFTER SEVERAL
MINUTES.
• THE THIN FIRST CORD REMAINS DURING IMPRESSION MAKING.
• TO BE SUCCESSFUL, THIS TECHNIQUE REQUIRES THAT ABOUT 1 MM OF
INTACT TOOTH STRUCTURE REMAINS BETWEEN THE TOP OF THE
INITIAL CORD AND THE PREPARATION MARGIN.
• CLINICIAN SHOULD BE CAREFUL NOT TO EXERT EXCESSIVE PRESSURE
ON THE TISSUES, WHICH CAN DAMAGE THE EPITHELIAL ATTACHMENT

42. HAEMORRHAGE CONTROL WITH AN INFUSER SYRINGE
• FILL THE SYRINGE WITH FE2(SO4)3 SOLUTION AND ATTACH THE INFUSER TIP.

43. • RUB THE TIP BACK AND FORTH FOR APPROXIMATELY 30 SECONDS OVER THE
HAEMORRHAGING AREA WHILE SLOWLY REPLENISHING THE SOLUTION BY
CONTINUOUS INJECTION.

44. IRRIGATE THE AREA WITH AN AIR-WATER SYRINGE AND GENTLY DRY THE TISSUES WITH
AIR, INSPECT TO DETERMINE THE DEGREE TO WHICH BLEEDING HAS DIMINISHED, REPEAT
SEVERAL TIMES IF NECESSARY, AND PLACE A DISPLACEMENT CORD.

45. INSPECT TO
DETERMINE THE
DEGREE TO WHICH
BLEEDING HAS
DIMINISHED

46. EVALUATION
• ON MANY OCCASIONS, THE CORRECT DECISION IS TO DELAY
IMPRESSION MAKING AND CONCENTRATE ON IMPROVING TISSUE
HEALTH (E.G., BY REASSESSING THE QUALITY OF THE INTERIM
RESTORATION AND REINFORCING ORAL HYGIENE INSTRUCTIONS AND
BY PRESCRIBING A CHLORHEXIDINE RINSE) RATHER THAN TO ATTEMPT
IMPRESSION MAKING UNDER ADVERSE CONDITIONS.
• MINOR HEMORRHAGING CAN SOMETIMES BE CONTROLLED WITH AN
ASTRINGENT (VISCOSTAT OR ASTRINGEDENT [15.5% FE2(SO4)3] USED
WITH THE DENTO-INFUSOR TIPS, OR BY INFILTRATING A LOCAL
ANESTHETIC DIRECTLY INTO THE ADJACENT GINGIVAL PAPILLAE

47. DISPLACEMENT PASTES
• SOME DENTISTS ADVOCATE DISPLACEMENT PASTE AS AN ALTERNATIVE TO CORD.
• ALCL3 -CONTAINING PASTE IS INJECTED INTO THE DRIED SULCUS WITH A SPECIAL
DELIVERY GUN
EXPA-SYL, KERR CORP.

48. ADVANTAGES AND DISADVANTAGES OF THIS SYSTEM:
• GOOD HAEMOSTASIS.
• LESS DISCOMFORT THAN WITH TRADITIONAL CORD.
• LESS TISSUE DISPLACEMENT IS ACHIEVED THAN WITH CORD, WHICH
MAY MAKE SUBSEQUENT LABORATORY STEPS SUCH AS DIE
TRIMMING MORE PROBLEMATIC.
• IMPROVED DISPLACEMENT MAY BE ACHIEVED IF THE PASTE IS
DIRECTED INTO THE SULCUS BY APPLYING PRESSURE WITH A
HOLLOW COTTON ROLL.

