fluid control and tissue management
TRANSCRIPT
8/8/2019 Fluid Control and Tissue Management
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Fluid Control in dentistry
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Fluid ControlObjectives
-Dry Field-Acess and Visibility
-Patient Protection
-To improve operating Efficiency
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Means of Fluid Control
MechanicalChemical1.Rubber Dam
2.High Volume vaccum
3.Saliva Ejector
4.Svedopter
5. Cotton Rolls
6.Absorbent Pads
7.Gingival Retraction cord
8.Gauze Pieces
1.Drugs
2.Local Anaesthesia
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Rubber DamRubber Dam Kit Should have the following
items in it
1.Rubber Dam Sheet
2.Rubber Dam Clamps3.Retainer forceps
4.Rubber Dam holder
5.Rubber Dam Punch
6.Lubricant
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1.Rubber dam sheet
Size 5´X5´ or 6´X6´
Thickness
Thin .006´
Medium .008´
Heavy .010´
Extra heavy .012´
Special heavy .014´
Color:-Blue and Green preffered
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2.Rubber dam Clamps
Parts
2 Jaws
1 Bow
4 Prongs
Types
Winged
Wingless
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3.Retainer Forceps
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4.Rubber dam holder
It is a U shaped frame
plasticMetal
(young¶s
frame)
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5.Rubber dam punch
Used for making holes in the
dam
Parts
Rotating metal disc
Sharp pointed
plugger
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High volume vaccumExcellent lip retractor
Used during preparation
phase
Advantages
Toxic material is readily
removedDecreases treatment
time
Removes debris
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Saliva ejector
Used as an adjunct to highvolume evacuation
Placed in the corner of the
mouth opposite the
quadrant being treated
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Svedopter
As metal saliva
ejector with attachedtongue deflector
Used when patient is
in upright position
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Drawbacks
Access to mandibular
surfaces of teeth limited
Position
Anterior part is
placed in incisor
region with tubing
under patient¶s arm
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Cotton rolls
With/without anaesthesia
Prefabricated/loose
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Gauze piecesSupplied in pieces
of 2´x2´ or larger
Act as throat screens
Better tolerated by
delicate tissues
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Absorbent pads/wafers
Made up of cellulose
More absorbent thancotton rolls or gauzes
Commonly used inside
the cheeks to cover the
parotid duct
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Chemical methodsDRUGS
1.Antisialogogues
GIT anticholinergics
Commmonly used are
Methantheline bromide
Propantheline bromide
Clonidine hydrochloride
2.Antianxiety drugs
Diazepam
LOCAL ANAESTHESIA
More comfortable
Less sensitive
Patient is less anxious
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Retraction of gingival tissues
Mechanical
Copper band
Retraction cord
Rubber dam
Chemicomechanical
Vasoconstrictors
Epinephrine
Aluminium chloride
Ferric sulphate
Alum
Surgical
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Mechanical methods
1.COPPER BAND
Used to carry impression
material as well as todisplace gingiva to expose
the finish lines
Can cause njury to
gingival tissues
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2.Retraction cords
Braided /non braided
Plain /impregnated
It causes
Displacement of free
gingiva
Transient dehydration of
tissues
Decreased bleeding
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Technique for placement of cord
1.Retracting the cord from the
bottle
2.Cord twisted
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3.Loop of cord formed
around the tooth and held
tightly
4.Cord should be inserted starting
from the mesial surface of the toothuntil the distal surface
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5.Cord should be tucked into the
sulcus progressively
6.Holding of cord
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7.Angling of instrument toward the root
8.excess cord cut off near
interproximal area of mesial
surface
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9.After cutting off the excess at the
mesial end the disal end of cord istucked until it overlaps the tucked
mesial end
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Surgical methods
1.Rotary curretage(Gingetttage)
Requisites
Absence of bleeding from probing from gingiva
The depth of sulcus is less than 3mm
Presence of adequate keratinised gingiva
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Technique
Torpedo diamond is used to do
gingettage along with finish
line preparation
A retraction cord is used to
arrest bleeding in theginggetaged area
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2.Electrosurgical retraction
Denotes surgical reduction of sulcular epithelium using using an electrode to produce
gingival retraction
Also known as surgical diathermy
Indications
In areas of inflammed gingival tissue
In cases with gingival proliferation around finish
linesContraindications
Patients with cardiac pacemakers
Use of topical anaesthetic avoided
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Advantages
Sophisticated technique
Little or no bleeding
Quick procedure
Disadvantages
Technique sensitive
Difficult to control heat dissipation
Excessive pressure may cause tissue damage
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Types of current used
Unrectified damped current
Partially rectified damped current
Fully rectified currentFully rectified filtered current
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Electrosurgical unit
Two electrodes attached to
each unit
Surgical electrode
Ground electrode
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Principles
oLocal anaesthesia should be given
oAromatic oil applied to vermilion border of the lip
oGrounding done before usage of electrode
oLight pressure should be applied
oElectrode should never be placed stagnant at any point
oNo dragging /charring the tissues
Proper power setting
Swift passage of electrode
Rest interval b/w
strokes
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1.Technique for gingival sulcus enlargement
J shaped electrode used
Speed of probe 7mm/s
Tissue debris cleaned
Four motions involved
Electrode run in facial,
mesial, lingual and distaldirection
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Incisions for gingival crevice enlargement
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Sulcus wiped out with
hydogen peroxide
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2.Technique for crown lengthening
The diamond is held such
that one of its surfaces align
the tooth surface
Crown lengtheningcompleted
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3.Technique for removal of edentulous cuff
Edentulous cuff
Removal using loop
electrode