![Suction tips/ saliva ejectors
■ Disposable saliva ejectors
■ Transparent [ plastic]
■ Multi coloured [ plastic]
■ Hygoformic saliva ejector](https://image.slidesharecdn.com/fluidcontrol-230415054503-565ea712/85/FLUID-CONTROL-AND-SOFT-TISSUE-MANAGEMENT-IN-FPD-14-320.jpg)
FLUID CONTROL AND SOFT TISSUE MANAGEMENT IN FPD
- 1. FLUID CONTROL AND SOFT TISSUE MANAGEMENT IN FPD BY- DR.SWETHA.S 2ND YEAR PG
- 2. TABLE OF CONTENTS ■ INTRODUCTION ■ SOURCE OF MOISTURE IN CLINICAL ENVIRONMENT ■ CLASSIFICATION ■ METHODS OF MOISTURE CONTROL MECHANICAL CHEMICAL CHEMICOMECHANICAL SURGICAL RECENT ADVANCEMENTS IN RETRACTION CONCLUSION REFERENCES
- 3. Sources of moisture in clinical environment 1.Saliva ■ Salivary glands-parotid, submandibular, sublingual ■ The mean flow rate (+/- SD) of unstimulated saliva was 0.26 +/- 0.16 ml/min and that of saliva while chewing six different foods was 3.6 +/- 0.8 ml/min. 2.Blood Inflamed gingival tissues/Iatrogenic damage 3.Water/dental materials Rotary instruments, triplex syringe, etchants, irrigant solutions On a average a high speed rotatory cutting instrument is 30 mL per minute 4.Gingival crevicular fluid - 0.05 to 0.20 µL per minute
- 4. How is moisture control important? 1.Patient related factors Provides comfort. Protects from swallowing or spirating foreign bodies. 2. Task/technique being performed Dental materials are moisture sensitive, success of adhesion and physical properties relies on a dry field.
- 5. 3. Operator related factors ■ Infection control to minimise aerosol production ■ Increased accessibility to operative site ■ Improves visibility of the working field ■ Less fogging of the dental mirror. ■ Prevents contamination.
- 6. Classification ■ 1.Barkmier W.W. and Williams H.W(1978) a. Surgical Retraction Gingivectomy and Gingivoplasty Electrosurgery Rotary Gingival Curettage b. Non-Surgical Retraction Rubber dam and clamps Retraction cords impregnated and non-impregnated Retraction rings copper bands
- 7. ■ 2. Thompson M.J.(1959) 1.Conventional 2.Radical ■ 3. B.W.Benson et al (1986) 1.Mechanical method 2.Mechanico-chemical method 3.Rotary gingival curettage 4.Electrosurgical methods.
- 8. Rubber dam ■ Introduced by S C Barnum 1864 USES ■ For core build up, pattern fabrication ■ impression making of inlays and onlays ■ Removal of old restoration and caries ■ For cementation Contraindication ■ Should not be used with poly-vinylsiloxane interferes with polymerization Patients allergic to latex
- 9. Advantages ■ Isolate one/more teeth ■ Eliminates saliva from operating site ■ Retracts soft tissue Disadvantages ■ Time consuming and patients objection ■ Unusual tooth shapes or positions that cause inadequate clamp placement ■ Partially erupted teeth ■ Broken down teeth ■ Patients suffering from asthma
- 10. Rubber dam set ■ Rubber dam ■ Rubber dam punch ■ Rubber dam clamps ■ Rubber dam clamp forceps ■ Rubber dam frame/holder
- 12. High volume vacuum ■ Powerful suction device, use of 10mm diameter tips, and a properly functioning suction pump set to evacuate one liter per minute of fluid Uses ■ Apparatus also removes small operatory debris ■ Excellent lip retractor Disadvantages ■ Cannot be used for impression & cementation procedure
- 13. Saliva ejector • Low volume suction devices • 300 ml/ min is the suction rate • Adjunct to high volume vacuum/ rubber dam/cotton rolls Uses Removes saliva from the floor of mouth Removes water slowly
- 14. Suction tips/ saliva ejectors ■ Disposable saliva ejectors ■ Transparent [ plastic] ■ Multi coloured [ plastic] ■ Hygoformic saliva ejector
- 15. Cotton rolls ■ Commonest and cheap ■ Controls small amounts of moisture and retracts cheek and tongue ■ Keeps its shape and does not fall apart when full of saliva ■ Provides acceptable dryness for procedures ■ Cementation ■ Impression making Uses Different types of cotton rolls Wrapped Braided
- 16. Reusable saliva ejectors ■ Saliva ejector with tongue guards ■ Steel
- 17. Svedopter ■ Metal saliva ejector with a tongue retractor ■ Used for mandibular arch ■ Most effective when patient is in a nearly upright position.
