How to Manage Bleeding Tissue
The issue of inflamed tissue and bleeding is one of the most frustrating parts of making impressions in restorative dentistry. There are a number of different ways to manage this issue, such as, Ferrous Sulphate and Superoxol.
While these products will help minimize bleeding, the trouble with them is they tend to clot the bleeding rather than shutting down the blood supply to the entire area. However, there is one simple trick you can use to aid in making impressions a bit easier, and cleaner, which will enable you to move forward in your treatment.
When you have a lot of inflammation and bleeding to deal with in a particular patient, you can certainly use the products mentioned above, but getting to the root of the bleeding problem will help you work more efficiently. Effectively shutting down the blood supply to an area can be achieved by using the vasocontrictive properties of an anesthetic with epinephrine.
Using Lidocaine 1/100,000 or 1/50,000 with epinephrine has been found to significantly reduce the blood flow to the area you’re working in. What you want to do is infiltrate the entire site so that the tissue blanches white, signaling you that there is minimal blood flow to the area. Typically this is accomplished by infiltrating into the papilla from the facial and lingual.
Using this tip is the most reliable way to stop blood flow to a particular area. Ferrous Sulphate and Superoxol are great candidates, but their blood-inhibiting powers can get disrupted by even the smallest amount of tissue manipulation after use. Additionally they tend to leave clotting debris on the preparation, often on the margin. Using this vasoconstrictive technique will allow you to manipulate the tissue without posing any risk for the reoccurrence of constant hemorrhage.
I have been using the technique for years. Xylocaine 1:50,000 epi. I get the blanched tissue but have always wondered why it bleeds so much out of the needle injection site. I make it a point not to get the needle injection site near the margin of the crown prep. Anyone else notice this affect?
Hello Michael,
I have tried a number of techniques including the one mentioned in the article. For many years, I have been using Siltrax 7 retraction cord with epi dipped in Hemodent solution and then dried. I place the cord, trim the ends, and immediately rinse with water. After finishing the prep to the cord, I then place Gingi-Pak’s retraction cord as my second cord. I wait 5 minutes, remove the Gingi-Pak cord, and impress without the need to inject Lidocaine into the surrounding gingival tissues.