FLUID

CONTROL &
SOFT TISSUE
MANAGEMENT
IN FPD
BY
VESTA ENID LYDIA.R
III BDS
CSICDSR
MADURAI
FIXED PARTIAL DENTURE
A partial denture
that is luted or
otherwise securely
retained to natural
teeth ,tooth roots
,and / or dental
implant abutments
that furnish
primary support for
abutments.
TOOTH PREPARATION
DE VANS PRINCIPLE
The perpetual preservation of
what remains is most important
than the meticulous replacement
of what is lost.
Care should be taken to prevent
excessive tooth preparation
There should be minimal
possible reduction done to
obtain required characteristics
REQUIRED CHARACTERS OF
PREPARED TOOTH

FINISH
LINE
FLUIDS OF ORAL CAVITY
Saliva

Gingival bleeding during tooth preparation

Sulcular fluid

Water from hand piece

OBJECTIVES OF FLUID CONTROL
& TISSUE MANAGEMENT
ISOLATION

RETRACTION

ACCESSIBILITY
ISOLATION OF
FLUIDS
HOW CAN V ACHIEVE
ISOLATION TO CONTROL
FLUIDS?

MECHANICAL
METHODS

CHEMICAL METHODS
MECHANICAL METHODS
OF FLUID CONTROL
a.Rubber dam

b.Suction devices
High volume vaccum
Saliva ejector
Svedopter
Y SHOULD V ISOLATE THE
OPERATIVE SITE?
To obtain a dry clean operating field
For easy access and visibility
To improve the properties of dental
materials
To protect the patient and the
operator
To improve the operating efficiency
RUBBER DAM
 USES OF RUBBER DAM
Isolation of 1 or
more teeth
Eliminates saliva
from operating field
Retracts soft
tissues
DISADVANTAGE OF RUBBER DAM
Difficult to
use while
preparing
tooth for
fixed partial
denture
SUCTION DEVICES
HIGH VOLUME VACCUM
SALIVA EJECTOR
SVEDOPTER
HIGH VOLUME
VACCUM
HIGH VOLUME VACUM
Helps in removing small debris
during crown preparaton

Good lip retractor

SALIVA EJECTOR
SALIVA EJECTOR
It is placed at the
corner of the
mouth opposite to
the quadrent to be
operated
SVEDOPTER
SVEDOPTER
It is used teeth for
isolating mandibular
teeth

It is a metal saliva

ejector attached
with a tongue
deflector
DISADVANTAGES OF
SVEDOPTER
Access to the lingual surface of
mandibular teeth is limited
Cant be used when mandibular tori
precludes its use
It may injure the soft tissues
CHEMICAL METHODS
OF FLUID CONTROL
ANTI-SIALOGOUGES
LOCAL ANASTHETICS
ANTI-SIALOGOGUES
CONTROLS SALIVARY FLOW
THEY ARE GIT ANTI-CHOLINERGICS
THAT INHIBIT THE ACTION OF
MYOEPITHELIAL CELLS IN SALIVARY
GLANDS,PRODUCING DRY MOUTH
COMMONLY USED ANTI-
SIALOGOGUES
Methantheline bromide (banthine) :50 mg 1 hour
before procedure

Propantheline bromide (pro-banthine) : 15 mg 1 hour

before procedure

Clonidine hydrochloride (antihypertensive) : 0.2 mg 1

hour befor procedure
RETRACTION OF
GINGIVAL TISSUE
Y DO VHAVE TO RETRACT
THE GIGIVAL TISSUES?
It is retracted to obtain maximum exposure of
finish line
Gingival retraction permits completetion of
the preparation and cementation of the
restoration and helps the operator to make a
complete impression of the preparation.
FINISH LINE EXPOSURE?
It is a line of
demarcation / or
The peripheral extension
of a tooth preparation / or
The planned junction of
two materials / or
The terminal portion of
prepared tooth
IMPORTANCE OF FINISH LINE
EXPOSURE
The gingival tissue must be healthy & free of
inflammation before cast restorations are fabricated
The finish line must be reproduced in the impression .the
marginal fit is very important in preventing recurrent
caries and gingival inflammation (marginal intergrity)
Hence the finish line should be temporarily exposed to
reproduce entire preparation
TECHNIQUES OF GINGIVAL
RETRACTION?
THEY ARE CLASSIFIED AS
Mechanical methods
Chemico mechanical
methods
surgical
MECHANICAL
METHODS OF
GINGIVAL
RETRACTION
Copper band
Retraction cord
Rubber dam
COPPER BAND
COPPER BAND
It is used to carry the impression as well as to displace the
gingiva to expose the finish line.
TECHNIQUE OF COPPER BAND
Copper band is a welded tube corresponding to the size
of the prepared tooth.
One end if the tube is trim to follow the outline of the
gingival finish line.
After poistioning and contouring the prepared tooth it is
filled with modelling compound and the impression is
made.

