tissue management

• -begin w/ healthy tissue
• -don't traumatize the gingiva
• -protect tissue by placing a cord in the sulcus when preparing a sub-gingival area

• -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

• -provides hemostasis by occluding capillaries w/ coagulum
• -applied by infusor

• electrosurgery units & lasers
• -biological width must be maintained
• -irregular healing may occur***
• -better for posterior vs. anterior (according to Dr. Gay D)

• -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

• -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

• -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

the proper handling of the gingival tissues to allow for optimal conditions for impressions & bonded restorations

• -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

evaluate for: inflammation, edematous margins, bleeding on probing, attachment loss

treat by: prophy, s/rp, surgery

• prophy: 2 weeks
• s/rp: 4-6 weeks
• surgery: 6-8 weeks
• surgery in the anterior esthetic zone: 8 weeks or more