- 19. PINK PETAL
- 20. CHEMICAL METHODS
- 21. Gastrointestinal anti cholinergic drugs that inhibit action of myo-epithelial cells of salivary gland 1.Common drugs • Bromide (Banthine) 50 mg 1 hr before procedure • Propantheline bromide (Pro-Banthine) 15mg 1 hr before procedure • Clonidine hydrochloride (Antihypertensive) 0.2mg 1 hr before procedure • Atropine 1 tablet of 0.4mg per day ANTI SIALAGOGUES
- 22. Contraindication of anti-sialogogues a. Methantheline and propanthelin contraindication Hypersensitivity to drugs Glaucoma Asthma Congestive heart failure Obstructive condition of GI tracts or urinary tracts b. Clonidine hydrochloride • Its an anti hypertensive drug hence should be given cautiously • Causes drowsiness
- 24. DEFINITION ■ Gingival retraction is the deflection of marginal gingiva away from the tooth.(tissue dilatation)- GPT ■ Gingival retraction is a process of exposing margins when making impression of prepared teeth.
- 25. IMPORTANCE OF FINISH LINE EXPOSURE The finish line must be reproduced in the impression. The marginal integrity is very important in preventing recurrent caries and gingival inflammation. So, the finish line must be exposed temporarily to reproduce the entire preparation.
- 26. When a gingival retraction technique is utilized, forces act in four directions on the gingival tissues. These are the retraction, displacement, collapsing and relapsing forces . 1. Retraction is the downward and outward force exerted on the gingival tissues by the retraction technique or material; 2. Displacement is the downward force resulting from excessive pressure during retraction or in unsupported gingival tissues; 3. Relapse is when the gingival tissues rebound to their original position; and 4. Collapse is when the gingival tissues are further compressed towards the tooth as a result of using close-fitting trays for impression.
- 27. MECHANICAL METHOD ■ Copper ring technique ■ Matrix band and wedges ■ Gingival protector ■ Anatomic retraction caps ■ Retraction cords
- 28. Copper ring technique ■ This method involves the use of a copper band or ring, with the gingival margins festooned according to the gingival contours. ■ This is useful for impression of an indirect restoration with subgingival margins, where the copper band is filled with modelling compound or elastomeric impression material, and seated on the prepared tooth along the path of insertion. ■ This method physically displaces the tissue, which stays retracted when the copper band is removed, so that the subsequent impression records the subgingival tooth structure. ■ This technique may result in damage to the gingival tissues during placement, as the assembly is difficult to remove once set due to the presence of undercuts.
- 30. Matrix band and wedges ■ Matrix bands can provide retraction of gingiva and isolation when used for cervical or subgingival restorations. ■ Wedges placed inter-proximally physically depress the gingival for retraction, and can protect the gingiva during preparation of the tooth.
- 31. Gingival protector ■ This is a small instrument with a crescent-shaped tip, which can be placed and adjusted according to the contour of the gingival tissues physically to protect the gingiva during preparation of tooth structure close to the gingival margin. ■ They are useful during subgingival cavity removal and cavity preparation, finishing veneer and other indirect restoration margins and to check the proper seating of crowns with subgingivally placed margins
- 32. Anatomic retraction caps ■ The retraction caps follow the same principle as the copper bands, except that they are pre-shaped, for easy placement between adjacent teeth and, once in place, the patient bites on it. ■ The physical pressure arrests haemorrhage and opens the sulcus for the final impression.
- 33. CHEMICOMECHANICAL METHODS OF GINGIVAL RETRACTION A method of combining a chemical with pressure packing, which leads to enlargement of the gingival sulcus as well as control of fluids seeping from the sulcus.
