CHAPTER 16: FLUID CONTROL AND SOFT TISSUE Svedopter

MANAGEMENT • For isolation and evacuation of the mandibular teeth,

• Saliva/water must be removed for patient’s comfort the metal saliva ejector with attached tongue
and safety and operator’s access and visibility. deflector is excellent
• Gingiva must be displaced to make a complete • Uses:
impression, preparation, and cementation of the ✓ can be used without cotton rolls during the
restoration. preparation phase
✓ used with the patient in a nearly upright
FLUID CONTROL position
• Removal of water in a greater degree of dryness using ✓ used without assistant
low-volume (saliva ejector) or high-volume vacuum • Disadvantages:
with proper isolation. ✓ limited access on lingual surface of
mandibular teeth
✓ care must be exercised to avoid bruising the
tender tissue in the floor of the mouth by
overzealously cinching down the clamp that
fits under the chin
✓ presence of mandibular tori usually precludes
its use.
• Use medium size only
Rubber dam
• Most effective of all isolation
• Uses:
✓ Old restorations removal
✓ Pulp exposure
✓ When a pin-retained amalgam or composite
resin core is required
✓ For inlays and onlays (if the occlusal reduction
is done before dam is placed)
• Disadvantages:
✓ When use with elastomeric material
▪ Dam must be lubricated
▪ Clamp must remove/avoided.
✓ SHOULD NOT be used with PVS material
▪ Rubber dam inhibits its
polymerization.
✓ More likely to produce more aggravation in
Full or partial crowns when used.
High-Volume Vacuum
• A high-volume suction tip is extremely useful during
the preparation phase and is most effectively used
with an assistant.
• Can be use as a lip retractor
• NOT practical during the impression or cementation
phases.

Saliva Ejector
• Placed in the corner of the mouth
• Uses:
✓ Can be used even without assistant
✓ Most useful with high vacuum
✓ Used alone for the maxillary arch for
impressions and cementations with cotton
roll
✓ Used in mandibular arch with cotton roll.
• Disadvantage:
✓ Tongue control and fluid removal may be less
than ideal
Antisialagogues
• For the patient who salivates excessively
• Glycopyrrolate (Robinul, Baxter)/ (Robinul, Shionogi
Pharma)
✓ anticholinergic medication
✓ treatment of peptic ulcers
• clonidine hydrochloride (Catapres, Boehringer
Ingelheim)
✓ antihypertensive agent
 Finish Line Exposure • Aluminum chloride [AlCl3 ], alum (aluminum
• gingiva is healthy and free from inflammation potassium sulfate) [AlK(SO4 )2 ], aluminum sulfate
• preparation finish line must be temporarily exposed [Al2 (SO4 )3 ], and ferric sulfate [Fe2 (SO4 )3 ] are also
to ensure reproduction of the entire preparation used for gingival retraction
• accomplished by 3 TECHNIQUES Technique:
1. Mechanical
2. Chemicomechanical
3. Surgical
a) Rotary Curettage
b) Electrosurgery
1. Mechanical
• Copper band or tube
✓ serve as a means of carrying the impression
material as well as a mechanism for displacing
the gingiva to ensure that the gingival finish
line is captured in the impression

✓ been used with

▪ impression compound
➢ die can be made of amalgam
or electroplated metal
▪ elastomeric materials.
➢ die can be formed of stone or
electroplated metal
✓ can cause incisional injuries of gingival tissues
✓ recession is minimal (0.1mm)-healthy;
(0.3mm) general
✓ useful for situations in which several teeth
have been prepared.
▪ capturing all of the finish lines in one
impression decreases as the number
of prepared teeth increases.
• Rubber dam
✓ Used for limited number of teeth
✓ Plain cotton cord was used for sulcus
enlargement
▪ will not control sulcular hemorrhage.

2. Chemicomechanical (retraction cord)

• combining chemical action with pressure packing
• sulcular width of at least 0.2 mm was required to
prevent distortion of the sulcular impression.
• racemic epinephrine
✓ most popular chemical for gingival retraction
✓ cord impregnated with 8% racemic
epinephrine was the most commonly used
means of producing gingival retraction
• 3 CRITERIA for a gingival retraction material
1. effectiveness in gingival displacement and
hemostasis
2. absence of irreversible damage to the gingiva,
and
3. minimal untoward systemic effects.
3. Surgical
A. Rotary curettage
• a “troughing” technique, the purpose of which is to
produce limited removal of epithelial tissue in the
sulcus while a chamfer finish line is being created in
tooth structure
• “gingetage” technique
✓ used with the subgingival placement of
restoration margins
• must be done only on healthy, inflammation-free
tissue to avoid the tissue shrinkage that occurs when
diseased tissue heals
• 3 FACTORS
1. absence of bleeding upon probing
2. sulcus depth less than 3.0 mm
3. presence of adequate keratinized gingiva