49. MATERIAL IS DISPENSED FROM A SYRINGE DIRECTLY INTO THE SULCUS

50. PASTE IS DIRECTED INTO
THE GINGIVAL TISSUES
AROUND THE PREPARED
MARGIN

51. AFTER 1 TO 2 MINUTES, THE PASTE IS REMOVED WITH COPIOUS
AMOUNTS OF WATER
PREPARED TOOTH BEFORE IMPRESSION MATERIAL IS INJECTED

52. • DISPLACEMENT PASTES RELY ON VOLUMETRIC EXPANSION INITIALLY
DESCRIBED BY FEINMANN AND MARTIGNONI, COMBINED A
POLYDIMETHYLSILOXANE WITH A TIN CATALYST RESULTING RELEASE OF
GAS RESULTED IN A VOLUMETRIC EXPANSION.
• WHEN THE PASTE WAS APPLIED INTO THE SULCUS, FOLLOWED BY QUICK
SEATING OF A PREFABRICATED INTERIM CROWN, THE VOLUMETRIC
EXPANSION RESULTED IN AN APICALLY DIRECTED FLOW THAT ENLARGED
THE GINGIVAL SULCUS AND ALLOWED IMPRESSION MAKING.
• WHEN THE PASTE WAS APPLIED INTO THE SULCUS, FOLLOWED BY QUICK
SEATING OF A PREFABRICATED INTERIM CROWN, THE VOLUMETRIC
EXPANSION RESULTED IN AN APICALLY DIRECTED FLOW THAT ENLARGED
THE GINGIVAL SULCUS AND ALLOWED IMPRESSION MAKING.

53. EXPANDING POLYMERIC
FOAM PROVIDES TISSUE
DISPLACEMENT WITH
MINIMAL DISCOMFORT OR
GINGIVAL TRAUMA.

54. OCCLUSAL MATRIX IMPRESSION TECHNIQUE
• FIRST REPORTED BY LAFORGIA, AND SUBSEQUENTLY WITH MORE
CONTEMPORARY MATERIALS BY LIVADITIS.
• AN INDEX IS FABRICATED FROM A RIGID MATERIAL, SUCH AS
POLYETHER, DIRECTLY OVER THE PREPARED TEETH.

55. • INDEX IS TRIMMED SHORT OF THE MARGIN BY APPROXIMATELY 1 MM
WITH A SCALPEL.
• ON INTRAORAL VERIFICATION, THE INDEX IS FILLED WITH MEDIUM-
BODIED IMPRESSION MATERIAL AND SEATED OVER THE TOOTH
PREPARATIONS, WHICH ENSURES AN APICALLY DIRECTED FLOW OF
THE IMPRESSION MATERIAL.
• A REGULAR BODIED IMPRESSION MATERIAL IS THEN SEATED IN A
SUITABLE IMPRESSION TRAY OVER THE INDEX

57. ELECTROSURGERY:
• ELECTROSURGERY HAS BEEN RECOMMENDED FOR ENLARGEMENT OF THE
GINGIVAL SULCUS AND CONTROL OF HEMORRHAGE TO FACILITATE
IMPRESSION MAKING.
• ELECTROSURGERY HAS BEEN DESCRIBED FOR THE REMOVAL OF IRRITATED
TISSUE THAT HAS PROLIFERATED OVER PREPARATION FINISH LINES, AND IT IS
COMMONLY USED FOR THAT PURPOSE.
• ELECTROSURGERY IS UNQUESTIONABLY CAPABLE OF TISSUE DAMAGE,
KALKWARF ET AL REPORTED THAT WOUNDS CREATED BY A FULLY RECTIFIED,
FILTERED CURRENT IN THE HEALTHY GINGIVA OF ADULT MALES
DEMONSTRATED EPITHELIAL BRIDGING AT 48 HOURS AND COMPLETE
CLINICAL HEALING AT 72 HOURS.
• WHEN VARIABLES ARE PROPERLY CONTROLLED IN ELECTROSURGERY,
UNTOWARD EVENTS IN WOUND HEALING ARE RARE

