tissue management

  1. best management of tissues
    • -begin w/ healthy tissue
    • -don't traumatize the gingiva
    • -protect tissue by placing a cord in the sulcus when preparing a sub-gingival area
  2. when bleeding occurs..
    • -viscostat (15.5-20% ferric sulfate)
    • -injection of vasoconstrictor (anesthetic w/ epi 1:100,000 or 1:50,000)
    • -electro-cautery (for simple gingivoectomy)
    • -laser-cautery
  3. viscoStat
    • -provides hemostasis by occluding capillaries w/ coagulum
    • -applied by infusor
  4. cauterizing
    • electrosurgery units & lasers
    • -biological width must be maintained
    • -irregular healing may occur***
    • -better for posterior vs. anterior (according to Dr. Gay D)
  5. gingival retraction
    • -twisted retraction cord
    • -braided retraction cord
    • -knitted retraction cord

    -twisted rc: soft, absorbend cord of long fiber cotton, tightly wound to prevent unraveling & fraying during packing (we don't have this @ MUSoD)

    -braided rc: braided cotton cord strands will NOT separate, and packing instruments will NOT penetrate & seize the cord strands

    -knitted rc: compressible interlocking chains transport greater amounts of hemostatic agent to the sulcus. offering more predictable, effective hemostasis & tissue management
  6. gingival retraction: single cord technique
    • -for supragingival or slightly subgingival margins
    • -cord pushes gingiva apically & horizontally
    • -do NOT prep into the JE area; the JE where the cord will be located; prep margins are w/in the sulcus
    • -ideally 1 mm coronal to JE is where the margin should be
  7. gingival retraction: two cord technique
    • -complete supragingival preparation
    • -place one cord to fill 1/2 of the sulcus to retract tissue
    • -complete subgingival preparation
    • -place 2nd cord prior to impression
    • -healthy tissue: wait 5 minutes; if dense/fibrotic tissue: wait 7-10 minutes
    • -take out 2nd cord prior to impressing
  8. tissue management
    the proper handling of the gingival tissues to allow for optimal conditions for impressions & bonded restorations
  9. tissue requirements
    • -hard & soft tissues should be clean & dry
    • -no hemorrhaging
    • -horizontal retraction of gingival tissues to allow for adequate thickness of impression material
    • -vertical retraction to allow for visualization of the gingival margin
  10. tissue evaluation:
    evaluate for: inflammation, edematous margins, bleeding on probing, attachment loss

    treat by: prophy, s/rp, surgery
  11. treatment after perio therapy
    • prophy: 2 weeks
    • s/rp: 4-6 weeks
    • surgery: 6-8 weeks
    • surgery in the anterior esthetic zone: 8 weeks or more
Card Set
tissue management
tissue management