Soft Tissue Management

Question 1

What should be done before the crown prep

Answer 1

Assess the periodontal stats and give OHI

Should complete any periodontal treatment required ± surgery to ensure a healthy periodontium

Question 2

Why should we ensure that there is a healthy periodontium before the crown prep

Answer 2

• Untreated gingivitis creates swollen, inflamed and loose gingival tissues
• Can create difficulties when assessing and preparing the finish line you want, obtaining moisture control, reproducing the finish lines in the impression
• Can result in suboptimal marginal crown fit and increase risk of further perio deterioration and caries

Question 3

Why are sub-gingival preparations risky when doing a crown prep

Answer 3

• Difficult to do and risks marginal leakage
• Risks encroaching on the biological width leading to persistent gingival inflammation, alveolar bone loss and gingival recession

Question 4

What can dictate more apically placed margins in crown prep

Answer 4

• Deep extensive restorations or short clinical crown height

Question 5

What can be done if more apically placed margins are indicated in crown prep

Answer 5

Surgical crown lengthening should be considered

Question 6

When is soft tissue management required in the impression stage of crown preps

Answer 6

If some or all of the preparation finish line are at or are sub-gingival

Question 7

Why is gingival retraction (soft tissue management) needed for sub gingival preparations in the impression stage

Answer 7

• To prevent bleeding
• to act as a physical barrier and retract the gingival tissues?
• Allows an accurate impression of the preparation margins

Question 8

What is the aim of the plain retraction cord method of soft tissue retraction

Answer 8

Sulcus enlargement to physically displace the gingivae away from the finish line

Question 9

What is a disadvantage of the plain retraction cord method of soft tissue retraction

Answer 9

Sulcular haemorrhage (this method is quite shit)

Question 10

Why can sulcular haemorrhage be problematic in the crown procedure

Answer 10

leads to moisture control difficulty and poor impression accuracy (impression materials are hydrophobic)

Question 11

What is the aim of the copper band method of soft tissue retraction

Answer 11

To displace the gingivae and helps to carry the impression material to ensure the finish line is captured in the impression (this method is shit)

Question 12

What are the disadvantages of the copper band method of soft tissue retraction

Answer 12

• Traumatic
• Not effective
• Not accurate
  (method is shit)

Question 13

What is the impregnated retraction cord method of soft tissue retraction

Answer 13

• Retraction cord soaked in a chemical solution

- Then its the same as the plain retraction band method

Question 14

What is the aim of the impregnated retraction cord method of soft tissue retraction and what is the benefit of the chemical action

Answer 14

Aim = enlarge the sulcus

Chemical action = control sulcular haemorrhage creating a more accurate impression of the preparation margins

Question 15

What are the disadvantages of the impregnated retraction cord method of soft tissue retraction

Answer 15

• Systemic side effects
• Inflammation and tissue necrosis
• Staining

Question 16

What solutions are used in the impregnated retraction cord method of soft tissue retraction

Answer 16

• Ferric Sulphate 15%
• Alum AlK(SO4)3
• Aluminium sulfate

Question 17

What does the crown lengthening method of soft tissue retraction involve

Answer 17

Bone removal and gingival re-contouring

Question 18

What are the advantages of the crown lengthening method of soft tissue retraction

Answer 18

• Increases the crown height and retention
• create supra gingival margins
• Improves aesthetics

Question 19

What are the disadvantages of the crown lengthening method of soft tissue retraction

Answer 19

• Discomfort
• Finish line on root surface cementum (bonding issues)
• Furcation involvement (cleaning)
• Increased crown:root ration
• Need to allow time for healing

Question 20

What is the aim of the rotary curettage method of soft tissue retraction

Answer 20

The limited removal of the sulcular epithelium with rotary instruments while preparing the marginal finish line

Question 21

What is the advantage of the rotary curettage method of soft tissue retraction

Answer 21

quick

Question 22

What are the disadvantage of the rotary curettage method of soft tissue retraction

Answer 22

• Trauma and haemorrhage with poor healing
• Increased risk of periodontal destruction

This method is also shit and is rarely used

Question 23

What is the aim of the retraction paste method of soft tissue retraction

Answer 23

Gingival retraction pastes can be used to create space between the prepared tooth and the sulcus

Question 24

What are some of the properties of the retraction pastes used in soft tissue retraction

