fluid control and gingival displacement
TRANSCRIPT
![Page 1: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/1.jpg)
1
Fluid control & Soft tissue
management
By Shruti SudarsananRoll no.-14Final year part-II
![Page 2: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/2.jpg)
2
INTRODUCTION• Control of fluids and appropriate
displacement of gingiva are essential during tooth preparation to obtain accurate impressions, and for cementation.
• They enhance-– Operator visibility– Patient comfort
![Page 3: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/3.jpg)
3
FLUID CONTROL• OBJECTIVES
– Primarily- to remove fluids, isolate and retract oral tissues
– Enhance operator visibility and patient comfort
– Prevent aspiration of fluids along with restorative debris
– Ensure a dry operating field in preparation for impression and cementation procedures
– Enhance properties of dental materials
![Page 4: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/4.jpg)
4
METHODS
• Rubber dam• Absorbents• High vacuum suction• Saliva ejector• Svedopter• Anti sialogogues• Local anaesthetic
![Page 5: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/5.jpg)
5
RUBBER DAM
Introduced by S C Barnum in1864•Most effective of all isolation devices•Used to isolate tooth during restorative procedures, preparation, impression and cementation of indirect restoration•When used with elastomeric impression materials, it should be lubricated and clamp removed
![Page 6: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/6.jpg)
6
CONTRAINDICATION Should not be used with poly-vinylsiloxane
interferes with polymerization Patients allergic to latex
DISADVANTAGES Time consuming and patients objection Unusual tooth shapes or positions that
cause inadequate clamp placement Partially erupted teeth Broken down teeth
Patients suffering from asthma
![Page 7: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/7.jpg)
7
Rubber dam set Rubber dam Rubber dam punch Rubber dam clamps Rubber dam clamp forceps Rubber dam frame/holder
![Page 8: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/8.jpg)
8
Simplest method Commonest and cheap For isoltaing maxillary arch, single cotton roll in
the buccal vestibule adjacent to maxillary first molar where the parotid duct opens is sufficient
For isolating the mandibular arch, multiple cotton rolls are placed on the buccal and lingual side of the prepared tooth or else single long cotton roll can be placed in maxillary and mandibular mucobuccl folds
COTTON ROLLS
![Page 9: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/9.jpg)
9
Prefabricated are more compact No. 2 cotton roll- 1 ½” Long and 3/8” in
diameter are most popular A saliva ejector is usually placed on the
lingual sulcus for fluid removal
An absorbent cord may also be placed buccaly in conjunction with cotton rolls.
![Page 10: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/10.jpg)
10
Controls small amounts of moisture and retracts cheek and tongue
Keeps its shape and does not fall apart when full of saliva
Provides acceptable dryness for procedures
CementationImpression making
Uses
![Page 11: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/11.jpg)
11
• Wrapped – 100% cotton interior.Non-woven fabric
• Braided-Made of silky yarn.
Different types of cotton rolls
![Page 12: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/12.jpg)
12
Cotton roll holder
Holds cotton rolls in place
Advantages• Cheek and tongue are
slightly retracted• Enhances visibility
![Page 13: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/13.jpg)
13
ABSORBENTS These are pressed paper wafers covered on one side with a reflective foilPaper side is placed against dried buccal tissue. Useful for short period of isolation Alternative when rubber dam application is impractical Retracts cheek
Different absorbent devices:• Dry tips• Reflective shields
![Page 14: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/14.jpg)
Dry tips[Moisture absorbing cards]
Keeps parotid gland in check for 15 minute Absorbs more moisture compared to cotton
rolls
14
![Page 15: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/15.jpg)
Reflective shields Mirror-like reflective film allows illumination Checks saliva control for parotid gland Ideal for sealant and dental hygiene
proceduresWhen removing absorbent
cards/cellulose wafers it may be necessary to moisten them with the water gun to prevent inadvertent removal of epithelium from cheek.
