Fluid Control and Tissue Management

8/8/2019 Fluid Control and Tissue Management

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Fluid Control in dentistry



Fluid ControlObjectives

-Dry Field-Acess and Visibility

-Patient Protection

-To improve operating Efficiency



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



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



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

plasticMetal

(young¶s

frame)



5.Rubber dam punch

Used for making holes in the

dam

Parts

Rotating metal disc

Sharp pointed

plugger



High volume vaccumExcellent lip retractor

Used during preparation

phase

Advantages

Toxic material is readily

removedDecreases treatment

time

Removes debris



Saliva ejector

Used as an adjunct to highvolume evacuation

Placed in the corner of the

mouth opposite the

quadrant being treated



Svedopter

As metal saliva

ejector with attachedtongue deflector

Used when patient is

in upright position



Drawbacks

Access to mandibular

surfaces of teeth limited

Position

Anterior part is

placed in incisor

region with tubing

under patient¶s arm



Cotton rolls

With/without anaesthesia

Prefabricated/loose



Gauze piecesSupplied 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 thancotton 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 todisplace 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 toothuntil 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 istucked until it overlaps the tucked

mesial end



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



Technique

Torpedo diamond is used to do

gingettage along with finish

line preparation

A retraction cord is used to

arrest bleeding in theginggetaged 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

linesContraindications

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 currentFully 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 distaldirection



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 lengtheningcompleted



3.Technique for removal of edentulous cuff

Edentulous cuff

Removal using loop

electrode



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Fluid Control and Tissue Management