• Disadvantage:
✓ potential for destruction of periodontium

B. Electrosurgery
• recommended for enlargement of the gingival sulcus
and control of hemorrhage to facilitate impression
making
• cannot stop bleeding once it starts
• removal of irritated tissue that has proliferated over
preparation finish lines
• An electrosurgery unit
✓ high-frequency oscillator or radio transmitter
that uses either a vacuum tube or a transistor
to deliver a high-frequency electrical current
of at least 1.0 MHz (one million cycles per
second)
✓ generates heat
✓ called “surgical diarthermy”
 Grounding
• use of ground electrode for patient’s safety
• aka ground plate, indifferent plate, indifferent
electrode, neutral electrode, dispersive electrode,
passive electrode, or patient return

• electricity at high frequency will pass through a body

without producing a shock (pain or muscle spasm),
producing instead an increase in the internal
temperature of the tissue.
• Electrosurgery produces controlled tissue destruction
to achieve a surgical result.
• Current flows from a small cutting electrode that
produces a high current density and a rapid
temperature rise at its point of contact with the tissue • Grounding the chair is not an acceptable alternative
because it can cause patient’s burn
• ground be placed under the thigh rather than behind
the back

Types of current
1. Unrectified, Damped Current
• Oudin or Tesla current
• characterized by recurring peaks of power
that rapidly diminish Contraindications
• current produced by the old hyfurcator or • patients with cardiac pacemakers
spark gap generato • presence of flammable agents
• disadvantages: ✓ use of topical anesthetics such as
✓ gives rise to intense dehydration and ethylchloride and other flammable aerosols
necrosis
✓ coagulation, and healing is slow and Technique:
painful
✓ NOT USED

2. Partially Rectified, damped (Half-Wave Modulated)

• current produces a wave form with a
damping in the second half of each cycle
• disadvantages:
✓ lateral penetration of heat, with slow
healing occurring in deep tissues
✓ produces good coagulation and
hemostasis, but tissue destruction is
considerable

3. Fully Rectified (Full-Wave Modulated)

• A better current for enlargement of the
gingival sulcus
• produces a continuous flow of energy
• good, and there is some hemostasis

4. Fully Rectified, filtered (Filtered)

• current is a continuous wave that produces
excellent cutting
• produces less injury and tissue healing than
modulated
• disadvantage
✓ after 2 weeks, healing wound is bad
Proper technique with the cutting electrode can be summed Crown lengthening
up in three points: • Gingivectomy using a diamond electrode
1. Proper power setting
2. Quick passes with the electrode
3. Adequate time intervals between strokes

Gingival Sulcus Enlargement

• small, straight or J-shaped electrode is selected

• A whole tooth should be encompassed in four

separate motions—facial, mesial, lingual, and distal—
at a speed of no less than 7 mm per second
• If a second pass is necessary in any one area, 8 to 10
seconds should be allowed before that stroke is
repeated.

Lasers
• Light Amplification by Stimulated Emission of
Radiation
• nonionizing radiation
• were once bulky and expensive, become smaller and
less expensive.
• three areas may guide the dentist’s choice.
1. Wavelength
✓ shorter the wavelength, the better
the hemostasis,
✓ longer the wavelength, the cleaner
the incision
2. pulse characteristics
✓ for tissue cooling and less thermal
damage
3. maximum wattage
✓ Tough, fibrous connective tissue such
as a frenum requires more wattage
✓ Soft tissue – 1-2 watts
• Uses:
✓ Tooth whitening
✓ Periodontal treatment
Removal Of an Edentulous Cuff ✓ Caries treatment
• Remnant that forms into a roll or cuff that results in ✓ Incision, excision, vaporization, ablation, and
difficulty to fabricate a pontic with cleanable coagulation
embrasures and strong connectors ▪ Gingival troughing for crown
• By the use of large loop electrode with high power set impressions
▪ Gingivectomy
▪ Gingivoplasty
▪ Hemostasis
▪ Papillectomies
▪ Reduction of gingival hypertrophy
▪ Soft tissue crown lengthening
✓ Ortho and resto
✓ FPD
▪ Holmium-doped yttrium aluminum
garnet (Ho:YAG)
✓ Increase resistance to caries
• Disadvantage:
✓ could cause serious damage if used
improperly. The hazards include eye damage,
skin damage, and fire hazard.