The topic of my most recent webinar on Dental XP is tissue management. The way we interact with the gingival tissue is a key ingredient in our restorative success. There are distinct aspects of tissue management all of which contribute to the overall result.
Pre-Restorative Tissue Health
Patients may present with generalized periodontal issues that require treatment prior to moving into the restorative phase or localized areas of gingival inflammation. Using a combination of mechanical therapy, which includes scaling and root planing and laser therapy, and adjunctive services including chlorhexidine varnish the goal is to work with tight, healthy gingival tissues. In addition we may need to provisionalize teeth or place temporary fillings in order to correct tooth contours and facilitate tissue health.
Restorative Tissue Management
The less we traumatize the tissue during the restorative phase, the more predictable the gingival outcome. I use a variety of techniques including pre-wedging, rubber dam placement and retraction cord to protect the gingival tissues and minimize damage during tooth preparation. My goal during for a final impression is flash if 1mm by 1mm, and this requires careful attention to the gingiva and creating space. A variety of techniques can help us obtain the results we are after including double cord retraction, laser troughing or a combination of the two.