15
![Page 16: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/16.jpg)
16
HIGH VACUUM SUCTION Powerful suction device, use of 10mm
diameter HVE tips, and a properly functioning suction pump set to evacuate one liter per minute of fluid
It is used in prepartory phase along with an assistant
![Page 17: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/17.jpg)
17
Uses Apparatus also removes small operatory
debris Excellent lip retractor
Disadvantages Cannot be used for impression & cementation procedure
![Page 18: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/18.jpg)
18
SALIVA EJECTOR (LOW VACUUM SUCTION)
• 300 ml/ min is the suction rate• May be used during tooth preparation in
maxillary arch by placing it in the corner of the mouth opposite the side being prepared, with the patient’s head turned towards that side
• Can be used without any assistanceUses Removes saliva from the floor of mouth Removes water slowly
![Page 19: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/19.jpg)
19
Suction tips/ saliva ejectors
Disposable saliva ejectors - Transparent [ plastic] - Multi coloured [ plastic] - Hygoformic saliva ejector - Mirror vac - Lingua fix
![Page 20: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/20.jpg)
20
- Steel - Saliva ejector with tongue guards
Reusable saliva ejectors
![Page 21: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/21.jpg)
21
SVEDOPTER• Metal saliva ejector with a tongue retractor• Used for mandibular arch• Most effective when patient is in a nearly
upright position.
![Page 22: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/22.jpg)
22
Drawbacks• Intraoral discomfort if proper size not
selected• Bruises tender soft tissue in floor of
mouth• Access to lingual surface of mandibular
teeth may be limited• Contraindicated in the presence of
mandibular tori
![Page 23: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/23.jpg)
23
ANTI SIALAGOGUES• Gastrointestinal anti cholinergic drugs that
inhibit action of myo-epithelial cells of salivary gland
Common drugs• Methaniline Bromide (Banthine) 50 mg tab 1
hr before procedure • Propantheline bromide (Pro-Banthine)- 7.5-
15mg 1 hr before procedure • Intra oral injection- 2-6mg• Onset of action5-10 min
• Atropine 1 tablet of 0.4mg• Dicyclomine -10-20mg
![Page 24: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/24.jpg)
24
Contraindication of anti-sialogogues
Methaniline and propanthelin contraindication Hypersensitivity to drugs Glaucoma Asthma Congestive heart failure Obstructive condition of GI tracts or
urinary tracts
![Page 25: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/25.jpg)
25
Antihypertensive drugs
• Clonidine hydrochloride-– 0.2mg 1 hr before procedure– Safer than anticholinergics– Should be used with caution with other
anticholinergics– Can cause drowsiness
![Page 26: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/26.jpg)
26
LOCAL ANAESTHETIC• Mechanism of action
– Nerve impulse from the periodontal ligament form part of the mechanism that regulate salivary flow. These are blocked by local anaesthetic
![Page 27: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/27.jpg)
27
GINGIVAL RETRACTION
DEFINITION• Gingival Retraction is the deflection of the
marginal gingiva away from a tooth (GPT8)• Also called as gingival displacement or
tissue dilation• Gingival retraction is a process of exposing
margins when making impression of prepared teeth.
![Page 28: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/28.jpg)
28
AIMS AND OBJECTIVES• Reflect gingiva and produce enlargement or
dilate gingival sulcus• To obtain 0.2-0.4 mm of horizontal
displacement of marginal gingiva• To achieve 0.5 mm of vertical exposure of
unprepared portion of tooth• To expose the prepared finish line• To control the GCF• Provides access for the impression materials
to record accurately the finish margins• Helps to obtain accurate marginal fit which
will reduce marginal leakage and subsequent deterioration of tooth
![Page 29: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/29.jpg)
29
MECHANICAL
MECHANOCHEMICAL
CHEMICAL
SURGICAL
METHODS
![Page 30: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/30.jpg)
30
This method physically displaces the gingiva
1. Rubber dam2. Copper band/metal band/ rings3. Plain cotton thread, cotton cord, unwaxed
floss, 2/0 untreated surgical silk4. Magic foam
MECHANICAL METHODS
![Page 31: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/31.jpg)
31
RUBBER DAM• It is used when limited
number of teeth in one quadrant are being restored and when perforations do not have to extend subgingivally
• Heavy and extra heavy rubber dams were used
• Retraction is done by rubber dam and clamps (No. 212 cervical retainer)
• Produced retraction by compression
![Page 32: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/32.jpg)
32
Advantages Control of seepage and hemorrhage. Ease of application.
