Avoiding and Treating Dental Complications

Best Practices in Dentistry
Wiley-Blackwell (Verlag)
  • erschienen am 29. April 2016
  • |
  • 256 Seiten
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
978-1-118-98804-6 (ISBN)
Complications from dental procedures are inevitable and encountered by all dental professionals. Avoiding and Treating Dental Complications: Best Practices in Dentistry is designed to address proper management of these situations in everyday practice.
* Covers a range of dental issues and complications found in daily practice
* Written by experts in each specialty
* Features tables and charts for quick information
* Includes clinical photographs and radiographs
1. Auflage
  • Englisch
  • Hoboken
  • |
  • USA
John Wiley & Sons
  • 19,57 MB
978-1-118-98804-6 (9781118988046)
1118988043 (1118988043)
weitere Ausgaben werden ermittelt
Deborah Termeie, DDS, is Clinical Instructor in Periodontics at the UCLA School of Dentistry and maintains an active private practice in Los Angeles. She is a Diplomate of the American Board of Periodontology. Dr. Termeie has written several peer-reviewed journal articles and is the author of the best-selling textbook Periodontal Review.
List of contributors, vi
Acknowledgments, viii
1 Best practices: Restorative complications, 1
2 Periodontal complications, 29
3 Endodontic complications, 50
4 Prosthodontics complications, 73
5 Oral surgery complications, 103
6 Complications of local anesthesia, sedation, and general anesthesia, 120
7 Implant complications, 144
8 Pediatric dentistry complications and challenges, 176
9 Orthodontic complications and the periodontal aspects related to clinical orthodontics, 202
Index, 237

Best practices: Restorative complications

Richard G. Stevenson III

Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA

Rubber dam challenges

Metal clamps damage tooth structure or porcelain surfaces of crowns

Prevention and management

The use of light cured provisional material can reduce the potential of metal rubber dam clamps to cause iatrogenic damage (Liebenberg, 1995). Prior to clamp placement, a small amount of composite based material may be added to the metal prongs of the clamp. Alternatively instead of metal clamps, the use of plastic rubber dam clamps is less likely to damage tooth structure or existing restorations (Madison, Jordan, and Krell, 1986).

Placing a matrix band on the same tooth as a rubber dam clamp

Prevention and management

One of the methods to solve this complication is to open the clamp with rubber dam forceps and then place the matrix under the prongs and then release the clamp on the band, securing it during the procedure. Another method is to use a sectional matrix secured with a wedge and compound, thus avoiding the clamp entirely.

Poor adaption of rubber dam to partially erupted teeth or a short clinical crown lacking a supragingival undercut is a common challenge leading to clamp instability

Prevention and management

Ford, Ford, and Rhodes (2004) advocate the use of the split dam technique along with a caulking agent to achieve an adequate seal. Morgan and Marshall (1990) recommend that a glass ionomer cement, like Fuji Plus, may be mixed according to the manufacturer's directions and loaded into a composite syringe. The material is syringed along the gingival margins of the tooth to be prepared to approximate normal tooth contours. A plastic instrument may be used to shape the material to create adequate facial and lingual undercuts. The material provides a circumferential surface against which the rubber dam may seal. After the procedure is completed, the glass ionomer/composite material may be removed with a large spoon excavator or curette.

Wakabayashi et al. (1986) recommend that a small amount of self-curing resin mixture be placed at the gingival margin on the reciprocal surfaces of the tooth and cured well, after which a standard clamp is set apical to the resin spots, as this will facilitate supragingival retention of a rubber dam clamp.

Class V cavity preparation and restoration complications

Lacerating gingival tissue and compromising periodontium due to poor gingival tissue management and isolation

Prevention and management

Isolation of class V cervical lesions for soft tissue displacement, moisture containment, and infection control can utilize several methods, including rubber dam isolation, placing retraction cord in the sulcus, minor gingival surgery using a radio-surgical laser, scalpel gingivectomy prior to rubber dam retainer placement, cotton roll/saliva ejector isolation, and the use of clear matrix systems for anatomical contour.

