1. Tissue Management I

Question 1

Before starting the impression what should you do first (3 things)

Answer 1

Ask the patient

• Secure provisional?
• Tooth aysmptomatic?

Administer LA

Question 2

Benefits of administering LA before impression

Answer 2

• Patient comfort
• Reduced salivary flow
• Reduced bleeding

Question 3

Why does LA contribute to less saliva flow

Answer 3

Pain increases saliva flow (less pain less saliva)

Question 4

When removing an RDP provisional the hemostat should be placed where

Answer 4

at the connector- should alternate from one connector to the other

Question 5

After removing the pateint’s temp and before the impression you should consider what

Answer 5

• Is the tooth prep adequate

- (Correct reductions and distinct finishline)

Question 6

Pre-reqs for a good impression are (3 things)

Answer 6

• Gingival health
• Saliva control
• Displacement of gingiva

Question 7

Reasons to make a well fitting temp

Answer 7

• Maintain tooth comfort

- Maintain gingival health and position

Question 8

If you are going to take an impression and the patients tissues are inflammed you should

Answer 8

• Reinforce OHI

- Perscribe chlorhexidine (1 week)

Question 9

Chlorhexidine shouldn’t be used for more than how long

Answer 9

10 days

Question 10

What are the reasons these issues occur with temps

• Cement washout
• Debris collection

Answer 10

• -Cement washout=Poor fit

- Debris collection=Rough surface

Question 11

Cement can be removed from the tooth with

Answer 11

Explorer

Prophy cup and pumice

Question 12

Impression materials for crown and bridge are (hydrophilic/hydrophobic)

Answer 12

hydrophobic

Question 13

Blood and saliva lead to what issues with impression

Answer 13

• Bubbles
• Voids
• Distortions
• Dilution of cord chemicals

Question 14

What is the most common saliva control method (mechanical/pharmacologic)

Answer 14

mechanical (saliva ejector, cotton rolls, dri-angles, etc.)

Question 15

What are the two pharacologic categories of anti-sialogogue meds

Answer 15

• Anticholinergic meds

- Antihypertensive meds

Question 16

Give examples of anticholinergic and antihypertensive meds

Answer 16

Anticholinergic
-Atropine sulfate
-Pro-banthine
(Also dicyclomine and propantheline)

Antihypertension
-Clonodine

Question 17

Contraindications for anticholinergic and antihypertensive meds

Answer 17

Anticholinergic

• Heart disease
• Glaucoma

Antihypertensive

• No specific contraindications
• Caution in patients using hypertensive meds

Question 18

What are anti-cholinergic drugs contraindicated in people with glaucoma

Answer 18

can lead to permanent blindness (prevalence of undiagnosed gluacoma in the population is high and come physicians suggest that all patients be evaluated opthalmologically before anticholinergics are used)

Question 19

What are the three categories of gingival managment

Answer 19

• Mechanical
• Chemomechanical
• Surgical (electrosurgery or laser)

Question 20

What are the two forms of mechanical gingival retraction

Answer 20

• Rectraction cords (most common)

- Displacement paste

Question 21

Describe displacement paste

Answer 21

• Contains AlCl3

- Less effective retraction compared to cords

Question 22

What are the advantages of electrosurgery over surgical gingivectomy with a scalpel

Answer 22

• Less discomfort

- Less bleeding

Question 23

Disadvantages of electrosurgery

Answer 23

• Can cause recession
• Contraindicated in patients with electronic medical devices (i.e pacemaker)
• Not suitable on thin attached gingiva

Question 24

What types of instruments (i.e mirrors) should be used with electrosurgery

Answer 24

plastic (metal –> electric shock)

Question 25

_Electrode is best for sulcular enlargement and _ is best for gingival contouring

Answer 25

Thin wire...loop

Question 26

T/F anesthesia is not required for electrosurgery

Answer 26

f

Question 27

What mode should the electrosurgery machine be set to

Answer 27

unmodulated alternating current

Question 28

How do you know is the instrument setting is too high and too low

Answer 28

too high= sparking | too low= tip will drag

Question 29

Cutting strokes shouldn't be repeated within _sec of each other

Answer 29

5

Question 30

Contact with metal restorations greater than 0.4 sec has ben shown to cause what in dogs

Answer 30

irreversible pulpitis

Question 31

After electrosurgery and before the cords are place the sulcus should be irrigated with

Answer 31

hydrogen peroxide

Question 32

Advantages of soft tissue laser for gingival displacement

Answer 32

- No anesthesia needed - Achieves tissue ablation and hemostasis - Favorable tissue healing

Question 33

Astringent causes what to the gingival tissues

Answer 33

- Transient ischemia | - Shrinkage of gingival tissues

Question 34

Tissues start to relapse as quick as _ sec after cord removal

Answer 34

30

Question 35

What are the three types of retraction cords

Answer 35

- Twisted - Knitted - Braided

Question 36

Compared knitted and braided cords

Answer 36

Knitted - May collapse in sulcus - Shear when hit with handpeice (better Braided - Doesn't collapse in sulcus (no memory) --> better displacement - Better fluid absorption - Easier to apck - Cord grabs on to but and comes out

Question 37

The smallest and largest sizes of knitted and braided cords are

Answer 37

Knitted - Smallest= 000 - Largest= 0 Braided - Smallest= 0 - Largest= 2

Question 38

Braided cords are impregnated with

Answer 38

aluminum potassium sulfate

Question 39

Braided cords shouldnt be combined with what astringent and why

Answer 39

ferric sulfate ---> staining

Question 40

T/F Epinephrine is the more potent astringent

Answer 40

F- epi is not and astringent it is a vasoconstrictor

Question 41

Hemodent --> Viscostat --> Astringident --> Viscostat clear -->

Answer 41

Hemodent --> Aluminum chloride Viscostat --> Ferric Sulfate Astringident --> Ferric sulfate Viscostat clear --> aluminum chloride

Question 42

Contraindications for epi use in the cord

Answer 42

- History of cardiovascular disease - Hyperthyroidism - Allergy to epinephrine

Question 43

Signs of epinephrine syndrome

Answer 43

- Tachycardia - Increased respiration rate - Nervousness - Increased BP - Post op depression

Question 44

Conc of epi to use in cords is

Answer 44

0.1%

Question 45

Astringents constrict blood flow through what mechanism

Answer 45

coagulation

Question 46

pH of viscostat is? hemodent?

Answer 46

both are acidic

Question 47

Implications of acidity of viscostat and hemodent

Answer 47

- Decalcification of tooth structure --> sensitivity | - Removal of smear layer --> affects adhesion to tooth if done right before cementation

Question 48

Recommendations to reduce the implications of the acidity of astringents

Answer 48

- Minimize contact with tooth - Minimize application time - Before cementation clean the tooth with pumice and consider use of desensitizer