- 34. It should produce effective gingival displacement and hemostasis It should not produce any irreversible damage to the gingiva It should not have any systemic side effects. Ideal Requirements for Chemicals Used with Gingival Retraction Cord
- 35. Chemico-mechanical Methods They combine chemical action with pressure packing. Abandoned caustic chemicals. ■ Sulfuric acid. ■ Trichlor acetic acid. ■ Negatol (49% condensation product of metacresol sulfonic acid and formaldehyde). ■ Zinc chloride. Chemical action ■ Vasoconstrictors shrinkage of tissue. ■ Biologic fluid coagulants. ■ Surface layer tissue coagulants.
- 36. Chemicals Used In gingival retraction The following chemicals are generally local vasoconstrictors which produce transient gingival shrinkage. 0.1-0.8 % Racemic epinephrine. 5- 25%Aluminium chloride. 100% Alum. (Aluminium potassium sulphate) Aluminium sulphate. Ferric subsulphate (monsel solution) 20-100% tannic acid 45% negatol 8-40% zinc chloride sol 13.3% ferric sulpate sol
- 37. Mechanism of action • Epinephrine and nor- epinephrine Vasocostrictors • Aluminium chloride, tannic acid, alum. Biologic fluid coagulants • Zinc chloride and silver nitrate. Surface layer tissue coagulants
- 38. ■ EPINEPHRINE ■ 0.1%-8% racemic epinephrine is used ■ 0.2 mg -1 mg of epinephrine per inch of cord Contraindications of epinephrine Cardiovascular disease Hypertension Diabetes Hyperthyroidism Known hypersensitivity to epinephrine Patients taking Tricyclic depressants Ganglionic blockers Cocaine
- 39. Astringent ■ Mechanism of action Precipitation of protein Inhibit transcapillary movement of plasma protein Act as caustics at low concentration & irritants in moderate concentration. Low cell permeability.
- 40. Alum (Potassium aluminium sulfate) ■ 100% of alum soaked in retraction cord ■ Advantages Safer and fewer systemic effects than epinephrine Good tissue recovery Can be placed inside the sulcus safely for 20 min Disadvantages 0.1% of crestal bone loss less gingival dispacement
- 41. Aluminum chloride ■ Mechanism Precipitate protein Constrict blood vessels Extract fluid from tissues Used in 5-25% concentration for 10 min Least irritating Disadvantage Interferes with the setting of PVS materials
- 42. Ferric sub-sulfate ■ Also known as monsel’s solution • More effective than epinephrine • Good tissue recovery •Recommended time- 3 min Disadvantages Solution is messy Corrosive and injurious to soft tissues Stain teeth High acidity
- 43. Ferric sulfate ■ 13- 20% ■ Provides hemostasis on exposed connective tissue ■ Recommended packing time-1-3 min ■ Disadvantages Modify setting reaction of polyvinyl siloxane ■ Stains gingival tissue yellow-brown to black Tannic acid ■ 20-100% Recommended time- 10 min ■ Good tissue recovery
- 44. ZINC CHLORIDE (bitartarate) 8% - 40% ■ 8% =displacement = epinephrine. ■ it can cause severe necrosis of the tissues that did not heal in 60 days ■ 40% =displacement > epinephrine. Is very caustic and is termed as a chemical cautery agent. ■ These sol. are not recommended for use as they are Eschariotic and cause permanent injury to soft tissue and even bone.