58. • AN ELECTROSURGERY UNIT WORKS BY PASSAGE OF A HIGH
FREQUENCY CURRENT (1 TO 4 MILLION HZ [1 HZ = 1 CYCLE/
SECOND) THROUGH THE TISSUE FROM A LARGE ELECTRODE TO A
SMALL ONE.
• AT THE SMALL ELECTRODE, THE CURRENT INDUCES RAPID
LOCALIZED POLARITY CHANGES THAT CAUSE CELL BREAKDOWN
(“CUTTING”).
• FOR RESTORATIVE PROCEDURES, AN UNMODULATED ALTERNATING
CURRENT IS RECOMMENDED BECAUSE IT MINIMIZES DAMAGE TO
DEEPER TISSUES

59. FOLLOWING FACTS SHOULD BE CONSIDERED BEFORE ELECTROSURGERY IS
ATTEMPTED:
1. CONTRAINDICATED IN OR NEAR PATIENTS WITH ANY ELECTRONIC MEDICAL DEVICE
(E.G., A CARDIAC PACEMAKER, TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
[TENS] UNIT, INSULIN PUMP).
2. NOT SUITABLE ON THIN ATTACHED GINGIVAE (E.G., THE LABIAL TISSUE OF
MAXILLARY CANINES)
3. NOT BE USED WITH METAL INSTRUMENTS BECAUSE CONTACT COULD CAUSE
ELECTRIC SHOCK. (PLASTIC MIRRORS AND EVACUATION TUBES ARE AVAILABLE.)
4. PROFOUND SOFT TISSUE ANESTHESIA IS MANDATORY.
5. A THIN WIRE OR SLIGHTLY TAPERED ELECTRODE IS BEST FOR SULCULAR
ENLARGEMENT

60. 6. ELECTRODE SHOULD BE PASSED RAPIDLY THROUGH THE TISSUE WITH A SINGLE
LIGHT STROKE AND KEPT MOVING AT ALL TIMES.
7. IF THE TIP DRAGS, THE INSTRUMENT IS AT TOO LOW A SETTING, AND THE CURRENT
SHOULD BE INCREASED.
8. IF SPARKING IS VISIBLE IN THE TISSUE, THE INSTRUMENT IS AT TOO HIGH A
SETTING, AND THE CURRENT SHOULD BE DECREASED.
9. ELECTRODE MUST REMAIN FREE OF TISSUE FRAGMENTS
10.CONTACT LASTING JUST 0.4 SECOND HAS BEEN SHOWN TO LEAD TO IRREVERSIBLE
PULPAL DAMAGE IN DOGS.
11.SULCUS SHOULD BE IRRIGATED WITH HYDROGEN PEROXIDE BEFORE THE
DISPLACEMENT CORD IS PLACED

62. ELECTROSURGICAL CURRENT FLOWS FROM THE UNIT TO THE ACTIVE (CUTTING)
ELECTRODE (A) TO THE GROUND (G) AND BACK TO THE UNIT

63. TYPES OF CURRENT:
• THE UNRECTIFIED, DAMPED CURRENT IS CHARACTERIZED BY
RECURRING PEAKS OF POWER THAT RAPIDLY DIMINISH.
• IT IS THE CURRENT PRODUCED BY THE OLD HYFURCATOR OR SPARK
GAP GENERATOR, AND IT GIVES RISE TO INTENSE DEHYDRATION AND
NECROSIS.
• IT CAUSES CONSIDERABLE COAGULATION, AND HEALING IS SLOW
AND PAINFUL.
• SOMETIMES REFERRED TO AS THE OUDIN OR TESLA CURRENT
• IT IS NOT USED ROUTINELY IN DENTAL ELECTROSURGERY TODAY.

