Written by Dr. Trevor Morhaliek
Gingival hemostasis is critical for optimum longevity and aesthetics when seating your restorations. Without it, marginal leakage is likely, and could seriously compromise your case. Here are some tips on how to keep things under control.
- Hemostasis begins before you prep! Ensure your patient has great gingival health first. Have their teeth professionally cleaned. Encourage proper home care. When the tissues are healthy, gingival architecture can be more accurately controlled, allowing you to establish predictable margin placement at the prep visit.
- Establish a gingival health protocol for use with patients wearing provisional restorations. Be sure your patient understands how important it is to keep their gums healthy while wearing the provisionals. If the gums are swollen and bleeding at the seat visit, you may not be able to seat the case! Add a hydrogen peroxide regimen to their normal brushing habits.. Twice daily, have your patient use a micro-mop syringe filled with H2O2. Have them trace the gumline on all prepared teeth while slowly extruding the H2O2 solution. Then, use Butler’s Soft-Picks to push the solution under and through the gingival embrasures of the provisional restorations. This will really help keep the tissues healthy for a more successful seat visit.
- Assemble and prepare an arsenal of great hemostatic tools. No one technique nor material can manage every situation… I like to have the following on hand.. Superoxyl, Traxodent, hemostatic pellets, retraction cord, H2O2, and my diode laser nearby at every seat appointment. Use these to control any bleeding areas or “put out fires” as I like to call it. Have all of them readily available, and well organized. You don’t want to be running through the drawers and searching for things in a frenzy if things go a little sideways!
- Anticipate bleeding and control it before it starts! Immediately after removing the provisionals, apply H2O2 to all the prepared teeth using a microbrush. This will act as a preventative measure while giving you another chance to scour the preps for any residual resin that may prevent a fully seated fit of the restorations. Carefully use your diode laser to cauterize any threatening areas. After try-in, but before final bonding, consider using Traxodent gingival paste in the most troublesome areas. Again, don’t wait for it to bleed. Be proactive and attack these areas before moving on… Superoxyl works brilliantly on a tiny microbrush to ‘put out the fires’ as they pop up.
I hope these tips on gingival hemostasis help you deliver a more predictable, efficient and less stressful seat visit!
Dr. Trevor Morhaliek is a Program Director with Frontier Institute, the educational organization partnered with Frontier Dental Laboratories and Frontier Group. He is the owner of Simple Amazing Smiles in Kelowna, BC. Through his training at the Las Vegas Institute, the Millennium Institute, PTIFA and Frontier Institute, Dr. Morhaliek has developed a diverse skill-set in the fields of Aesthetic Dentistry and Facial Aesthetics. As a general practitioner with a passion for natural-looking dental restorative solutions, Dr. Morhaliek believes dental aesthetics are very important to patients and understands the link between a beautiful smile and self confidence. He has successfully created a unique “culture of care” within his practice that has had a positive impact on the lives of his patients and his team.