Fluid Control Flashcards by Michael McMahan

Controlling water and saliva during tooth preparation
Too much water – you can’t see and patient is drowning
Too little water – you can heat tooth and cause pulpal necrosis

Fluid Control

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Saliva and crevicular fluid management is crucial for making a quality
impression and for proper cementation
-Soft tissue management, such as gingival displacement, is important for
the preparation, impression, and cementation.

Gingival Control

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Managed with lasers, Electrosurge, or a scalpel to re-contour the
gingiva as well as move or remove it from the operative environment.

Soft tissue management

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Uses for \_\_\_\_\_\_\_:
-Still the gold standard for isolation and 
moisture control
-Caries, O&R, removing old restorations
-Placing a Core
-During Post and Core procedures
-When tissue retraction is difficult 
(hypertrophied tissue or a pseudopocket)

Rubber Dam

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_______ can be used during
preparation and cementation of
Inlays and Onlays.

-provides necessary
isolation for resin cement
procedures.

-used during
preparation for Inlay/Onlay.
Then, it is removed to check
occlusion and clearance.

Rubber Dam

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Primary way to manage fluid during

preparations is with ________

high speed suction

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Isolates both Max and Mand at the same time.
Retracts tongue and cheek
Continually aspirates fluids and oral debris
Obturates throat – prevents aspiration of material
**Used in clinics at UMKC

Isovac and Isolite

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T/F: Medications can be used to reduce saliva (anti-sialagogues)

True

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-Decreases stomach acid and other secretions
including saliva
-Contraindicated in patients with heart disease /
glaucoma/ asthma

GI Anticholinergics (Robinul / Pro-Banthine)

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-Safer that anticholinergics but have side effects like
sedation, blurred vision, allergic reactions
-Caution for hypertensive patients.

Clonidine (anti-hypertensive drug)

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________ is critical in the preparation and

design process of a crown or bridge.

Periodontal health

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Poorly contoured restorations are responsible for 
\_\_\_\_\_\_\_ reactions:
-Roughness and porosity of materials
-Inaccessibility for patient OH
-Lack of patient OH
-Defective crown margins
-Invasion of biological width

inflammatory

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________ for two weeks prior to crown
preparation can be useful in more significant
inflammation situations.

Chlorhexidine 0.12%

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Crown Finish line ideally no deeper than _____ the depth of the sulcus.
-Usually ___-____mm sub gingival

half
the depth
0.5 – 1.0

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______ gingiva– More
susceptible to damage and
recession.

Thin, scalloped

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Rapid marginal recession may occur as
soon as __ weeks. (results in
unpredictable tissue levels).

2 weeks

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These all cause ______

Damage during tooth preparation
Over contoured provisional
Over contoured final crowns
Injury caused by cord packing
Poor OH resulting in inflammation

Poor gingival control causing inflammation

Tissue displacement must be _____.

gentle

Purpose of _______ –

To Displace the Gingiva for margin exposure
As a cutting guide during tooth preparation
Tissue protection during margin placement
Visualization of finish line
Displacement of gingival tissue for impression
When margin is at or below the gingival contour
For impression and die trimming
Control of crevicular fluids
water, saliva, blood

Tissue Retraction

Placement of \_\_\_\_\_\_ prior to 
preparation.
-Improves visibility
-Reduces tissue trauma
-Acts as a guide for margin placement

retraction cord

T/F: Most often, begin with a rough
preparation supragingival to start. Then
pack cord. Proceed to finalization of
preparation and margin.

True

_____ causes horizontal and vertical displacement of tissues to visualize the margin placement
Allows subgingival margins without significant damage to tissues
Can be left in place for final impression using 2 Cord technique
Aiming for no deeper than half the depth of the sulcus.

Cord

Tissue covering subgingival margins must be
retracted or displaced horizontally by _______:
-Provides space for enough impression
material to record this anatomy.
-Removes fluids and anatomy to accurately
record the crown margins.
-Helps arrests heme
-Aid in cleanliness and dryness prior to
impression.

Packing Cord:

_______ medicaments control crevicular fluids

and seepage

Hemostatic

``` Retraction Cord soaked in ______ Advantages: -Can be kind to tissues -Sulcus not overly harmed and left clean -No additional tissue loss Disadvantages: -Extra epinephrine systemically for patient. ```

Epinephrine

``` ______ are substances that cause constriction of soft tissues. They have a massive use in bleeding control in various dental procedures such as impression making in fixed prosthodontics, class V restorations and root surface restorations, etc. ```

Astringents

What astringent do we use?

Aluminum chloride

``` Advantages: -Moderate hemostasis and tissue shrinkage -Precipitates protein -Contracts blood vessels -Extracts fluid from tissues -Leaves sulcus clean -Sulcus not overly harmed -Does not inhibit PVS polymerization Disadvantages: -Nasty taste ```

Buffered aluminum chloride

``` Advantages: -Stypic (clotting agent) -Applied to cut tissue for best hemostasis Disadvantages: -Leaves a dark residue (esthetic issue) -Causes dentin discoloration (delayed) -don’t use with veneers or esthetic anterior cases. -Inhibits setting of PVS impression materials -leads to inaccurate impressions Dentin darkening ```

Ferric Sulfate (15%) Astringedent

Which astrigent is used for fixed prosthodontics?

Aluminum chloride

:Possible high acidity of gingival retraction fluids (GRFs) and the high affinity of iron for hard tooth tissues, resulting in an interaction with bacterial byproducts and precipitation of insoluble ferric sulfide in the porous demineralized dentin.

Dentin Darkening

Provide adequate thickness of impression material and access to the preparation margin. Reduces tears and distortions of impression material Sulcus is opened in a cone shape

Retraction cord

-Use of single cord for entire circumference -In deeper sulcus, a second cord could be used in select area -Remove all cords for impression -Best used in shallow sulcus

Single Cord Technique

_______ Technique -#000 or #00 pre-packed into sulcus. -Second cord placed over the top of existing cord -For impression, top cord is removed. Second cord (lower, smaller cord is left in place for the impression). -If smaller cord is picked up in impression, it is cut off prior to pouring up in stone -Remember – must remove first cord after impression and before patient goes home! Severe inflammation and pain can occur. -This technique is considered the gold standard for impression taking. All other techniques are compared to this.

Double Cord

Should local anesthetic used in tissue retraciton?

Yes: Patient comfort Aids in heme and salivary flow reduction

SHould you pack cord at a straight up and down angle?

No; 45 degree angle

Packing _____ starting point will keep cord in place3-5 minutes.

toward

Allow cord to sit and be isolated (dry and heme free) for how long?

3-5 minutes.

-Burns tissue away -Burnt tissue odor -Cauterizes (no bleeding after) -Tissues heal quickly -Predictability of final tissue contour or location is unpredictable -Inexpensive! (maybe $500 versus $5,000 for laser) -Easy to use

Electrosurge

Vaporizes tissue ”Cut” around the tooth is usually ragged Laser can be slow to cut. Best for fine detail work. If there is a lot of tissue to contour or remove, use Electrosurge. Hemorrhage is not a problem Tissue heals well Laser available in UMKC Clinic

Laser

Intentional use of a handpiece to remove excess gingiva Hemorage can be a problem here Tissues will heal, but may have some discomfort to patient Healing contour and levels is unpredictable Final impression not likely to happen same day. Patient will have to come back for assessment of healing results and of tooth preparation and impression.

Rotary