64. • A PARTIALLY RECTIFIED, DAMPED (HALF-WAVE MODULATED)
CURRENT PRODUCES A WAVE FORM WITH A DAMPING IN THE SECOND
HALF OF EACH CYCLE.
• THERE IS LATERAL PENETRATION OF HEAT, WITH SLOW HEALING
OCCURRING IN DEEP TISSUES.
• THE DAMPING EFFECT PRODUCES GOOD COAGULATION AND
HEMOSTASIS
• TISSUE DESTRUCTION IS CONSIDERABLE
• HEALING IS SLOW

65. • THE FULLY RECTIFIED, FILTERED (FILTERED) CURRENT IS A
CONTINUOUS WAVE THAT PRODUCES EXCELLENT CUTTING.
• HEALING OF TISSUES CUT BY A CONTINUOUS WAVE CURRENT WILL BE
BETTER INITIALLY THAN TISSUES CUT BY A MODULATED WAVE.
• THE CONTINUOUS WAVE PRODUCES LESS INJURY TO THE TISSUE THAN
DOES A MODULATED WAVE.
• HOWEVER, A CONTROLLED HISTOLOGIC STUDY FOUND THAT AFTER 2
WEEKS, HEALING OF WOUNDS PRODUCED BY FILTERED CURRENT WAS
NOT REMARKABLY BETTER THAN HEALING OF WOUNDS PRODUCED BY
NONFILTERED FULL-WAVE MODULATED CURRENT

66. GROUNDING:
• FOR THE PATIENT’S SAFETY, IT IS IMPORTANT THAT THE CIRCUIT BE
COMPLETED BY THE USE OF THE GROUND ELECTRODE WHICH IS ALSO
KNOWN AS A GROUND PLATE, INDIFFERENT PLATE, INDIFFERENT
ELECTRODE, NEUTRAL ELECTRODE, DISPERSIVE ELECTRODE, PASSIVE
ELECTRODE, OR PATIENT RETURN.
• THE SAFE USE OF ELECTROSURGERY DICTATES THAT CURRENT FLOW
BE FACILITATED ALONG THE PROPER CIRCUIT FROM THE GENERATOR
TO THE ACTIVE ELECTRODE, THE PATIENT, AND BACK TO THE
GENERATOR.
• BECAUSE PATIENT BURNS HAVE BEEN ATTRIBUTED TO FAULTY
GROUNDING IN MANY CASES THE PROPER GROUNDING OF A PATIENT IS
CONSIDERED TO BE THE SINGLE MOST IMPORTANT SAFETY FACTOR
WHEN ELECTROSURGERY IS USED

67. • ORINGER RECOMMENDED THAT THE GROUND BE PLACED UNDER THE
THIGH RATHER THAN BEHIND THE BACK, AS IS OFTEN DONE.
• CONTACT WITH A SMALL, BONY PROTUBERANCE, SUCH AS A
VERTEBRA OR SHOULDER BLADE, COULD PRODUCE A SUFFICIENTLY
HIGH CURRENT DENSITY TO CAUSE A BURN.
• THE ONLY PRECAUTION TO BE OBSERVED IN PLACING THE GROUND
UNDER THE LEGS IS THAT THE PATIENT DOES NOT HAVE KEYS IN A
PANTS POCKET OR IS NOT WEARING METAL GARTERS (ALTHOUGH THE
LATTER IS UNLIKELY).

68. CONTRAINDICATIONS:
• SHOULD NOT BE EMPLOYED ON PATIENTS WITH CARDIAC PACEMAKERS, WHEN
BRADYCARDIA OCCURS BECAUSE THE HEART DOES NOT EMIT AN IMPULSE, THE
PACEMAKER FIRES AT AN APPROPRIATE RATE TO KEEP THE HEART BEATING,
EXTERNAL ELECTROMAGNETIC INTERFERENCE HINDERS THE PACEMAKER’S
SENSING FUNCTION.
• INCORRECTLY SENSING THE INTERFERENCE AS AN INTRINSIC MYOCARDIAL
IMPULSE, THE GENERATOR SHUTS DOWN UNTIL THE INTERFERENCE CEASES,
WITH CONSEQUENCES THAT COULD BE QUITE SERIOUS FOR THE PATIENT.
• SHIELDING IN RECENT PACEMAKER MODELS DIMINISHES THE RISKS FROM
EXTRANEOUS ELECTROMAGNETIC INTERFERENCES, BUT THE USE OF
ELECTROSURGERY IS STILL CONTRAINDICATED FOR THOSE PATIENTS WHO WEAR
PACEMAKERS

