hello and welcome to chair side live I'm Megan strong and I'm will Schmitt registered dental
assistant here at gladwell dental and today you know what we're doing I have no idea I'm gonna
let you know we're continuing dr. Chi's series where he's addressing the common errors and
solutions when taking digital intraoral scams and this second installment he's talking about one of
the most important factors in getting an accurate scan and we all know what it is well why is your
control oh my goodness is this it's as if we work in the least ideal conditions something doctor
Chi today we'll talk about cord retraction tissue management of course blood and saliva management
and more importantly he's gonna do this on a live patient whilst getting the clutter let's
go dr. G taking impressions on patients is very very challenging and it's equally as challenging
with digital impressions because now you're taking images of the teeth the opposing and
there's a lot of soft tissue that move around and one of those critical aspects is how do
you create isolation keeping the soft tissue out of the way and moisture controlling moisture is
extremely important when it comes to getting an accurate impression with digital scans so we'll
review some tips on how to control the moisture keeping the soft tissue out of the way so that
you can achieve the most accurate skin let's take a look in this segment we're gonna discuss how to
control moisture on our patient during the skin in the lower posterior region it's one of the
most challenging areas to scan because there's a accumulation of saliva in that area and also
there's movable soft tissue that can really impact the accuracy and the efficiency at which we can
scan with our digital impressions system so what we're gonna do here is play some retraction aids
some isolation aids to control the moisture and allow us to accurately capture the prep area so
the first thing that we want to do before we take the scan is to use a saliva ejector or suction to
remove as much of the moisture as we can as much saliva and fluids as we can and then while the
area is a little more dry then we can place some isolation aids like cotton rolls or dry angles to
not only retract but to capture and absorb any fluids that might accumulate during the skin
process while those pieces are in we also want to air dry over the preparation the soft tissue and
the adjacent teeth we want to remove any saliva or fluids that might be sitting on the surface of
the teeth that could impact the accuracy of our digital impression so let's take a look at how
we're going to go through with these techniques to improve the accuracy and efficiency of our scan
sequence all right so our patient has had the cord place for about five minutes and now we're gonna
prepare the lower right quadrant for our skin the first thing that we're gonna do is saliva
ejector or suction as much fluids and saliva as we can I'll also use an air syringe to kind of blow
off any excess fluids over the adjacent teeth first I don't worry about the prep right now I
actually want the prep to remain hydrated the core to stay hydrated so there's less of a risk of any
bleeding during the removal so we'll dry off the adjacent teeth while suctioning excess fluids and
then we're gonna place any of our isolation aids like cotton rolls or dry angles within
the lingual vestibule on the buccal vestibule to help absorb any fluids during the skin so
again the first thing we'll do usually during the the time the cord has been sitting there for that
retraction a lot of saliva accumulation can occur so we try to so live ejector suction as much as
we can and then I'll use the air syringe just over the adjacent teeth to push off any excess
fluids in those areas once that's done then we'll place a cotton roll within the lingual
vestibule so depending on the space usually one but sometimes you can get two in there and this
again will help with the absorption of any fluids and also it helps to retract the tongue kind of
keeping that out of the way because we do want to keep an eye on the soft tissues surrounding
the area we're scanning because that could interfere with the accuracy of our skin once
I place the cotton rolls on this lower quadrant I won't really worry about anything on the buccal
side on the cheek side so I'm just using a mirror to help retract this area and now I want to pull
the cord while it's still wet so I pull the cord very very slowly and while it's wet those are two
key aspects of the court removal at this point to help minimize any bleeding during the removal
or post removal once I remove the cord now I'll evaluate the preparation I want to ensure that
I have the retraction that I was aiming for with the cord placement and I also wants to remove any
excess fluid and moisture over the preparation so I start off on the top of the prep and then work
my way around the axial surfaces and now air dry within the sulcus we want to get rid of as much
fluids as we can at this point and of course if the patient has a lot of inflammation any
bleeding you want to get that under control first so if you notice any bleeding go ahead and use any
of your hemostatic agents like viscous stat or stringent apply that to the soft tissue in the
areas that are affected get that under control first if there's any bleeding whatsoever and that
is on to the preparation during the scan the scan accuracy has been affected so it's been decreased
so we do want to make sure that's under control in this case there's no bleeding so now again
I'll make sure the prep and also the adjacent teeth again are really dry because the more dry
the area is the better chance the scanner has of capturing that information so now we'll go ahead
and take our scan and if you have any excess lighting like your overhead light you do want
to turn that off or move it away if there's a lot of excess light it could also affect the way the
scanner captures the area so now I'll activate the camera over the preparation and in this case
with the eye taro element the first scan that we capture will be of the preparation some focus on
the prep and again the more dry the area is the easier the scanner will capture the sight
okay so in this case we've captured the preparation now we'll move on to our
quadrant scan so for the quadrant scan before the skin really before any scan I just evaluate
the area we can put a little bit of air over the preparation and adjacent teeth again because it
can be difficult as your focus there's so many things to focus on your positioning with the
camera the screen the monitor on the scanner to watch the way our digital model is developing so
we can sometimes lose track of what's happening over the prep whether there's fluids or bleeding
that's occurring so now for the quadrant scan I'll position over the last tooth and then I'll
work my way toward the mesial and maintaining a position over the occlusal so for all quadrant
situations for a single unit prep or multiple unit prep if we're just concerned with that
lower right area I like to scan from the last tooth to at least the cuspid or the canine once
I reach the canine tooth number 27 now I'll rotate to the lingual and now we'll capture
the lingual surfaces of the adjacent teeth first in this case and then begin working my way back
to the last tooth now i'll rotate to the buccal and on the buccal once i rotate to this area can
visualize the buccal surfaces of those teeth then I'll begin working my way toward the mesial as we
go toward the mesial the camera may have less of a chance of retracting the lower lip so you may
need to use either your finger or a mirror or some type of retraction aid to keep that
out of the way as we come closer to the front and what can also help is ask the patient to
close slightly close just a little bit and that way the soft tissues a little more movable so
you can maintain that rotation to the buccal and capture the areas that are critical to the success
your preparation and restorative situation but you can see the main things here we started off
with the suctioning of the excess saliva and then we dried off the adjacent teeth a little bit and
after that we place a couple cotton rows on the lingual vestibule that helps with the retraction
of the tongue and also the absorption of any fluids during the scan because if you don't
put those absorption aids the cotton rolls or even a dry angle there could be saliva that wool then
seep onto the adjacent teeth and prep during the scan and that could throw off the accuracy of your
digital impression that's how we go through the controlling of the moisture in a lower posterior
situation again suction dry making sure the area is dry and then go through your sequence making
sure nothing else goes on to the prep during the scan and then that way you can achieve an accurate
digital impression thank you so much for that dr. Qi and stay tuned for the next installment in this
series or dr. Qi will talk about acquiring proximal contact information sounds like a
good plan but hey if you missed the first episode you can always head over to chairside live.com to
catch up and get ready because we got more coming absolutely but for today we're all
wrapped up so thank you so much for watching we'll meet you right back here next time
you