Tissue displacement

Writing
by
Dr. Osama Fawzy
Head department of Crowns & bridges
 definition
It’s the process of pushing the gum tissue
away from the tooth surface temporary

Aim
better examination ,preparation and
accurate impression
 indications
1- during examination to detect the carious
lesion
2- during the preparation for positioning the
finishing line ,avoid the soft tissue injury
3-during the impression to exposé the
preparation and finishing line
4- during the cementation to make sure no
over hanging or open margin or ement
entrance
 requirements
1-Must create a proper space horizontally
2- create clean and dry filed free from blood
3- maintains the periodontal tissue healthy
Methods of tissue displacement
I Mechanical method
II- chemico-mechanical
III- surgical
 I- Mechanical methods
Duration ;24 h longer time gives permanent
recession
Ways of mechanical method
Ways of mechanical method 1-
Softened the gutta percha pack
with copper band
Indicated when inter proximal hypertrophy

Mechanism:
- When the gingival hypertrophy is confined to the
inter-proximal space.

- Zinc oxide & eugenol are mixed with a piece of

gauze & packed in the inter-proximal space.

- Gutta percha is softened & packed in the inter-

proximal space.
Mechanical Tissue dilation

A, Oversized copper band should be about 2.0

mm
wider than the mesiodistal width of the tooth.

B, The gingiva is trimmed & contoured inward to

allow the
band to just clear the preparation margin during
the impression procedure.
Copper band
with plug; vent
with a loop of
dental floss.
 Finish line exposure

The end of a copper band In a copper band

is trimmed to follow the impression, the band displaces
prepared F.L. the free gingiva
 2- temporary crown and gutta
percha
Indicated when gingival hypertrophy in
more than one surface

Trimmed the crown or copper band ,then

softening the gutta perch and replaced
over the tooth for 24 h
 3- Rubber dam
By making a hole in the rubber
Provide clean dry field
 4- orthodontic rubber
By pushing the orthodontic band in gingival
sulcus by blunt instrument and lifted 24 h
5- un waxed and waxed dental
floss
 II- Chemico-mechanical
Advantage
1- universal method
Duration 5- 10 minutes
 Ways of chemico-mechanical
It make by use chemically impagenated cord
Will push the gingiva mechanically, while the
chemical having the contraction and
anticoagulant action for bleeding
 technique
This technique achieved by cord treated with
1- epinephrine 1/1000
2-epinephrine 8%
This contraindicated for cardiac patient, other wise
epinephrine syndrome
- Tachycardia
- -increase blood pressure neurosis
- -post operative depression
3- aluminum chloride 2%-25%
Alum saturation 100%
5- ferric sulphate 13.3 %
6- tannic acid 20-100%
7-negatol solution 45 %
 ferric sulphate 13.3 %

Gauze pack in place. Ferric sulfate solution is applied to

the gingiva
with the tip of the special syringe.
A- cut piece of cord 2-inch

A 2-inch piece of
retraction
cord is cut.
B- piece of cord twisted to make it
small as possible

The cord is twisted to make it as tight & as small as possible.

C- looping the cord around the
tooth and held it firmly
C- blunt instrument used pushing
the cord under the free gingiva
D- excess cord is cut off at inter
proximal area
E- placing the distal area is
continue
placement the cord in the sulcus
 III- surgical methods
Indicated when
1- generalized gingival hyper trophy
2- increase length of the gingiva
 1- conventional surgical technique
Preformed by the scalpel
Make gingvectomy at the level of epithelium
attachment
 2- electro-surgery
It done by electrical - cattery , high
electrical frequency current pass through a
very small electrode thus generated heat,
finally cutting the tissue and gingival
Disadvantage.
Need experience
May result permanent recession
Delay healing
 Disadvantages.

Need experienced hands to avoid

destruction of the periodontium due
to over deepening of the sulcus
 Contraindications:

 Pts with pace maker.

 Pts with delayed healing e.g. under radiation therapy.
 Thin attached gingiva of the labial of upper canines.
 - If tissue drags  increase the current.
 - If sparking is visible  decrease current.
 - Hold the electrode // to the long axis of the teeth.
 - Irrigate with H2o.
 - Start with the labial surface, then the mesial &
 lingual, finally the distal surface with a speed
 7mm/sec.
 Electro surgical technique

Typical electrosurgical unit with

active electrode (A) & ground
electrode (B).

Electrosurgical electrode
enlarges the
gingival sulcus.

5 commonly used electrosurgical electrodes: A, coagulating;

B, diamond loop; C, round loop; D, small straight; E, small
loop.
 Electro surgery :

Electrosurgical current flow from the unit to the

active electrode (A) to the ground (G) back to the unit
 A small drop of strong scented oil is
placed on the upper lip to help mask
the unpleasant odor associated with
electrosurgery.

Electrodes must be completely seated

in the hand-piece (left). If bare metal
is left exposed any place but at the tip
(arrow), the patient or the operator
could be burned.
A, Small loop electrode. B, Electrode in position
beneath preparation margin. C, Subgingival
tissue trough 0.3 to 0.5 mm beneath margin
A, Straight wire electrode.
B, Varitip electrode
Facial surface enlargement

Buccolingual
view
illustrating the
use of AP 1.5
for tissue
dilation.
 Contra indication
1- Patient with pace maker
2- patient with delayed healing
(under radiation)
3- thin attached gingiva
 3- rotary or gingettage
It’s a troughing technique using a rotary instrument

Defined as; limited removal of inner epithelial tissue in the

sulcus while creating a chamfer finishing line using a
torpedo stone
Done on healthy and inflamed gingiva

Technique
The finishing line created at the rest of gingiva then the
torpedo stone with water spray use wd to extend the
finishing line underneath the gingival sulcus
A- rotary curettage at the level of
gingival crest

Gingatage diamond refining margin

& removing inner sulcur epithelium
B- torpedo stone forms the chamfer
finishing line and removing the
tissue
C- cord placed sulcus for
hemostasis
 4- laser gingival displacement
Removal of epithelial tissue using laser
Advantage
- Faster
- More efficient
- -painless
- More sterile
- Bloodless,
- Less post operative pain
 A crown preparation with mesial
margin level with the gingival margin
Retraction by blowing air cervicaly
 Retraction by adrenaline-
impregnated braided cord
An instrument designed to insert
gingival retraction cord
The instrument in use
 Thank you
for attention