Tissue Management ppt

8/12/2019 Tissue Management ppt

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Indications Subgingival extensions of margins

Control of gingival hemorrhage or fluid f low

Increase length of clinical crowns

Enhancing restoration

Recording preparation margins during impressions

Removal of gingival overgrowth


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Methods for gingival retraction Mechanical

ChemicoMechanical

Rotary curettage

Electrosurgery


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Mechanical method


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Mechanical method

Mechanically displace gingival tissue outwards andapically away from the tooth surface.

Indicated in cases where gingiva is normal & healthywith adequate attached gingiva.

Provides minimal gingival retraction


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Copper band Is use as a means of carrying impression material

Mechanism for displacing the gingiva


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Technique Copper Band is welded to form a tube corresponding

to the size of the tooth

On end is trimmed, to follow gingival finish line Tube is filled with modeling compound & seated along

path of insertion


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Indication

- Situations in which several teeth have been

prepared

Advantages

-Minimal recession

Disadvantages

-Incisional injuries

Excessive pressure on the tissue


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Retraction cord Pressure packing into the gingival sulcus provide

sufficient gingival retraction


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ChemicoMechanical


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It is a method of combining a chemical with pressurepacking

It enlarge the gingival sulcus as well as controllingfluids seeping from the sulcus


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Types of retraction cord

Cotton Synthetic

Braided Twisted

Woven/ knitted

Coarse

Fine

Impregnated

Non-impregnated


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Knitted cord sizes

#000

#00#0

#1

#2

Braided cord

#7=#00

#8=#0#9=#1

#10=#2

Twisted#7= #00

#8= #0#9= #1#10= #2


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Factors to consider Dark color to maximize contrast with tissues, tooth &

cord

Absorbent to allow uptake of wet medicamentAvailable in different diameters to accommodate

varying morphologies of gingival sulcus


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Commonly used chemicalsAluminum chloride

Aluminum potassium sulphate

Ferric sulfate 8% racemic epinephrine


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CRITERIA FOR GINGIVAL

RETRACTION MATERIAL

Effectiveness in gingival displacement

& hemostasis. Absence of irreversible tissue damage.

Should not produce harmful systemic effects.


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Technique Operating area should be dry and the quadrant of the

prepared tooth should be isolated

The cord is twisted to make it tight and small

Cord should be dipped in the solution on a dapen dish


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Looped around thetooth and packed intothe gingival sulcusstarting from the mesialsurface and establishnear the distal end


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Packing material


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Instrument should beangled slightly towardsthe root to facilitatesubgingival placement ofthe cord

After 10 minutes the cordshould be removed slowly

to avoid bleeding


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Rotary curretage


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It is a troughing technique, wherein a portion of theepithelium within the sulcus is removed to expose thefinish line

Should be done only on healthy gingiva


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IndicationsAbsence of bleeding upon probing

Depth of the sulcus is


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Hand piece should be run at slow speed

Abundant water supply should be sprayed duringprocedure

Retraction cord is impregnated to control bleeding

Cord is removed after 4-8 mins and sulcus thoroughlyirrigated with water


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Electrosurgery


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Also known as Surgical Diathermy

Produces controlled tissue destruction to achieve asurgical result


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IndicationAreas of inflammation in gingival tissue where the

retraction cord cannot be used

Gingival proliferation around the prepared finish line

Enlargement of gingival sulcus& control ofhemorrhage to facilitate impression making


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Contraindication Patients with cardiac pacemakers


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Technique Profound anesthesia

Place a drop of aromatic oil on upper lip

Check the equipment for all connections Use a very light pressure and quick deft strokes

Do not push electrodes through the tissue


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Ensures smooth passage of electrode without draggingor charring of tissue


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THANK YOU!

Tissue Management ppt

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