Answer 24

• Some are medicated e.g. with Aluminium Chloride

- Material is viscous and maintains rigidity, displacing the gingivae away from the tooth without causing trauma

Question 25

What is the method of retraction paste application

Answer 25

- Express the paste around the preparation, directly into the sulcus - Leave for 2 minutes, then wash away with water, dry the tooth and take the impression

Question 26

What are the advantages of the retraction paste method of soft tissue retraction

Answer 26

- Quicker and seems easier than using retraction cord with astringent

Question 27

What are the disadvantages of the retraction paste method of soft tissue retraction

Answer 27

- Can be technique sensitive with a suboptimal result

Question 28

Describe the process of applying the impregnated retraction cord in soft tissue retraction

Answer 28

- Obtain good moisture control - Choose appropriate size retraction cord and cut to rough length of tooth circumference - Place cord in dappens pout with astringent solution for 3 mins - Remove cord and place on tissue (tastes terrible) - Loop cord around tooth using flat plastic push cord into gingival crevice - Leave for about 4 mins, then wash well and remove cord - Rinse and dry sulcus and preparation - Syringe impression material into the sulcus and all the way around the tooth and take impression

Question 29

How do you obtain good moisture control in the impregnated retraction cord method

Answer 29

- Suction and salivary ejector | - Cotton wool rolls

Question 30

How long should you place the retraction cord in the astringent solution for at least

Answer 30

3 mins

Question 31

Why should you place the impregnated retraction cord onto a tissue after its been in the astringent solution

Answer 31

removes excess as it tastes horrible

Question 32

What is the difference between the impregnated retraction cord method where you take the cord out and the method where you leave it in

Answer 32

- After packing into the sulcus you should ensure that there is no excess cord left above the gingival margin so the impression material can cover the entire margin and just beyond it - Leave the retraction cord in the sulcus while taking the impression

Question 33

When can you remove the impregnated retraction cord in the method where you leave it in the sulcus

Answer 33

- Can come out when you remove the impression - If not you can leave it in situ whilst cementing the temp crown - When temp bond sets you can then remove the retraction cord and most of the excess temp cement will also come out with it

Question 34

Why might you want to choose the method of leaving the impregnated retraction cord in the sulcus

Answer 34

- Even though haemolytic agents are used, removal of the cord can cause trauma or remove the blood clot, causing haemorrhage and problems obtaining an accurate impression, this technique avoids this risk

Question 35

Describe the method for the 2 cord impregnated retraction cord method

Answer 35

- Two impregnated cords are packed into the sulcus - Smaller cord is placed first and remains in the sulcus during the impression stage - Larger cord is placed on top in the same stages as other methods

Question 36

What are the aims of the 2 impregnated cord method of soft tissue retraction

Answer 36

- the smaller cord reduces the risk of gingival cuff recoiling and displacing partially set impression material

Question 37

What are the disadvantages of the 2 impregnated cord method of soft tissue retraction

Answer 37

Increased inflammation and tissue damage

Question 38

What is the aim of the electrosurgery method of soft tissue retraction

Answer 38

- Controlled tissue destruction from a current flowing from a small cutting electrode that produces a high current and temperature at the point of contact with the tissue

Question 39

When is the electrosurgery method of soft tissue retraction used

Answer 39

- When the situation doesnt allow or isn't desirable to only use a retraction cord alone e.g. when the tissue has proliferated over the preparation finish lines - Widening of the gingival sulcus, coagulation, gingivectomy

Question 40

What are the contraindications for the electrosurgery method of soft tissue retraction

Answer 40

- Don't used with cardiac pacemakers (can interfere with their function) - Don't use with topical anaesthetics or flammable aerosols

Question 41

Describe the steps that are taken in the electrosurgery method of soft tissue retraction

Answer 41

- Ensure anaesthesia - Check unit, grounding, settings and connections - Good general moisture control - Practice strokes (unit off) - Turn on unit, use high volume suction and cut by applying light pressure in smooth sweeping strokes (7mm/sec) - Tip shouldn't be stationary at any point, don't drag the tissue - Clean debris on the tip (gauze) - careful of heat - Leave adequate time intervals between cutting strokes (10 seconds) to allow tissue to cool down or you risk necrosis of tissue and underlying alveolar bone - Give post op

Question 42

What needs to be avoided in the mouth when doing the electrosurgery method of soft tissue retraction

Answer 42

- Metal restorations - Metal instruments - Contact with bone