69. • BECAUSE IT CAN PRODUCE SPARKS IN USE, ELECTROSURGERY SHOULD NOT
BE USED IN THE PRESENCE OF FLAMMABLE AGENTS, THE USE OF TOPICAL
ANESTHETICS SUCH AS ETHYL CHLORIDE AND OTHER FLAMMABLE
AEROSOLS SHOULD BE AVOIDED WHEN ELECTROSURGERY IS TO BE USED.
• THERE IS A SLIGHT DANGER ATTACHED TO THE USE OF NITROUS OXIDE WITH
ELECTROSURGERY BECAUSE OF THE ENRICHED OXYGEN ATMOSPHERE THAT
WILL BE PRESENT IN THE ORAL CAVITY AND NASOPHARYNX.
• CASES INVOLVING FLASH FIRES CAUSED BY DENTAL ELECTROSURGERY IN
THE PRESENCE OF NITROUS OXIDE–OXYGEN ANALGESIA IS MINIMAL.
• GIVEN THE RIGHT CIRCUMSTANCES WITH AN EXTREMELY DRY MOUTH AND
AN ACCUMULATION OF OXYGEN, A SMALL SPARK CAUSED BY THE
ELECTRODE TOUCHING A METALLIC RESTORATION COULD CONCEIVABLY SET
OFF A DRY COTTON PACKING, SO USE A SLIGHTLY MOIST COTTON.

70. TECHNIQUE
• VERIFY THAT ANAESTHESIA IS PROFOUND AND REINFORCE IT IF NECESSARY.
• WITH A COTTON TIPPED APPLICATOR, PLACE A DROP OF A PLEASANT-SMELLING AROMATIC OIL,
SUCH AS PEPPERMINT, AT THE VERMILION BORDER OF THE UPPER LIP.
• CHECK THE EQUIPMENT TO MAKE SURE ALL THE CONNECTIONS ARE SOLID

71. • BE ESPECIALLY CERTAIN THAT THE CUTTING ELECTRODE IS SEATED COMPLETELY
IN THE HANDPIECE, IF ANY UNINSULATED PORTION OF IT OTHER THAN THE
CUTTING TIP IS EXPOSED OUTSIDE THE HANDPIECE CHUCK, IT COULD PRODUCE AN
ACCIDENTAL BURN ON THE PATIENT’S LIP.

72. • PROPER USE OF ELECTROSURGERY REQUIRES THAT THE CUTTING ELECTRODE BE
APPLIED WITH VERY LIGHT PRESSURE AND QUICK, DEFT STROKES.
• THE PRESSURE REQUIRED HAS BEEN DESCRIBED AS THE SAME NEEDED TO DRAW A
LINE WITH AN INK-DIPPED BRUSH WITHOUT BENDING THE BRISTLES

73. • TO PREVENT LATERAL PENETRATION OF HEAT INTO THE TISSUES WITH SUBSEQUENT
INJURY, THE ELECTRODE SHOULD MOVE AT A SPEED OF NO LESS THAN 7 MM PER
SECOND.
• IF IT IS NECESSARY TO RETRACE THE PATH OF A PREVIOUS CUT, 8 TO 10 SECONDS
SHOULD BE ALLOWED TO ELAPSE BEFORE REPEATING THE STROKE.
• THIS WILL MINIMIZE THE BUILDUP OF LATERAL HEAT THAT COULD DISRUPT
NORMAL HEALING.
• THE POWER SELECTOR DIAL IS INITIALLY SET AT THE LEVEL RECOMMENDED BY THE
MANUFACTURER, AND ADJUSTMENTS ARE MADE AS NECESSARY.
• AS THE ELECTRODE PASSES THROUGH THE TISSUE, IT SHOULD DO SO SMOOTHLY
WITHOUT DRAGGING OR CHARRING THE TISSUE