Disadvantages Full arch models cannot be made. Severe cervical extension preparations. Cannot be used with polyvinyl-siloxane
impression materials
![Page 33: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/33.jpg)
33
COPPER BAND Means of carrying the impression material
and a mechanism for gingival retraction. Impression compound and elastomeric
materials have been used One end of copper band is trimmed to
follow the conntours of gingival margins. The top part is plugged with resin or compound
A vent is placed to allow escape of excess impression material
![Page 34: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/34.jpg)
34
• Dental floss is threaded through the vent to ease band removal
![Page 35: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/35.jpg)
Gingival margin are crimped to adapt to gingival contour
Giingival extension is marked with pencil and trimmed
Copper band selected and placed on tooth and buccal surface is marked
35
![Page 36: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/36.jpg)
36
![Page 37: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/37.jpg)
37
• The tube is filled with impression material and is seated parallel to the long axis of the prepared tooth such that the contoured metal margins coincide with the free gingival margins gently displacing them
• It is no longer used routinely• Disadvantage:
– can cause injury to the gingiva and and retraction is also minimal
• Advantages:– Effective for single crown– Can be used in situations where
margins are subgingival
![Page 38: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/38.jpg)
38
– Indication: with multiple abutments and when full arch impressions of multiple abutments have not recorded one/ two teeth properly
![Page 39: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/39.jpg)
39
COTTON THREADS• Retraction achieved is purely
physical• No hemostasis• Very less retraction and transient
![Page 40: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/40.jpg)
MAGIC FOAM Recent development Consists of a ‘comprecap’- a hollow cotton
and ‘Magic Foamcord’- a polyvinyl siloxane material
a desired size of comprecap is selectedLimitationLimited clinical indicationsLess hemostaticNo improvement in speed/quality compared to cordLess effective on sub gingival margin 40
![Page 41: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/41.jpg)
Magic foamcord is injected around the preparation and inside the comprecap and is placed over the prepared tooth
After 3-4 min, the comprecap is removed along with the magic foamcord
41
![Page 42: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/42.jpg)
42
RETRACTION CORDS (PLAIN)• Gingival retraction cord is a tapered
diameter cord that can be wrapped several times about a tooth that causes flared gingival crevice
• Most popular method• Physically pushing away the gingiva from
the finish line• Are arbitrarily numbered by their
manufacturers according to their diameter• Plain cords contain no retraction chemical• Does not control sulcular fluid seepage
![Page 43: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/43.jpg)
43
• Poor in its ability to displace gingiva• Tissue recovery is excellent• Over packing traumatise the tissue, hence
placed firmly but gently• Wetting the cord before the removal
prevents injury
![Page 44: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/44.jpg)
44
CLASSIFICATION1. Surface texture: wet/dry2. Configuration: twisted, braided or knitted3. Surface finish: waxed/ unwaxed4. Thickness (colour coded)
Black 000 (extra small)Yellow 00 (small)Purple 0Blue-1Green-2Red-3 (extra large)
5. Chemical treatment- plain/ impregnated
![Page 45: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/45.jpg)
45
Twisted gingival retraction cords
Allow the dentist to customize the cord as individual strands can be removed
![Page 46: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/46.jpg)
46
Knitted gingival retraction cord
• Interlocking loops
• Longitudinally elastic
• Transversely resilient• Transport greater amount of chemical
agent
![Page 47: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/47.jpg)
Braided gingival retraction cord
Firm Flexible Multistrand Donot separate easily
and donot unravel while being inserted
47
![Page 48: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/48.jpg)
48
MECHANICOCHEMICAL METHODS
CHEMICAL
ACTIONPRESSURE PACK
ENLARGE-MENT
OF GINGIVAL SULCUS
![Page 49: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/49.jpg)
49
Advantages• Enlargement of gingival sulcus• Control of fluid seeping from the walls of
gingival sulcus is readily accomplished• Achieve good hemostasis with less trauma