DISADVANTAGE OF COPPER BAND

Causes injury to the gingival tissues
RETRACTION CORD
RETRACTION CORD
Pressure packing the
retraction cord into
the gingival sulcus
provides gingival
sulcus.
Can be made with
absorbent material
like cotton
CHEMICO-
MECHANICAL
METHODS OF
GINGIVAL
RETRACTION
 
CHEMICO-MECHANICAL METHODS
OF GINGIVAL RETRACTION
 A chemical with pressure packing in an retraction cord

enlargement of gingival sulcus as well as control of fluids

seeping from gingival sulcus
CHEMICALS USED FOR GINGIVAL
RERACTION
They are generally local vasoconstrictors which produce
gingival shrinkage.
8 % racemic epinephrine
Aluminium chloride
Alum(aluminium potassium sulphate)
Alumminium sulphate
Ferric sulphate
IDEAL REQUIREMENTS OF
CHEMICALS USED FOR GINGIVAL
RETRACTION CORDS
Should produce effective gingival
displacement and haemostasis
It should not produce any irreversible damage
to gingival
It should not have any systemic side effects
CONTRAINDICATIONS OF
EPINEPHRINE
TECHNIQUE OF USING RETRACTION CORD

The cord can be

packed with a
special instrument
like fischer
packing
instrument or a
DE plastic
instrument IPPA
SURGICAL METHODS
OF RETRACTION
SURGICAL METHODS OF GINGIVAL
RETRACTION

Surgical method are

GINGETTAGE

ELECTROSURGERY
ROTTARY
CURETTAGE
(GINGETTAGE)
ROTARY CURETTAGE (GINGETTAGE)

It is a troughing technique , wherein a

portion of the epithelium within the sulcus
is removed to expose the finish line.
It should bedone only on the healthy
gingival tissue
CRIETERIA TO BE FULLFILLED FOR
GINGETTAGE

There should be no bleeding on

probing
The depth of the sulcus should
be minimum of 3 mm
TECHNIQUE OF GINGETTAGE

It is usually done simultaneously along with finish line

preparation
Portion of sulcular epithelium is removed using a torpedo
diamond bur.
To improve tactile sense handpiece is run very slowly
Abundant water should be sprayed during the procedure
A retraction cord is impregnated with AlCl 3 can be used
to control bleeding
DISADVANTAGES OF GINGETTAGE

Instrument has poor tactile sense so

this technique is very sensitive
It can potentially damage the
periodontium
ELECTROSURGICAL
RETRACTION
ELECTROSURGICAL RETRACTION
It is the surgical
retraction of the sulcular
epithelium using an
electrode to produce
gingival retraction
The procedure is called
surgical diathermy.
INDICATIONS OF ELECTOSURGICAL
RETRACTION
Areas of inflammation in gingival
tissue where the retraction cord
cannot be used
Gingival proliferation around the
prepared finish line
CONTRAINDICATIONS OF
ELECTOSURGICAL RETRACTION
Patients with cardiac pacemakers
Use of topical anesthesia such as
ethylchloride and other
inflammable aerosols should be
avoided when electrosurgery is to
be used.
SURGICAL ELECTRODE or THE CUTTING
ELECTRODE
It is like a probe and produces intense heat during surgical
procedures
Numerous cutting edge designs are available some of
them are
Coagulation loop
Diamond loop
Round loop
Small loop
USES OF ELECTROSURGICAL
UNIT
Gingival sulcus
enlargement
Crown lengthening
Removal of edentulous
cuff
TECHNIQUE FOR GINGIVAL SULCUS
ENLARGEMENT USING AN
ELECTROSURGICAL PROBE
Electode is positioned positioned parallel to the long axis
of the tooth
A small J shaped bur is used for the procedure
A whole of the tooth can be covered in 4 separate motions
namely facial,mesial,lingual and distal
Debris in the sulcus should be removed using cotton
pellets dipped in hydrogen peroxide
 TECHNIQUE FOR SURGICAL CROWN
LENGTHENING
It is done when the clinical
crown is shorter than the
anatomic crown
It is the removal of
hyperplastic gingival in
order to expose the clinical
crown
It is done using diamond
electrode
When there is excess wound
periodontal dressing is done.
TECHNIQUES OF REMOVAL OF
EDENTULOUS CUFF
Edentulous cuff is an remnant of
inter dental papilla
Which is seen in the proximal sides
of the edentulous space
It is removed by using an
electrosurgical unit
FINAL IMPRESSION
BITE REGISTRATION
The dentist may determine that an accurate
bite registration is necessary to establish the
proper occlusal relationship during mounting.

A bite registration can be made in many ways.

Some of the common methods use reinforced
bite registration wax, or dental stone mixed
with slurry water (water from model trimmer).
INTERIM (TEMPORARY CROWN) OR FPD
The last step in this appointment is that a temporary
crown or FPD must be made to cover and protect the
prepared tooth or teeth while the permanent prosthesis is
being fabricated.
Temporary crowns or FPD's can be constructed from
preformed acrylic resin and aluminum shells.
Plastic stints and alginate impressions can also be used
with self-curing acrylic resin to make an interim
prosthesis.
When the temporary is finished, a temporary cement such
as zinc oxide and eugenol is used to deliver the interim
CONCLUSION
BIBILOGRAPHY