74. • IF THE TIP DRAGS AND COLLECTS SHREDS OF CLINGING TISSUE, THE UNIT HAS
BEEN PLACED ON A SETTING THAT IS TOO LOW.
• IF THE TISSUE CHARS OR DISCOLORS, OR IF THERE IS SPARKING, THE SETTING IS
TOO HIGH.
• A HIGH-VOLUME VACUUM TIP SHOULD BE KEPT IMMEDIATELYADJACENT TO THE
CUTTING ELECTRODE AT ALL TIMES TO DRAW OFF THE UNPLEASANT ODORS THAT
ARE GENERATED.
• A WOODEN TONGUE DEPRESSOR OR PLASTIC-HANDLED MIRROR SHOULD BE USED
RATHER THAN THE METAL-BACKED MOUTH MIRROR.
• CUTTING SHOULD BE STOPPED FREQUENTLY TO CLEAN ANY FRAGMENTS OF
TISSUE FROM THE ELECTRODE BY WIPING IT WITH AN ALCOHOL-SOAKED 4 × 4–
INCH SPONGE

75. ROTARY CURETTAGE
• THE CONCEPT OF USING ROTARY CURETTAGE WAS DESCRIBED BY AMSTERDAM IN
1954
• ROTARY CURETTAGE IS A “TROUGHING” TECHNIQUE, THE PURPOSE OF WHICH IS TO
PRODUCE LIMITED REMOVAL OF EPITHELIAL TISSUE IN THE SULCUS WHILE A
CHAMFER FINISH LINE IS BEING CREATED IN TOOTH STRUCTURE.
• ALSO CALLED GINGETAGE AND USED WITH THE SUBGINGIVAL PLACEMENT OF
RESTORATION MARGINS.
• THE REMOVAL OF EPITHELIUM FROM THE SULCUS BY ROTARY CURETTAGE IS
ACCOMPLISHED WITH LITTLE DETECTABLE TRAUMA TO SOFT TISSUE.
• ROTARY CURETTAGE, HOWEVER, MUST BE DONE ONLY ON HEALTHY TISSUE TO AVOID
THE TISSUE SHRINKAGE THAT OCCURS WHEN DISEASED TISSUE HEALS.

76. SUITABILITY OF GINGIVA FOR THE USE OF THIS METHOD IS
DETERMINED BY THREE FACTORS:
• ABSENCE OF BLEEDING UPON PROBING.
• SULCUS DEPTH LESS THAN 3.0 MM
• PRESENCE OF ADEQUATE KERATINIZED GINGIVA

77. IN CONJUNCTION WITH AXIAL REDUCTION, A SHOULDER FINISH LINE IS PREPARED AT THE LEVEL
OF THE GINGIVAL CREST WITH A FLAT-END TAPERED DIAMOND.
A TORPEDO-NOSED DIAMOND OF 150 TO 180 GRIT IS USED TO EXTEND THE FINISH LINE APICALLY,
ONE-HALF TO TWO-THIRDS THE DEPTH OF THE SULCUS, CONVERTING THE FINISH LINE INTO A
CHAMFER.
CORD IMPREGNATED WITH ALUMINUM CHLORIDE IS GENTLY PLACED TO CONTROL
HEMORRHAGE, CORD IS REMOVED AFTER 4 TO 8 MINUTES, AND THE SULCUS IS THOROUGHLY
IRRIGATED WITH WATER

78. CROWN LENGTHENING:
• THERE ARE CIRCUMSTANCES IN WHICH IT MAY BE DESIRABLE TO HAVE A LONGER
CLINICAL CROWN ON A TOOTH THAN IS PRESENT.
• IF THERE IS A SUFFICIENTLY WIDE BAND OF ATTACHED GINGIVA SURROUNDING
THE TOOTH, THIS CAN BE ACCOMPLISHED WITH A GINGIVECTOMY USING A
DIAMOND ELECTRODE.