- 46. Classification of retraction cords Depending on the configuration Twisted Knitted Braided Depending on surface finish Wax Unwaxed
- 47. ■ Depending on the chemical treatment Plain Impregnated Depending on number strands Single Double-string ■ Depending on the thickness (color coded) Black - 000 Yellow - 00 Purple - 0 Blue - 1 Green - 2 Red - 3
- 48. ■ Indications of #000 Anterior teeth Double packing Substitute for black silk suture as lower cord in the "two-cord" technique ■ Indications of #00 • Preparing and cementing veneers • Restorative procedures dealing with thin, friable tissues
- 49. ■ Indications of #0 • Lower anteriors • When luting near gingival and subgingival veneers • Class III, IV and V restorations • Second cord for "two-cord" technique ■ Indications of #1 • Tissue control and/or displacement when soaked in coagulative hemostatic solution prior to and/or after crown preparations • Protective "pre-preparation" cord on anteriors
- 50. ■ Indications of #2 • Upper cord for "two-cord" technique • Tissue control and/or displacement when soaked in coagulative hemostatic solution prior to and/or after crown preparations • Protective "pre-preparation" cord on anteriors ■ Indications of #3 Areas that have fairly thick gingival tissues where a significant amount of force is required • Upper cord for those desiring the "two-cord" technique
- 51. Instruments used for gingival retraction • Evacuator • Scissors • Cotton pliers • Mouth mirror • Explorer • Fisher ultrapak packer • DE plastic filling instrument IPPA
- 52. Fisher ultrapak packer ■ Small Packer (45 degrees to handle) ■ Small Packer (90 degrees to handle) 45 degrees Heads at 45 degrees Three packing sides. Small packer for lower anteriors and upper lateral incisors. 90 degrees Three sided heads One of the heads in line with shank Second is at a right angle to the shank.
- 54. Techniques of gingival retraction Single cord technique. Double cord technique. Infusion technique of gingival displacement. Every other tooth technique.
- 55. SINGLE CORD TECHNIQUE ■ The operating area should be dry. Fluid control should be done with an evacuating device and the quadrant containing the prepared tooth is isolated with cotton rolls. ■ Next, the retraction cord is drawn from the dispenser bottle with sterile cotton pliers and a piece of approximately 5 cm (2 inch) long is cut off.
- 56. ■ The cord is twisted to make it tight and small ■ The retraction cord should be dipped in 25% AlCl3 solution in a dapen dish. ■ Haemorrhage can be controlled by using haemostatic agents. ■ The retraction cord is looped around the tooth and held tightly with the thumb and forefinger.
- 57. ■ The cord is packed into the gingival sulcus starting from the mesial surface of the tooth. The cord should be stabilised near the distal end of the tooth. ■ The cord can be packed with special instruments like Fischer Packing instrument or a DE plastic instrument IPPA.
- 58. ■ Force should be applied in a mesial direction during cord placement so that the packed preceding segment does not get dislodged. ■ Occasionally it may be necessary to hold the cord with one instrument while packing with another. The instrument used for packing should be angled slightly towards the root to facilitate the sub-gingival placement of the cord
- 59. ■ The instrument is inclined at an angle towards the tooth surface. If it is held parallel to the long axis of the tooth, the retraction cord will be pushed against the wall of the gingival crevice, and will rebounce
- 60. ■ Excess cord is cut off near the inter-proximal area such that a slight overlap of the cord occurs in this region. If the overlap occurs on the facial and lingual surfaces, the gingival finish line in that area may not be replicated properly in the impression.
- 61. ■ Atleast 2-3 mm of cord is left protruding outside the sulcus so that it can be grasped for easy removal. ■ After 10 minutes, the cord should be removed slowly in order to avoid bleeding. ■ If active bleeding persists, a cord soaked in ferric sulphate should be placed in the sulcus and removed after 3 minutes. ■ The impression should be made only after cessation of bleeding. ■ The retraction cord must be slightly moist before removal. Removing dry cord from the crevice can injure the delicate epithelial lining of the gingiva.
- 62. Double cord technique Indication • Impression of multiple prepared teeth • Impression for compromised tissue health ■ Small diameter cord is placed in sulcus ■ Second cord soaked with hemostatic agent placed over small cord for 8-10 minutes.
- 63. Infusion technique Indication ■ Controls hemorrhage Procedure ■ Retraction cord packed into the sulcus for 1-3 minutes. ■ Infuser used with a burnishing motion in the sulcus circumferentially 360° around the sulcus
- 64. EVERY OTHER TOOTH TECHNIQUE ■ In case of multiple anterior tooth preparations with close root proximity, placing the retraction cord simultaneously around all teeth will result in strangulation of interdental papillae. ■ This can impair gingival health as well as cause black inter-dental triangles. ■ To avoid this, ‘every other tooth’ technique of gingival displacement in combination with sectional impressions may be used to provide a better master cast in multiple tooth preparations.
