Fluid control & soft tissue management in fpd

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seminar on fluid control and soft tissue management for fixed partial denture

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Fluid control & soft tissue management in fpd

  1. 1. FLUID CONTROL & SOFT TISSUE MANAGEMENT IN FPD BY VESTA ENID LYDIA.R III BDS CSICDSR MADURAI
  2. 2. FIXED PARTIAL DENTURE  A partial denture that is luted or otherwise securely retained to natural teeth ,tooth roots ,and / or dental implant abutments that furnish primary support for abutments. 
  3. 3. TOOTH PREPARATION DE VANS PRINCIPLE  The perpetual preservation of what remains is most important than the meticulous replacement of what is lost.  Care should be taken to prevent excessive tooth preparation  There should be minimal possible reduction done to obtain required characteristics
  4. 4. REQUIRED CHARACTERS OF PREPARED TOOTH FINISH LINE
  5. 5. FLUIDS OF ORAL CAVITY  Saliva  Gingival bleeding during tooth preparation  Sulcular fluid  Water from hand piece
  6. 6. OBJECTIVES OF FLUID CONTROL & TISSUE MANAGEMENT  ISOLATION  RETRACTION  ACCESSIBILITY
  7. 7. HOW CAN V ACHIEVE ISOLATION TO CONTROL FLUIDS? MECHANICAL METHODS CHEMICAL METHODS
  8. 8. a.Rubber dam b.Suction devices High volume vaccum Saliva ejector Svedopter
  9. 9. Y SHOULD V ISOLATE THE OPERATIVE SITE? To obtain a dry clean operating field For easy access and visibility To improve the properties of dental materials To protect the patient and the operator To improve the operating efficiency
  10. 10. USES OF RUBBER DAM Isolation of 1 or more teeth Eliminates saliva from operating field Retracts soft tissues
  11. 11. DISADVANTAGE OF RUBBER DAM Difficult to use while preparing tooth for fixed partial denture
  12. 12. HIGH VOLUME VACCUM SALIVA EJECTOR SVEDOPTER
  13. 13. HIGH VOLUME VACUM Helps in removing small debris during crown preparaton Good lip retractor
  14. 14. SALIVA EJECTOR It is placed at the corner of the mouth opposite to the quadrent to be operated
  15. 15. SVEDOPTER It is used teeth for isolating mandibular teeth It is a metal saliva ejector attached with a tongue deflector
  16. 16. DISADVANTAGES OF SVEDOPTER Access to the lingual surface of mandibular teeth is limited Cant be used when mandibular tori precludes its use It may injure the soft tissues
  17. 17. ANTI-SIALOGOUGES LOCAL ANASTHETICS
  18. 18. CONTROLS SALIVARY FLOW THEY ARE GIT ANTI-CHOLINERGICS THAT INHIBIT THE ACTION OF MYOEPITHELIAL CELLS IN SALIVARY GLANDS,PRODUCING DRY MOUTH
  19. 19. COMMONLY USED ANTI- SIALOGOGUES  Methantheline bromide (banthine) :50 mg 1 hour before procedure  Propantheline bromide (pro-banthine) : 15 mg 1 hour before procedure  Clonidine hydrochloride (antihypertensive) : 0.2 mg 1 hour befor procedure
  20. 20. Y DO VHAVE TO RETRACT THE GIGIVAL TISSUES?  It is retracted to obtain maximum exposure of finish line  Gingival retraction permits completetion of the preparation and cementation of the restoration and helps the operator to make a complete impression of the preparation.
  21. 21. FINISH LINE EXPOSURE?  It is a line of demarcation / or  The peripheral extension of a tooth preparation / or  The planned junction of two materials / or  The terminal portion of prepared tooth
  22. 22. IMPORTANCE OF FINISH LINE EXPOSURE  The gingival tissue must be healthy & free of inflammation before cast restorations are fabricated  The finish line must be reproduced in the impression .the marginal fit is very important in preventing recurrent caries and gingival inflammation (marginal intergrity)  Hence the finish line should be temporarily exposed to reproduce entire preparation
  23. 23. TECHNIQUES OF GINGIVAL RETRACTION? THEY ARE CLASSIFIED AS Mechanical methods Chemico mechanical methods surgical
  24. 24. Copper band Retraction cord Rubber dam
  25. 25. COPPER BAND  It is used to carry the impression as well as to displace the gingiva to expose the finish line.
  26. 26. TECHNIQUE OF COPPER BAND  Copper band is a welded tube corresponding to the size of the prepared tooth.  One end if the tube is trim to follow the outline of the gingival finish line.  After poistioning and contouring the prepared tooth it is filled with modelling compound and the impression is made. DISADVANTAGE OF COPPER BAND Causes injury to the gingival tissues
  27. 27. RETRACTION CORD  Pressure packing the retraction cord into the gingival sulcus provides gingival sulcus.  Can be made with absorbent material like cotton
  28. 28. CHEMICO-MECHANICAL METHODS OF GINGIVAL RETRACTION  A chemical with pressure packing in an retraction cord  enlargement of gingival sulcus as well as control of fluids seeping from gingival sulcus
