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The frequently erros which encounter the dentist during the tooth preparation can be observed in dental lab after pouring the model . These errors lead to inadequate reduction , which force the technians to fabricate inadequate restorations
5 undercuts creating on axial surface (mesio-distal and bucco-lingual surfaces) and lack of parallelism of abutments result : lead to difficult seating of restoration (no seating)
8 - SHARP ANGLES ON THE PREPARATION result : poorly crown fit - may provide potential fracture stimulation for all ceramic
crowns
Problem
What to Do
Problem
What to Do
Problem
What to Do
Problem
What to Do
Problem
What to Do
Indication
1- During preparation - For accurate position of finish line and its extention during reduction , to avoid injury of gingiva and its bleeding 2- During impression taking
- To expose the marginal finish line to obtain completely reproduction of this margins and to provide sufficient bulk of impression material at the margin to prevent its tear or distoration upon removal from the mouth or pouring in stone
- to provide a clear and dry field , free from blood or gingival fluid during impression taking
1- mechanical technique
2- chemical technique 3- mechano-chemical technique
- retraction cord
- orthodontic rubber band or waxed dental floss
The commonly and widely used for mechano-chemical technique is a retraction cord impregnated in chemicalis
Procedure
- prepared teeth are dried and isolated with cotton rolls - saliva evacuators are placed (saliva suction) - cut enough piece of cord length to encircle the tooth opproximately 5cm - cord is dipped in chemicalis (25% alumium chloride ALCL3 solution in a dappen dish . note there is in sale ready impregnated retraction cord as
- the retraction cord is looped around the tooth and held tightly with the thumb and forefinger
- the cord is packed (pushed) into gingival sulcus starting from the mesial surface then proceed to lingual or buccal and end at distal surface
- the cord can be paked with special blunt instrument like Fischer packing instrument or DE plastic instrument .
The instrument should be angled slightly towards the root to facilitate the subgingival placement of the cord . - excess cord is cut off near the distal surface - after 5 10 minutes , the cord should be removed slowly to avoid bleeding (the cord must be slightly moist before removal because removing dry cord from the sulcus can injure the epithelial lining of the gingiva ( note dry cord adhere to capillaris of epithelial gingiva)
- after cord removal , impression is taken (must be sure that the area is clean from bleeding )
Placing retraction cord Cord is placed with gingiva and retracted forming shoulder
Cord packer
2 technique by expa-syl
Excellent retraction. Physically displaces tissue for superb marginal access. Safe. Minimal pressure required. No danger of rupturing epithelial attachment. Significant timesaving. Places quickly. Comfortable. Much less time and force needed than with packing cord. Haemostatic. Controls bleeding and crevicular seepage.(from sulcus)
Chemical technique
Chemicalis are frequently used to enhance the retraction process and to control hemorrhage (bleeding) , and commonly used in combination with retaction cord . Experience has shown that are safe when the time of use not exceed 15minutes
Requirements for chemicalis used with gingival retraction cord
Chemicalis used in this technique 1- aluminum chloride (25% Alcl3 solution hemodont ) 2- alum solution (Aluminuim potassuim sulphate) ALK(So4)2 3- Ferric sulphate Fe42(So4)3 ( ultrapack- astringent ) 4- tannic Acid solution 5- Epinephrine 1/1000 (8% Racemic epinephrine ) Epinephrine is cause hemostasis and local constriction which results in temporary gingival shrinkage but , its contraindicated and not recommended to use on gingival tissue in patient with :- Cardiovascular disease (CVS) increased heart rate (tahycardia )
Electro-surgical technique
This technique accomplished by electrosurgical apparatus (units)