![Page 50: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/50.jpg)
50
Requirements• Safe locally and systemically• Effective• Effects should be spontaneously
reversible• Absorbent• Provide hemostasis• No chemical injury to gingival tissues• Dark in colour and never red• should be available in different diameters
![Page 51: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/51.jpg)
51
Criteria for selcting size of cord
• The largest cord that can be placed in the sulcus atraumatically is chosen
• Smaller cords cause little trauma but the lateral displacement is inadequate
• Larger cords can cause trauma and even lead to recession (iatrogenic cause)
![Page 52: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/52.jpg)
52
Instrument• Fischer’s cord packer• Gingival retraction cord should be placed
with a small thin bladed instrument, using a gentle packing force to minimise soft tissue trauma
• Both smooth and serrated edges are available
![Page 53: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/53.jpg)
53
Gingival displacement medicaments
• Chemicals used along with retraction cords are classified as
Vasoconstrictors
Astringents
![Page 54: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/54.jpg)
54
Hemostatic agents• Racemic epinephrine- 8%• Alum solution (potassium aluminium sulfate) -
100%• Aluminium sulfate/ chloride solution -5-25%• Ferric sulphate -13.3%• Tannic acid- 20-100%
![Page 55: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/55.jpg)
55
Epinephrine• 0.1%-8% racemic epinephrine is used• 0.2 mg -1 mg of epinephrine per inch of cord• Recommended time: 5-10minutes• Mechanism of action: pronounced
vasoconstriction• Advantage: good displacement and
hemostasis• Tissue recovery-fair• Disadvantage: systemic reaction
![Page 56: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/56.jpg)
56
Contraindications of epinephrine
Cardiovascular diseaseHypertensionDiabetesHyperthyroidismKnown hypersensitivity to epinephrinePatients taking
Mono-amineoxidaseTricyclic depressantsGanglionic blockersCocaine
![Page 57: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/57.jpg)
57
Sympathomimetic amine
Tetrahydrozoline HCL- 0.05%Oxymetazoline-0.05%Phenyl epinephrine HCL-0.05%
Advantages More acceptable pH
![Page 58: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/58.jpg)
58
ASTRINGENT
Mechanism of action Precipitation of protein Inhibit transcapillary movement of plasma
protein Act as caustics at low concentration &
irritants in moderate concentration. Low cell permeability.
![Page 59: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/59.jpg)
59
Alum (Potassium aluminium sulfate)
100% of alum soaked in retraction cordAdvantagesSafer and fewer systemic effects than
epinephrineGood tissue recoveryCan be placed inside the sulcus safely for
20 minDisadvantages0.1% of crestal bone loss
![Page 60: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/60.jpg)
60
Aluminum chlorideMechanism Precipitate protein Constrict blood vessels Extract fluid from tissues
Used in 5-25% concentration for 10 min Least irritating
Disadvantage Interferes with the setting of PVS materials
![Page 61: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/61.jpg)
61
Ferric sub-sulfate
• Also known as monsel’s solution• More effective than epinephrine• Good tissue recovery• Recommended time- 3 minDisadvantages Solution is messy Corrosive and injurious to soft tissues Stain teeth High acidity
![Page 62: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/62.jpg)
62
Ferric sulfate
Recommended concentration-13- 20% Provides hemostasis on exposed
connective tissue Recommended packing time-1-3 min
Disadvantages Modify setting reaction of polyvinyl
siloxane Stains gingival tissue yellow-brown to
black
![Page 63: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/63.jpg)
63
Tannic acid
• Recommended concentration-20-100%• Recommended time- 10 min• Good tissue recovery
![Page 64: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/64.jpg)
64
Drug Advantages Disadvantages
Epinephrine Good tissue displacement Minimal tissue loss Good hemostasis
Systemic reactions Epinephrine syndrome
Alum Minimal tissue loss Extended working time
Less hemostasis & tissue displacement
Aluminum chloride Minimal tissue loss Good hemostasis
Local tissue destruction
Ferric sulfate Compatible with aluminum chloride
Good displacement
Non compatible with epinephrine
Tissue discoloration
Tannic acid Good tissue response Less displacement Minimal hemostasis
![Page 65: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/65.jpg)
65
Single cord technique.