- 66. SURGICAL METHODS (Troughing or Tissue dilatation) ■ Currently, the trough, soft-tissue excision, extends from the height of the free margin of the gingiva to a point 0.3–0.4 mm apical to the finish line margin of the tooth preparation. ■ Unlike other methods that provide gingival displacement, the surgical method removes gingival tissues and thus would require soft-tissue healing. ■ In this type of surgical gingival tissue management, burs are used to create a trough in the sulcus around the finish line. ■ It requires local anaesthesia to prevent patients from experiencing discomfort and can result in bleeding at the site. This method can be used for both direct and indirect types of restorations
- 67. ROTARY CURETTAGE (Amsterdam 1954) Troughing technique or “gingettage” Produce limited removal of epithelial tissue in the sulcus while a chamfer finish line is being created in tooth structure. Criteria for rotary curettage Done on healthy and inflammation free tissue to prevent tissue shrinkage Absence of bleeding on probing Sulcus depth less than 3.0 mm Presence of adequate keratinized gingiva
- 68. Electro Surgery ■ Electrosurgery denotes surgical reduction of sulcular epithelium using an electrode to produce gingival retraction ■ Mechanism of action Controlled tissue destruction. Current flows through a small cutting electrode a vacuum tube or a transistor to deliver a high frequency electrical current of at least 1.0 MHz The procedure is also called as “Surgical Diathermy”
- 69. TISSUE CONSIDERATIONS ■ Keep electrode in motion. ■ 5-10 seconds between applications. ■ Patient should be properly grounded. ■ Tissue must be moist. ■ Electrode must remain free of tissue fragments. ■ Electrode must not touch any metallic restorations.
- 70. Types of current 1.Fully Rectified current (modulated) – continuous flow of current – good cutting characteristics – enlargement of gingival sulcus 2.Fully Rectified current (filtered) – continuous current wave – excellent cutting characteristics – less injury than modulated current
- 71. 3.Partially rectified current (damped) ■ Considerable tissue destruction. ■ Slow healing. ■ Used for spot coagulation. 4.Unrectified current (damped) ■ Causes intrinsic dehydration and necrosis. ■ Slow and painful healing. ■ Not used in dental surgery.
- 72. ADVANTAGES Clear operating area without or no bleeding Healing by primary intension Less tissue loss after healing DISADVANTAGES Unpleasant odour. Slight loss of crestal bone Burn mark on the root surface Not suitable for thin gingiva. CONTRAINDICATIONS Patients with cardiac pace maker. Patients with delayed wound healing. Patients on steroid therapy. In the recently irradiated areas.
- 73. LASERS Indication Controlled tissue removal before impression making Tissue contouring Properties of laser depends on Wavelength Waveform TYPES OF LASERS Neodymium: yttrium-aluminium-garnet Erbium: yttrium- aluminum-garnet
- 74. ■ Advantages Minimum pain and discomfort Less fear ,anxiety and stress Minimum or no anesthesia No drill sounds Less chair time Reduced post operative complications Minimum or no bleeding Disadvantage Overuse causes shrinkage of tissue and also results in exposure of crown margin ■ Disadvantages ■ Er: YAG lasers are not good for producing hemostasis ■ CO2 laser provides no tactile feedback, leading to risk of damage to junctional epithelium.