Rubber dams help prevent operative-site exposure to blood and crevicular and intraoral fluids. In order to isolate a class V lesion, the hole in the rubber dam for the tooth to be restored is positioned approximately 3?mm facial to the normal hole position, slightly larger in size, and with slightly more distance between the adjacent holes. After the dam is placed, a 212-type clamp is engaged on the lingual side of the tooth and rotated into position in the facial, while stretching the dam apically to reveal the lesion. The beak of the 212-type clamp should be positioned at approximately 1?mm apical to the anticipated preparation gingival margin of the cavity preparation. This usually requires stabilization of the retainer with thermoplastic impression compound. In apically extensive lesions, the beaks of the 212-type clamp may be modified by bending the lingal beak coronally (not apically) and rotating the 212-type clamp facially during placement, securing with one hand while the compound is added to the bow of one side until it is hard. The decision to bend the facial beak apically will lead to a more restricted access to the lesion and thus should be avoided. The teeth must be dry for the heated compound to be secure. After one side is placed, the compound is placed on the other side of the bow. A safe alternative way to use heated compound is to take the Monoject syringe and trim back the tip so you have a wider lumen. Then take green stick compound, break it up into smaller pieces, and place it into the Monoject syringe. Immerse the syringe in hot water. The compound melts and you can then inject the compound into the desired area. It is much easier and safer than messing with a flame chairside and is much easier to direct into the desired location, especially if you are using one hand, which you often are in this situation since you are using the other hand to maintain the position of the 212-type clamp. When the restoration had been completed, rubber dam forceps easily break the compound loose upon retainer removal.

A recent technique to isolate the gingival margin of class V lesions employs a paste (Expasyl, Kerr, or Traxodent, Premier) that provides reasonable gingival retraction and hemostasis. These pastes consist of an organic, clay material (kaolin), mixed with aluminum chloride as a hemostatic agent. It is thick and firm yet viscous enough to be placed into the gingival sulcus. The paste is injected directly into the sulcus from a preloaded syringe at a recommended rate of 2?mm/s, using even pressure. If necessary, this can be followed by gently tamping on the paste with a plastic instrument or cotton pellet to ensure the paste is fully established or secured into the sulcus. Once the material has been applied and absorbs moisture and hemostasis is achieved, the material should be isolated from additional moisture and saliva. The paste is left in the sulcus for 1-2?min if the tissue is thin or 3-4?min if the soft tissue is thicker. The paste should then be removed by gently rinsing, followed with drying the site, prior to restoration placement. If necessary, the process can be repeated without traumatizing the tissue. Gingival retraction will last for 4?min after the paste has been rinsed and removed from the site.

Contouring class V restorations in the gingival area

When the lesion extends subgingivally, care must be taken not to damage the cementum with rotary instruments. If the restoration is not appropriately contoured and polished, it may lead to gingival inflammation due to food/plaque traps, secondary decay, and early failure of the restoration.

Prevention and management

A technique for better contouring and polishing uses a standard mylar matrix, which has been previously cut to fit the tooth to facilitate the insertion of composite resin into the cavity. Cutting the matrix is not always required. The matrix is inserted into one side of the cavity and fixed in place with a wooden wedge. It is then carefully inserted into the gingival sulcus, involving the entire cervical wall of the cavity (Figure 1.1).

Figure 1.1 A technique for better contouring and polishing uses a standard mylar matrix.

The unattached side of the matrix is positioned by inserting another wedge into the opposite side of the cavity. A photocured gingival barrier (OpalDam, OpalDam Green, Top Dam/FGM, Joinville, Santa Catarina, Brazil) is injected around the mylar matrix to stabilize it. This procedure is not difficult to perform but has to be done with precision in order to form a large enough occlusal/incisal opening between the matrix and the tooth to allow the insertion of restorative material. This procedure also allows the necessary volume of restorative material to be inserted without any excess and adequate separation between the gingiva and tooth, forming an angle that provides an aperture, wide enough for the composite resin syringe tip insertion. Some authors recommend contouring of the gingival aspect of the matrix by stretching the middle gingival portion over the handle of an explorer to gain a shape consistent with the emergence angle on the cementoenamel junction of the tooth prior to securing the matrix against the tooth. Another option is the use of a metal matrix; however, due to the light barrier created by the metal, light curing must be completed in two or more steps, first curing the accessible portion, then removing the metal, and curing the deeper portion with the light applied directly to the exposed restorative material. Some authors think that it works better than the mylar matrix in terms of maintaining shape and stability. This option can be especially useful in situations with intrinsic anatomical difficulties, as in molar furcations. The plastic mylar matrix has a lower risk of damage to soft tissue during insertion into the gingival sulcus and better light transmission for curing and visualization of the preparation cavity (Perez, 2010).

Complications involving liners and bases

Inappropriate use and selection of liners and bases in different clinical situations

Prevention and...

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