FLUID CONTROL & SOFT TISSUE MANAGEMENT IN FPD

BYVESTA ENID LYDIA.RIII BDS CSICDSR MADURAI

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.

 

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

REQUIRED CHARACTERS OF PREPARED TOOTH

FINISH LINE

FLUIDS OF ORAL CAVITYSaliva

Gingival bleeding during tooth preparation

Sulcular fluid

Water from hand piece

OBJECTIVES OF FLUID CONTROL & TISSUE MANAGEMENTISOLATION

RETRACTION

ACCESSIBILITY

ISOLATION OF FLUIDS

HOW CAN V ACHIEVE ISOLATION TO CONTROL FLUIDS?

MECHANICAL METHODS

CHEMICAL METHODS

MECHANICAL METHODS OF FLUID CONTROLa.Rubber dam

b.Suction devicesHigh volume vaccumSaliva ejectorSvedopter

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

RUBBER DAM

USES OF RUBBER DAMIsolation of 1 or more teeth

Eliminates saliva from operating field

Retracts soft tissues

DISADVANTAGE OF RUBBER DAM

Difficult to use while preparing tooth for fixed partial denture

SUCTION DEVICESHIGH VOLUME VACCUMSALIVA EJECTORSVEDOPTER

HIGH VOLUME VACCUM

HIGH VOLUME VACUMHelps in removing small debris during crown preparaton

Good lip retractor

SALIVA EJECTOR

SALIVA EJECTORIt is placed at the corner of the mouth opposite to the quadrent to be operated

SVEDOPTER

SVEDOPTERIt is used teeth for isolating mandibular teeth

It is a metal saliva ejector attached with a tongue deflector

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

CHEMICAL METHODS OF FLUID CONTROLANTI-SIALOGOUGESLOCAL ANASTHETICS

ANTI-SIALOGOGUESCONTROLS SALIVARY FLOWTHEY ARE GIT ANTI-CHOLINERGICS THAT INHIBIT THE ACTION OF MYOEPITHELIAL CELLS IN SALIVARY GLANDS,PRODUCING DRY MOUTH

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

RETRACTION OF GINGIVAL TISSUE

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.

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

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

TECHNIQUES OF GINGIVAL RETRACTION?THEY ARE CLASSIFIED AS

Mechanical methodsChemico mechanical methods

surgical

MECHANICAL METHODS OF GINGIVAL RETRACTIONCopper bandRetraction cordRubber dam

COPPER BAND

COPPER BANDIt is used to carry the impression as well as to

displace the gingiva to expose the finish line.

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

RETRACTION CORD

RETRACTION CORDPressure packing

the retraction cord into the gingival sulcus provides gingival sulcus.

Can be made with absorbent material like cotton

CHEMICO-MECHANICAL METHODS OF GINGIVAL RETRACTION 

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

CHEMICALS USED FOR GINGIVAL RERACTIONThey are generally local vasoconstrictors

which produce gingival shrinkage.

8 % racemic epinephrineAluminium chlorideAlum(aluminium potassium sulphate)

Alumminium sulphateFerric sulphate

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

CONTRAINDICATIONS OF EPINEPHRINE

TECHNIQUE OF USING RETRACTION CORD

The cord can be packed with a special instrument like fischer packing instrument or a DE plastic instrument IPPA

SURGICAL METHODS OF RETRACTION

SURGICAL METHODS OF GINGIVAL RETRACTION

Surgical method are

GINGETTAGE

ELECTROSURGERY

ROTTARY CURETTAGE(GINGETTAGE)

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

CRIETERIA TO BE FULLFILLED FOR GINGETTAGE

There should be no bleeding on probing

The depth of the sulcus should be minimum of 3 mm

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

DISADVANTAGES OF GINGETTAGE

Instrument has poor tactile sense so this technique is very sensitive

It can potentially damage the periodontium

ELECTROSURGICAL RETRACTION

ELECTROSURGICAL RETRACTIONIt is the surgical retraction of the sulcular epithelium using an electrode to produce gingival retraction

The procedure is called surgical diathermy.

INDICATIONS OF ELECTOSURGICAL RETRACTION

Areas of inflammation in gingival tissue where the retraction cord cannot be used

Gingival proliferation around the prepared finish line

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.

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

USES OF ELECTROSURGICAL UNITGingival sulcus enlargement

Crown lengtheningRemoval of edentulous cuff

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

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.

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

FINAL IMPRESSION

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).

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.

CONCLUSION

BIBILOGRAPHY