- 75. RECENT ADVANCES IN GINGIVAL RETRACTION
- 76. EXPASYL RETRACTION PASTE (SDS/KERR) aceteon 2000 COMPOSITION - kaolin – retracts the tissue - aluminium chloride- about 15%- hemostasis COMPOSITION - kaolin – retracts the tissue - aluminium chloride- about 15%- hemostasis
- 77. ■ The Expasyl paste is syringed into the crevicular space using a stable non deliberate pressure of 0.1N/nm. ■ When Expasyl is injected and held in place for a minute, it will generate sufficient pressure to acquire a sulcus opening of 0.5mm,for two minutes
- 78. ■ Advantages Effectively achieves hemostasis. Effectively retracts gingival tissues Less traumatic to tissues than cord packing. Faster than traditional cord. Easy removal from sulcus by rinsing. Dispenser tips can bent- improves intraoral access. Disadvantages Expensive Effective under limited conditions. Disposable metal dispenser tips are too large causes difficulty to express Thickness makes it difficult to express
- 79. MAGIC FOAM- Foamcord (Coltene/Whaledent) ■ Developed by Prof Dr. Dumfahrt Non-hemostatic gingival retraction system (Coltène/ Whaledent) First expanding vinyl polysiloxane material designed for retraction of the gingival sulcus
- 80. ■ Mechanism • Expansion of silicon foam. Magic foam cord is a polymeric material which is introduced into the gingival sulcus and allowed to set. The patient is advised to bite on a cap (comprecap) while maintaining the pressure on for 3 minutes. The material slightly expands during setting and produces exceptional lateral and vertical displacement. The cap and foam are removed after 5 minutes and the tooth is set for the final impression Limitation Limited clinical indications Less hemostatic No improvement in speed/quality compared to cord Less effective on sub gingival margin
- 81. Gingitrac (Centrix co) Based on vinyl polysiloxane material with aluminium sulfate astringent. Mild natural astringent gel Utilizes patient s bite pressure to push material into sulcus and retract gingiva Consists of Mixing gun Gingitrac cartridge Gingitrac matrix cartridge Mixing nozzle Dispensing tips Gingicap
- 82. Single-Unit Retraction Technique Select GingiCap Dispense GingiTrac into the GingiCap and around the prep.
- 83. Bite down and wait 5 minutes Ready for impression
- 84. Matrix Impression System(1983, Livaditis ) Procedure includes three steps. ■ First, a matrix of occlusal registration elastomeric material is done over the prepared tooth. ■ The retraction cord is removed and a definitive impression is recorded in the matrix using a high viscosity elastomeric impression material. ■ After the matrix impression is positioned, medium viscosity elastomeric material is loaded in an impression tray and is seated over the matrix and remaining teeth to create impression of the entire arch. ■ The design of the matrix also forces the high viscosity impression material along the preparations and into the sulcus. The matrix impression system uses three impression materials of different viscosities.
- 85. ■ Advantages ■ Eliminates chances of tearing of the sulcus ■ Cleans blood and debris from the sulcus area ■ Delivers impression material in the gingival sulcus slowly and with more accuracy and speed ■ Holds the sulcus open for an increased time. ■ Disadvantages ■ Increased chairside time.
- 88. Merocel Strips ■ Merocel retractions strips are synthetic material, which are specifically chemically extracted from a polymer hydroxylate polyvinyl acetate that creates a net-like strip without debris or free fragments. ■ Placement of Merocel retraction technique does not require use of local anesthesia. ■ The porous and sponge-like microstructure of Merocel produces a dry field for the impression to accurately capture the details. ■ The absence of fibers decreases the risk of postoperative problems.
- 89. Advantages ■ It is shaped easily ■ It effectively absorbs oral fluids ■ The sulcus is clean without the presence of any debris.
- 90. Stay put 1. IMPREGNATED Combines the advantages of both an impregnated and braided cord with the adaptability of an ultrafine copper filament. Aluminum chloride hexahydrate is used for impregnation. 2. Nonimpregnated stay put cord is also available which can be impregnated with hemostatic agent as needed. ■ Advantages ■ Hemostasis is fast ■ Possible to be preshaped ■ Pliable and can be adapted ■ Relatively safe for cardiac patients.
- 91. Gel-Cord G ■ Gelcord comprises of- 25% Aluminum Sulfate Gel. ■ Unlike liquid astringents it stays put when placed for maximum hemostasis. ■ The gel is rubbed mildly into the hemorrhaging area. ■ Gelcord is flavored well for greater patient acceptance and brightly colored for better visualization. It provides enough lubrication for the initial cord to slide easily into the sulcus.
- 92. Tissue Goo ■ Tissue Goo is a gel that contains active ingredient is 25% aluminum sulfate stays put where it is placed and provides ample hemostasis during tissue management processes. ■ The retraction cord will provide ideal tissue displacement, while absorbing the goo and deliver hemostasis.
