Managing the soft tissues

&
Bite Registration
Managing the soft tissues

So supra gingival margins are better

wherever possible
– Less risk of trauma from cutting / retraction
– Easier for impressions
– Healthier for gingival tissues
– Better for long term care
Supra or Sub-gingival margins

Easy Access Harder Very Difficult

Managing the soft tissues

There are two problems to trouble us:

Bleeding
Margin hidden under gums
 Controlling Bleeding
Direct blanching of the tissues with LA
– Very short action – 5 mins max
Direct use of heamostatic agent
– Adrenaline containing solutions, danger
of tachycardia!
– Metallic salts eg Aluminium chloride or
Ferric Sulphate are SAFER but are
acidic and will stain clothing!
Gentle packing with retraction chord,
usually impregnated with solution
Retraction Chord & Haemostat

Note: Sizes are colour coded

 Using Retraction Chord

Choose the right size

Small size, 00, 0 or 1 for fine pockets
Larger size, 2 or 3 for larger deeper ones
Single or Double chord technique

A single chord may

restart bleeding when it
is removed, just before
your imp!
A double chord
technique prevents that
Only second, larger
chord is removed
Smaller chord left in
pocket during imp
Retraction chord
Bite Registration – how the teeth meet

Common method:
Single sheet of evenly warmed wax in
centric occlusion
Alternatives recently used:
Silicone interocclusal record (Blu-Mousse)
 Bite registration with Silicone
Occlusion is unstable after bridge prep

Interocclusal
record