79. • IT IS FREQUENTLY NECESSARY TO DO A SECOND SERIES OF CUTS TO PRODUCE A
BEVEL AROUND THE FIRST.

80. • THIS BEVEL ALSO MUST BE DONE ONLY ON ATTACHED
GINGIVA.
• WHEN SURGERY LEAVES AN EXTENSIVE POSTOPERATIVE
WOUND, IT IS NECESSARY TO PLACE A PERIODONTAL
DRESSING, WHICH SHOULD BE CHANGED IN ABOUT 7 DAYS.
• LENGTHENED TOOTH THAT RESULTS FROM THIS SURGERY
SHOULD AFFORD BETTER RETENTION FOR ANY CROWN
PLACED ON IT

81. REMOVAL OF AN EDENTULOUS CUFF:
• FREQUENTLY, THE REMNANTS OF THE INTERDENTAL PAPILLAADJACENT
TO AN EDENTULOUS SPACE WILL FORM A ROLL OR CUFF THAT WILL
MAKE IT DIFFICULT TO FABRICATE A PONTIC WITH CLEANABLE
EMBRASURES AND STRONG CONNECTORS.
• BEFORE A PONTIC IS FABRICATED, AN EDENTULOUS RIDGE SHOULD BE
EXAMINED CAREFULLY, IF THERE ARE CUFFS, THEY SHOULD BE
REMOVED.
• A LARGE LOOP ELECTRODE IS USED FOR PLANNING AWAY THE LARGE
ROLL OF TISSUE
• WHEN THIS LARGER ELECTRODE IS USED, IT REQUIRES A HIGHER
POWER SETTING OF THE UNIT

82. CUSTOM TRAY FABRICATION:
• CUSTOM TRAY IMPROVES THE ACCURACY OF AN ELASTOMERIC
IMPRESSION BY LIMITING THE VOLUME OF THE MATERIAL, THUS
REDUCING TWO SOURCES OF ERROR:
a) STRESSES DURING REMOVAL
b) THERMAL CONTRACTION
• CUSTOM TRAYS CAN BE MADE FROM:
a) AUTO-POLYMERIZING RESIN
b) THERMOPLASTIC RESIN
c) PHOTOPOLYMERIZED RESINS

83. THERMOPLASTIC CUSTOM TRAY MATERIAL

84. VISIBLE LIGHT-POLYMERIZED CUSTOM TRAY MATERIAL

85. VACUUM-FORMED CUSTOM TRAY MATERIAL

86. CONSIDERATIONS WHILE MAKING A CUSTOM TRAY FOR
IMPRESSION:
• TRAY RIGIDITY IS IMPORTANT BECAUSE EVEN SLIGHT FLEXING OF THE
TRAY CAUSES DISTORTION OF THE IMPRESSION, THIS IS FRUSTRATING
BECAUSE THE ERRORS ARE USUALLY UNDETECTABLE UNTIL THE
PRACTITIONER ATTEMPTS TO SEAT THE RESTORATION.
• THIN, DISPOSABLE PLASTIC TRAYS ARE UNACCEPTABLE.
• RESIN MUST BE 2 TO 3 MM THICK FOR ADEQUATE RIGIDITY
• CLEARANCE BETWEEN THE TRAY AND THE TEETH SHOULD ALSO BE 2
TO 3 MM

87. STEP-BY-STEP PROCEDURE (USING AUTOPOLYMERISING RESIN)
• BASEPLATE WAX
• 0.025-MM (0.001-INCH) TIN OR ALUMINIUM FOIL
• SCALPEL
• SCISSORS
• WAXING INSTRUMENT
ARMAMENTARIUM

88. • USING A PENCIL, MARK THE BORDER OF THE TRAY ON THE DIAGNOSTIC CAST
APPROXIMATELY 5 MM APICALLY FROM THE CREST OF THE FREE GINGIVA.
• MAXILLARY TRAYS DO NOT ALWAYS NECESSITATE COVERING THE ENTIRE
PALATE