- 93. G CUFF ■ A Canadian company, named Stomatotech, launched a disposable plastic collar for gingival retraction which is inserted on the apical end of the abutment before the abutment is engaged to the implant. ■ The plastic collar is found between the apical part of the abutment and the gingival soft tissue. ■ Once the impression is retrieved from the mouth, the plastic collar is drawn out and removed permanently. ■ The plastic creates a valve preventing the liquids from contaminating the area of the finish line of the abutment.
- 94. Retraction Capsule ■ The recently introduced 3M™ ESPE™ Retraction Capsule is 15% aluminum chloride retraction paste. ■ It is packaged in unit-dose capsules with an extra-fine tip that fits directly into the sulcus. ■ When compared with retraction cords, the retraction procedure the retraction procedure with this material can be up to 50% faster. ■ Fine tip of the capsule offers improved access into the sulcus and interproximal areas. ■ As the tip of the capsule is plastic with round, soft edges, practitioners can use it with less apprehension about detrimental effects on the tissue and patient discomfort
- 95. Traxodent • Syringe-dispensed 15% aluminum chloride, hemostatic paste • Ergonomic syringe • Easy to use • Disposable and flexible tips • Each syringe can be repacked for maximum freshness • Paste with a malleable consistency
- 96. Racegel ■ Before impression making, it is used to obtain hemostasis and dry field in the sulcus. ■ Racegel becomes more viscous on tissue contact because of its thermodynamics. ■ It contains 25% aluminum chloride, oxyguinol, and excipients. ■ Aluminum chloride - astringent. ■ The gel can be used with or without gingival retraction cords. ■ Racegel produces finish line exposure with minimum bleeding. ■ It is easily rinsed, leaving no irritation of the surrounding tissue. Its thermal effect is reversible when rinsed with water.
- 97. Gingival displacement in digital impressions 15% aluminum chloride in an injectable matrix Cords avoided to prevent artifacts on digital impression
- 98. Gingival displacement in digital impressions 15% aluminum chloride in an injectable matrix Cords avoided to prevent artifacts on digital impression
- 101. References 1. Rosenstiel,Land,Fugimoto Contemporary Fixed Prosthodontics 3rd edi. The mosby co. 2. Shillingburg H.T etal. Fundamentals of fixed Prosthodontics.3r edi.quintessence pub.co
- 102. 1.Donovan T.E. et al: Review and survey of medicaments used with gingival retraction cords. J.P.D.1985 vol.58 pg.525-531 2.Miller I.F:Fixed dental prostheses. J.P.D.1958 vol.8 pg.483-495 3.Ruel J. et al:Effects of retraction procedure on periodontium of humans. J.P.D.1980 vol.44 pg.508-514 4.Reiman B.Milford:Exposure of subgingival margins by non-surgical gingival displacement. J.P.D.1976 vol.436 pg.649-654
- 103. 5.barkmier WW ,Williams H.W.:Surgical methods of gingival retraction for restorative dentistry. J.A.D.A. 1978,vol.96,pg.1002-1007 6.Benson D.W et al:Tissue displacement methods in fixed prosthodontics. J.P.D.1986,vol.55,pg.175-182 7.La Forgia A:Cordless tissue retraction for fixed prostheses J.P.D.1967,vol.17,pg.379 8.Buchanan W.T,Thayer K.E.:Systemic effeccts of epinephrine- impregnated retraction cords in fixed partial denture prosthodontics. J.A.D.A. 1982,vol.104,pg.482 9.Zeena Raja,Chandrashekharan Nair A clinical study on gingival retraction. A survey on the use of gingival retraction cords by dental professional. JIPS 2003,vol.3 pg.21,30
- 104. 10.W.D.Mello,V.Chitre et al:Gingival retraction cords-their role in tissue displacement:A Review JIPS2003,vol.3,pg.16 11.Charbeneau G.T. et al Operative Dentistry,Philadelphia 1966.Lea and febiger 12.Gillmore H.W. et al Operative Dentistry,4th edi.st.Louis 1982.C.v.mosby co. 13.Flocker J.E:Electrosurgical management of soft tissue and restorative dentistry. DCNA 1980 vol24 pg 247. 14.Jonston J.F,Phillips R.W. mordenr practice in crown and bridge prosthodontics.4th edi. Philadelphia,Saunders co.
- 105. THANK YOU