  29. 29. CHEMICALS USED FOR GINGIVAL RERACTION  They are generally local vasoconstrictors which produce gingival shrinkage. 8 % racemic epinephrine Aluminium chloride Alum(aluminium potassium sulphate) Alumminium sulphate Ferric sulphate
  30. 30. IDEAL REQUIREMENTS OF CHEMICALS USED FOR GINGIVAL RETRACTION CORDS  Should produce effective gingival displacement and haemostasis  It should not produce any irreversible damage to gingival  It should not have any systemic side effects
  31. 31. CONTRAINDICATIONS OF EPINEPHRINE
  32. 32. TECHNIQUE OF USING RETRACTION CORD The cord can be packed with a special instrument like fischer packing instrument or a DE plastic instrument IPPA
  33. 33. SURGICAL METHODS OF GINGIVAL RETRACTION Surgical method are GINGETTAGE ELECTROSURGERY
  34. 34. (GINGETTAGE)
  35. 35. ROTARY CURETTAGE (GINGETTAGE) It is a troughing technique , wherein a portion of the epithelium within the sulcus is removed to expose the finish line. It should bedone only on the healthy gingival tissue
  36. 36. FULLFILLED FOR GINGETTAGE There should be no bleeding on probing The depth of the sulcus should be minimum of 3 mm
  37. 37. TECHNIQUE OF GINGETTAGE  It is usually done simultaneously along with finish line preparation  Portion of sulcular epithelium is removed using a torpedo diamond bur.  To improve tactile sense handpiece is run very slowly  Abundant water should be sprayed during the procedure  A retraction cord is impregnated with AlCl 3 can be used to control bleeding
  38. 38. DISADVANTAGES OF GINGETTAGE Instrument has poor tactile sense so this technique is very sensitive It can potentially damage the periodontium
  39. 39. ELECTROSURGICAL RETRACTION It is the surgical retraction of the sulcular epithelium using an electrode to produce gingival retraction The procedure is called surgical diathermy.
  40. 40. INDICATIONS OF ELECTOSURGICAL RETRACTION Areas of inflammation in gingival tissue where the retraction cord cannot be used Gingival proliferation around the prepared finish line
  41. 41. CONTRAINDICATIONS OF ELECTOSURGICAL RETRACTION Patients with cardiac pacemakers Use of topical anesthesia such as ethylchloride and other inflammable aerosols should be avoided when electrosurgery is to be used.
  42. 42. SURGICAL ELECTRODE or THE CUTTING ELECTRODE  It is like a probe and produces intense heat during surgical procedures  Numerous cutting edge designs are available some of them are  Coagulation loop  Diamond loop  Round loop  Small loop
  43. 43. USES OF ELECTROSURGICAL UNIT Gingival sulcus enlargement Crown lengthening Removal of edentulous cuff
  44. 44. TECHNIQUE FOR GINGIVAL SULCUS ENLARGEMENT USING AN ELECTROSURGICAL PROBE  Electode is positioned positioned parallel to the long axis of the tooth  A small J shaped bur is used for the procedure  A whole of the tooth can be covered in 4 separate motions namely facial,mesial,lingual and distal  Debris in the sulcus should be removed using cotton pellets dipped in hydrogen peroxide
  45. 45. TECHNIQUE FOR SURGICAL CROWN LENGTHENING  It is done when the clinical crown is shorter than the anatomic crown  It is the removal of hyperplastic gingival in order to expose the clinical crown  It is done using diamond electrode  When there is excess wound periodontal dressing is done.
  46. 46. TECHNIQUES OF REMOVAL OF EDENTULOUS CUFF Edentulous cuff is an remnant of inter dental papilla Which is seen in the proximal sides of the edentulous space It is removed by using an electrosurgical unit
  47. 47. FINAL IMPRESSION
  48. 48. BITE REGISTRATION  The dentist may determine that an accurate bite registration is necessary to establish the proper occlusal relationship during mounting.  A bite registration can be made in many ways. Some of the common methods use reinforced bite registration wax, or dental stone mixed with slurry water (water from model trimmer).
  49. 49. INTERIM (TEMPORARY CROWN) OR FPD  The last step in this appointment is that a temporary crown or FPD must be made to cover and protect the prepared tooth or teeth while the permanent prosthesis is being fabricated.  Temporary crowns or FPD's can be constructed from preformed acrylic resin and aluminum shells.  Plastic stints and alginate impressions can also be used with self- curing acrylic resin to make an interim prosthesis.  When the temporary is finished, a temporary cement such as zinc oxide and eugenol is used to deliver the interim restoration onto the prepared tooth or teeth.
  50. 50. CONCLUSION
  51. 51. BIBILOGRAPHY

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