89. • ADAPT A WAX OR OTHER SUITABLE SPACER TO THE DIAGNOSTIC CAST,
TWO LAYERS OF BASEPLATE WAX RESULT IN A COMBINED THICKNESS
OF APPROXIMATELY 2.5 MM (THE SHEETS SHOULD BE MEASURED WITH A
THICKNESS GAUGE BECAUSE WAX THICKNESSES VARY).
• SOFTEN THE WAX BY CAREFULLY HEATING IT OVER A BUNSEN BURNER
OR IN HOT WATER.
• AFTER THE SECOND SHEET OF WAX HAS BEEN APPLIED, TRIM IT BACK
UNTIL THE PENCIL LINE IS JUST VISIBLE.
• THREE STOPS ARE NEEDED IN THE TRAY TO MAINTAIN EVEN SPACE FOR
THE IMPRESSION MATERIAL IN THE ORAL CAVITY. THESE ARE PLACED
ON NONFUNCTIONAL CUSPS OF TEETH THAT ARE NOT TO BE PREPARED

90. • BECAUSE THE WAX MAY MELT FROM THE POLYMERIZATION HEAT OF THE MATERIAL,
APPLY A LAYER OF TIN OR ALUMINUM FOIL OVER THE WAX TO PREVENT IT FROM
CONTAMINATING THE INSIDE OF THE TRAY.

91. • MIX AUTOPOLYMERISING ACRYLIC RESIN ACCORDING TO THE
MANUFACTURER’S RECOMMENDATIONS.
• THE USE OF VINYL GLOVES IS RECOMMENDED TO PREVENT THE
DEVELOPMENT OF SENSITIVITY TO THE MONOMER.
• AFTER THE RESIN IS MIXED, SET IT ASIDE UNTIL IT IS DOUGHY (WITH
THE CONSISTENCY OF PUTTY).
• CARE MUST BE TAKEN NOT TO STRETCH THE MATERIAL WHEN IT IS
MANIPULATED; THIN AREAS IN THE RESIN MAY CAUSE THE TRAY TO
BECOME FLEXIBLE AND PRODUCE DISTORTIONS

92. • GENTLY ADAPT THE RESIN TO THE CAST.
• A HANDLE MADE FROM THE EXCESS RESIN CAN BE ATTACHED AT THIS TIME.

93. • AFTER THE MATERIAL
HAS POLYMERIZED,
REMOVE IT FROM THE
CAST AND TRIM IT WITH
AN ACRYLIC-TRIMMING
BUR.
• ALL ROUGH EDGES
SHOULD BE ROUNDED
TO PREVENT SOFT
TISSUE TRAUMA.

94. EVALUATION OF CUSTOM TRAY:
1. COMPLETED CUSTOM TRAY NEEDS TO BE RIGID, WITH A CONSISTENT THICKNESS OF 2 TO
3 MM.
2. SHOULD EXTEND ABOUT 3 TO 5 MM CERVICAL TO THE GINGIVAL MARGINS AND SHOULD BE
SHAPED TO ALLOW MUSCLE ATTACHMENTS.
3. SHOULD BE STABLE ON THE CAST WITH STOPS THAT CAN MAINTAIN AN IMPRESSION
THICKNESS OF 2 OR 3 MM.
4. TRAY MUST BE SMOOTH, WITH NO SHARP EDGES.
5. THE HANDLE SHOULD BE STURDY AND SHAPED TO FIT BETWEEN THE PATIENT’S LIPS.
6. VOID DISTORTION FROM CONTINUED POLYMERIZATION OF THE TRAY SHOULD BE MADE AT
LEAST 9 HOURS BEFORE ITS USE.
7. WHEN A TRAY IS NEEDED MORE URGENTLY, IT CAN BE PLACED IN BOILING WATER FOR 5
MINUTES AND ALLOWED TO COOL TO ROOM TEMPERATURE