Double cord technique(DEKNATEL technique)
Techniques of gingival retraction
![Page 66: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/66.jpg)
66
SINGLE CORD TECHNIQUE
• One cord is placed in the sulcus• Most commonly used method• Indication: making impression of one to
three prepared teeth with healthy gingiva tissues
• Relatively simple and efficient• Operating field must be dry
![Page 67: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/67.jpg)
67
• Retraction cord drawn from bottle
• Cut appropriate length to encircle the tooth (2 inches approximately)
Twisting of retraction cord
![Page 68: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/68.jpg)
68
Looping of gingival cord so that the cut ends are on the lingual side
![Page 69: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/69.jpg)
69
Cord placement from mesial surface
Placement of cord sub gingivally
![Page 70: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/70.jpg)
70
Instrument must be angled towards the root
![Page 71: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/71.jpg)
71
Excess cord cut off in the mesial area
![Page 72: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/72.jpg)
72
Placement of distal end till it s overlapping the mesial part of cord
![Page 73: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/73.jpg)
73
Double cord technique
Indication– Impression of multiple prepared teeth– Impression for compromised tissue
health
![Page 74: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/74.jpg)
74
Procedure
Small diameter dry cord is placed in sulcus
Second cord soaked with hemostatic agent
Placed over small cord for 8-10 minutes
Moisten and remove the 2nd cord
Impression made
Small diameter cord is moistened and removed
![Page 75: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/75.jpg)
75
CHEMICAL METHOD• Recent development• Retraction achieved using only chemicals• Aluminium chloride containing paste
(expasyl)
![Page 76: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/76.jpg)
76
• Injected into sulcus prior to impression making
• Left in sulcus for 3-4 minwashed off impression is made
• Advantage- good hemostasis, less trauma• Disadvantage: retraction is less compared
to cord
![Page 77: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/77.jpg)
77
SURGICAL• Rotary curettage (gingettage)• Electrosurgery• Soft tissue lasers
![Page 78: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/78.jpg)
78
ROTARY GINGIVAL CURETTAGE
“Gingitage” or “Denttage”
Troughing techniquePurpose is limited removal of epithelial
tissue while a chamfer finish line is being created
![Page 79: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/79.jpg)
79
Criteria for rotary curettageDone on healthy and inflammation free tissue
to prevent tissue shrinkage Absence of bleeding on probingSulcus depth less than 3.0 mmPresence of adequate keratinized
gingiva
DISADVANTAGES• Poor tactile sensation using diamonds
deepening of sulcus• Destruction of periodontium may occur
![Page 80: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/80.jpg)
80
TechniqueShoulder finish line preparation prepared at
gingival crest using flat end tapered diamond
Finish line extended apically1/2-2/3 the depth of the sulcus by torpedo diamond
Aluminum chloride impregnated retraction cord placed in sulcus
Cord removed after 4-8 minutes
Sulcus irrrigated with water and impression made
![Page 81: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/81.jpg)
81
Shoulder prepared at the gingival level
Torpedo diamond bur to form chamfer finish line and removal
of epithelial sulcus
Cord placed in the troughed sulcus
![Page 82: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/82.jpg)
ELECTRO SURGERY
Electrosurgery denotes surgical reduction of
sulcular epithelium using an electrode to
produce gingival retraction
82
![Page 83: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/83.jpg)
83
Mechanism of action
Controlled tissue destruction.
Current flows through a small cutting electrode
a vacuum tube or a transistor to deliver a high frequency electrical current of at least 1.0 MHz
The procedure is also called as “Surgical Diathermy”
![Page 84: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/84.jpg)
84
technique• Width of gingival sulcus is enlarged by creating
a trough around the finish line
![Page 85: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/85.jpg)
85
• By angling the working electrode at 15-20 degree and carrying the tip through the tissue until it rests against the tooth, a small wedge of tissue is removed
Parallel angulation for thin gingiva
![Page 86: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/86.jpg)
86
• It must be moved at a speed of 7mm/sec to prevent lateral heat penetration
• No stroke should be immediately repeated• Atleast 5 seconds should be allowed to
elapse before repeating the stroke• Sequence of surgery
lingualfacialmesial distal surface
![Page 87: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/87.jpg)
87
CONCLUSION• Gingival displacement is an important
procedure for fabricating indirect restoration especially when subgingival finish lines are used
• Gingival displacement is relatively simple and effective when dealing with healthy gingival tissue and when margins are properly placed
• The most common technique used for gingival displacement is the use of gingival retraction cord with a hemostatic medicament
![Page 88: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/88.jpg)
88
References Shillingburg HT; Fundamentals of Fixed
Prosthodontics; Textbook of prosthodontics : V
Rangarajan. TV Padmanabhan
![Page 89: Fluid control and gingival displacement](https://reader033.vdocuments.us/reader033/viewer/2022061516/58ee82031a28ab3e498b4677/html5/thumbnails/89.jpg)
89
THANKYOU