Fluid Control in dentistry

A.SELVA AROCKIAM3RD YEAR BDSCSICDSRMADURAI

Fluid ControlObjectives

-Dry Field-Acess and Visibility-Patient Protection-To improve operating Efficiency

Means of Fluid ControlMechanical Chemical

1.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

Rubber DamRubber Dam Kit Should have the following items in it

1.Rubber Dam Sheet

2.Rubber Dam Clamps

3.Retainer forceps

4.Rubber Dam holder

5.Rubber Dam Punch

6.Lubricant

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

2.Rubber dam Clamps

Parts

• 2 Jaws

• 1 Bow

• 4 Prongs

Types

• Winged

• Wingless

3.Retainer Forceps

4.Rubber dam holder

It is a U shaped frame

plastic Metal

(young’s frame)

5.Rubber dam punch

Used for making holes in the dam

Parts

•Rotating metal disc

•Sharp pointed plugger

High volume vaccum•Excellent lip retractor

•Used during preparation phase

Advantages

•Toxic material is readily removed

•Decreases treatment time

•Removes debris

Saliva ejector

•Used as an adjunct to high volume evacuation

•Placed in the corner of the mouth opposite the quadrant being treated

Svedopter

•As metal saliva ejector with attached tongue deflector

•Used when patient is in upright position

Drawbacks•Access to mandibular surfaces of teeth limited

PositionAnterior part is placed in incisor region with tubing under patient’s arm

Cotton rolls

With/without anaesthesia

Prefabricated/loose

Gauze pieces•Supplied in pieces of 2”x2” or larger

•Act as throat screens

•Better tolerated by delicate tissues

Absorbent pads/wafers

•Made up of cellulose

•More absorbent than cotton rolls or gauzes

•Commonly used inside the cheeks to cover the parotid duct

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

Retraction of gingival tissues

Mechanical

•Copper band

•Retraction cord

•Rubber dam

Chemicomechanical

Vasoconstrictors

•Epinephrine

•Aluminium chloride

•Ferric sulphate

•Alum

Surgical

Mechanical methods 1.COPPER BAND

•Used to carry impression material as well as to displace gingiva to expose the finish lines

•Can cause njury to gingival tissues

2.Retraction cords

•Braided /non braided

•Plain /impregnated

It causes

•Displacement of free gingiva

•Transient dehydration of tissues

•Decreased bleeding

Technique for placement of cord

1.Retracting the cord from the bottle

2.Cord twisted

3.Loop of cord formed around the tooth and held tightly

4.Cord should be inserted starting from the mesial surface of the tooth until the distal surface

5.Cord should be tucked into the

sulcus progressively

6.Holding of cord

7.Angling of instrument toward the root

8.excess cord cut off near interproximal area of mesial surface

9.After cutting off the excess at the mesial end the disal end of cord is tucked until it overlaps the tucked mesial end

Surgical methods1.Rotary curretage(Gingetttage)

Requisites

•Absence of bleeding from probing from gingiva

•The depth of sulcus is less than 3mm

•Presence of adequate keratinised gingiva

Technique

Torpedo diamond is used to do gingettage along with finish line preparation

A retraction cord is used to arrest bleeding in the ginggetaged area

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 lines

Contraindications

•Patients with cardiac pacemakers

•Use of topical anaesthetic avoided

Advantages

•Sophisticated technique

•Little or no bleeding

•Quick procedure

Disadvantages

•Technique sensitive

•Difficult to control heat dissipation

•Excessive pressure may cause tissue damage

Types of current used

•Unrectified damped current

•Partially rectified damped current

•Fully rectified current

•Fully rectified filtered current

Electrosurgical unit

Two electrodes attached to each unit

•Surgical electrode

•Ground electrode

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

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 distal direction

Incisions for gingival crevice enlargement

Sulcus wiped out with hydogen peroxide

2.Technique for crown lengthening

The diamond is held such that one of its surfaces align the tooth surface

Crown lengthening completed

3.Technique for removal of edentulous cuff

Edentulous cuff

Removal using loop electrode

THANK YOU

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