MOISTURE

Control in Conservative Dentistry

Moisture Control
Definition Sources Why Control Methods of control

Definition
Is the passive or active removal of most of the fluids or any form of liquid from the oral cavity This can local or systemic Done during Routine Conservative Procedures RCT and Crown and Bridge

Sources of Moisture
Saliva Tissue fluids Water from Hand pieces and three way syringe

Sources of Moisture
Bleeding Gingival margin trauma or inflammation Pathologies abscess/ Sinus tracts-Pus Irrigating solutionsNormal saline, Naocl2, H O Chlorhexidine

Why Control Moisture

Improve visibility Reduce contamination Patient safety and comfort Intimate contacts with materials

Improve visibility
Of working field especially cavity prep and inspection Be able to visualize margins and finish lines Visualization of exposures or near exposures Judgment of cavity depth Improve indirect vision dry mirror head

Reduce Contamination
Main reasons for control of moisture Vital pulp if traumatic exposure or caries exposures occurs during operative procedures During Pulpotomy and Pulpectomy(RCT) Surgical Endodontics

Reduce Contamination
Material and Procedural Contamination  Lining materials  Lining procedures  Luting Materials  Filling materials  Filling Procedure  Impression/impression taking

Patient safety and comfort

Avoid patient choking Burning/Trauma from Caustic Irrigating Solution Increase working efficiency and in time avoid patient need to spit all the time

Intimate Contacts with Materials

Certain material cannot hold wet cavity dycal/GIC/Composite Filling materials expand due moisture Amalgam

Method of Control of Moisture

Active removal Passive removal/Isolation The choice of method of use depends on; Tasks being performed Amount of fluid generated Use of water is available

ACTIVE REMOVAL
Preparation phase  Cavity prep  Access cavity in RCT  Crown and Bridge prep  Impression phase  Try In and cementation  Restoration phase

Vacuum Evacuators
High Volume suction Very useful during prep phase Using high water coolant generational of water Clear area of operation to increase efficiency and save on time

High volume suction

Clear visualization of working area Clear placement of margins Dental Assistant  Clear the area  Dry the mirror HVS are Excellent lip/check retractors Normally used in combination Saliva injectors slow speed

HVS
 Not useful for Impression taking  Try In and Cementations

Saliva Injectors
Different types  With tongue retractors  Some metal tips  Plastic disposable types/ removable tips different lengths short and long  Surgical aspirating

Indications
Lone operator All procedures routine and fixed prosthesis work As adjunct to high suction Effective in cementation and impression procedures

Tongue Retractor types

Very good for Isolation and evacuation in lower teeth Used to retract the tongue with the tongue deflector Very good lone operator and case intermittent assistant

Drawbacks
Not careful bruising soft tissue Cut into the palate if wrong size is used Limited working position

Passive removal
Isolation Rubber Dam Absorbents  Cotton rolls  Cotton pellets  Gauzes/ cellulose wafers  Sponges

Absorbents
Uses During oral examination Dying of cavities for inspection/cotton pellets Before and during lining procedures During filling procedures During impression taking During Try-In and Cementation

Rubber Dam
Most effective isolation device used in Conservative Dentistry Use of RD  Removal old restoration  Isolation  Aseptic tech  RCT prevent inhalation and swallowing

Rubber Dam -Uses

Tooth coloured restorative procedures Try-In and cementations Partial veneers Advantages Good Isolation and contrast Increase working efficiency/time Better patient control

Systemic
Drugs Antisialagogues  Used in excessive salivation  Patients who mechanical removal is ineffective Used sparing cause general drying

Tissue Management
Prevention- OHI/Motivation Curative- Perio management Gingival Retraction Aim  Reduce gingival bleeding  Right position of gingival relation to margin positioning

Aims
Minimizing gingival recession Making sure finish line are at or above crestal bone Are able to reproduce the finish line especially in crown and bridge work

Retraction
This done using retraction cords It is temporary exposure of gingival sulcus Retraction ; Two actions  Displacement of gingival tissues  Control of fluids/ tissue fluid and bleeding

Retraction Cords
Supplied different sizes, 0-3 Knitted or some are single Chemical 8% epinephrine to give local vasoconstriction and transitory gingival shrinkage Tucker

Use of retraction cords

In cavity preps cervical lesions In crown and bridge In impression taking Try-In and Cementations Gingival in growths into the cavity

Procedure of use
Cut adequate length of knitted cord Form a loop and soak with hemostat Tack it in using tucker starting from mesial lingual more distally Gently press the cord away from you To avoid pulling

Procedure Cont.
Mark sure the margins are clear and distinct Leave small piece at finish to facilitate removal Do not over pack to avoid tearing gingival attachment After restoration wet cord during removal to avoid damage epithelial lining

Double Retraction
Using two cords Done mainly in crown and bridge work To ensure production of Margins and accurate impression taking ONE cord is removed before taking the impression and one is left