fluid control & soft tissue management in fpd
TRANSCRIPT
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FLUID CONTROL & SOFT TISSUE MANAGEMENT IN FPD
BYVESTA ENID LYDIA.RIII BDS CSICDSR MADURAI
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FIXED PARTIAL DENTUREA 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.
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TOOTH PREPARATIONDE VANS PRINCIPLEThe 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
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REQUIRED CHARACTERS OF PREPARED TOOTH
FINISH LINE
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FLUIDS OF ORAL CAVITYSaliva
Gingival bleeding during tooth preparation
Sulcular fluid
Water from hand piece
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OBJECTIVES OF FLUID CONTROL & TISSUE MANAGEMENTISOLATION
RETRACTION
ACCESSIBILITY
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ISOLATION OF FLUIDS
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HOW CAN V ACHIEVE ISOLATION TO CONTROL FLUIDS?
MECHANICAL METHODS
CHEMICAL METHODS
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MECHANICAL METHODS OF FLUID CONTROLa.Rubber dam
b.Suction devicesHigh volume vaccumSaliva ejectorSvedopter
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Y SHOULD V ISOLATE THE OPERATIVE SITE?To obtain a dry clean operating field
For easy access and visibilityTo improve the properties of dental materials
To protect the patient and the operator
To improve the operating efficiency
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RUBBER DAM
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USES OF RUBBER DAMIsolation of 1 or more teeth
Eliminates saliva from operating field
Retracts soft tissues
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DISADVANTAGE OF RUBBER DAM
Difficult to use while preparing tooth for fixed partial denture
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SUCTION DEVICESHIGH VOLUME VACCUMSALIVA EJECTORSVEDOPTER
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HIGH VOLUME VACCUM
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HIGH VOLUME VACUMHelps in removing small debris during crown preparaton
Good lip retractor
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SALIVA EJECTOR
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SALIVA EJECTORIt is placed at the corner of the mouth opposite to the quadrent to be operated
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SVEDOPTER
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SVEDOPTERIt is used teeth for isolating mandibular teeth
It is a metal saliva ejector attached with a tongue deflector
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DISADVANTAGES OF SVEDOPTERAccess to the lingual surface of mandibular teeth is limited
Cant be used when mandibular tori precludes its use
It may injure the soft tissues
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CHEMICAL METHODS OF FLUID CONTROLANTI-SIALOGOUGESLOCAL ANASTHETICS
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ANTI-SIALOGOGUESCONTROLS SALIVARY FLOWTHEY ARE GIT ANTI-CHOLINERGICS THAT INHIBIT THE ACTION OF MYOEPITHELIAL CELLS IN SALIVARY GLANDS,PRODUCING DRY MOUTH
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COMMONLY USED ANTI-SIALOGOGUESMethantheline 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
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RETRACTION OF GINGIVAL TISSUE
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Y DO VHAVE TO RETRACT THE GIGIVAL TISSUES?It is retracted to obtain maximum
exposure of finish lineGingival retraction permits
completetion of the preparation and cementation of the restoration and helps the operator to make a complete impression of the preparation.
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FINISH LINE EXPOSURE?It is a line of
demarcation / orThe peripheral
extension of a tooth preparation / or
The planned junction of two materials / or
The terminal portion of prepared tooth
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IMPORTANCE OF FINISH LINE EXPOSUREThe 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
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TECHNIQUES OF GINGIVAL RETRACTION?THEY ARE CLASSIFIED AS
Mechanical methodsChemico mechanical methods
surgical
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MECHANICAL METHODS OF GINGIVAL RETRACTIONCopper bandRetraction cordRubber dam
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COPPER BAND
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COPPER BANDIt is used to carry the impression as well as to
displace the gingiva to expose the finish line.
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TECHNIQUE OF COPPER BANDCopper 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 BANDCauses injury to the gingival tissues
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RETRACTION CORD
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RETRACTION CORDPressure packing
the retraction cord into the gingival sulcus provides gingival sulcus.
Can be made with absorbent material like cotton
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CHEMICO-MECHANICAL METHODS OF GINGIVAL RETRACTION
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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
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CHEMICALS USED FOR GINGIVAL RERACTIONThey are generally local vasoconstrictors
which produce gingival shrinkage.
8 % racemic epinephrineAluminium chlorideAlum(aluminium potassium sulphate)
Alumminium sulphateFerric sulphate
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IDEAL REQUIREMENTS OF CHEMICALS USED FOR GINGIVAL RETRACTION CORDSShould produce effective gingival
displacement and haemostasisIt should not produce any irreversible
damage to gingivalIt should not have any systemic side
effects
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CONTRAINDICATIONS OF EPINEPHRINE
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TECHNIQUE OF USING RETRACTION CORD
The cord can be packed with a special instrument like fischer packing instrument or a DE plastic instrument IPPA
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SURGICAL METHODS OF RETRACTION
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SURGICAL METHODS OF GINGIVAL RETRACTION
Surgical method are
GINGETTAGE
ELECTROSURGERY
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ROTTARY CURETTAGE(GINGETTAGE)
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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
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CRIETERIA TO BE FULLFILLED FOR GINGETTAGE
There should be no bleeding on probing
The depth of the sulcus should be minimum of 3 mm
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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
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DISADVANTAGES OF GINGETTAGE
Instrument has poor tactile sense so this technique is very sensitive
It can potentially damage the periodontium
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ELECTROSURGICAL RETRACTION
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ELECTROSURGICAL RETRACTIONIt is the surgical retraction of the sulcular epithelium using an electrode to produce gingival retraction
The procedure is called surgical diathermy.
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INDICATIONS OF ELECTOSURGICAL RETRACTION
Areas of inflammation in gingival tissue where the retraction cord cannot be used
Gingival proliferation around the prepared finish line
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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.
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SURGICAL ELECTRODE or THE CUTTING ELECTRODEIt is like a probe and produces intense heat
during surgical proceduresNumerous cutting edge designs are available
some of them areCoagulation loopDiamond loopRound loopSmall loop
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USES OF ELECTROSURGICAL UNITGingival sulcus enlargement
Crown lengtheningRemoval of edentulous cuff
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TECHNIQUE FOR GINGIVAL SULCUS ENLARGEMENT USING AN ELECTROSURGICAL PROBEElectode is positioned positioned parallel to
the long axis of the toothA small J shaped bur is used for the procedureA 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
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TECHNIQUE FOR SURGICAL CROWN LENGTHENINGIt 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.
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TECHNIQUES OF REMOVAL OF EDENTULOUS CUFFEdentulous 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
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FINAL IMPRESSION
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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).
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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.
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CONCLUSION
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BIBILOGRAPHY
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