JOURNAL CLUB PRESENTATION

GINGIVAL RETRACTION TECHNIQUES -

A PRE REQUISITE IN FIXED PROSTHODONTICS: A REVIEW
Lylajam S and Prasanth V . Health Sciences 2012;1(3) 


Presented by-
[Link] Kaur
[Link]
Dept. of Prosthodontics
and Crown & Bridge
CONTENTS

◆ Introduction
◆ Need and importance of displacement
◆ Requirements of gingival retraction
◆ Types of displacement
◆ Classification
◆ Mechanical methods
◆ Chemico mechanical methods
◆ Surgical methods
◆ Recent advances
◆ Conclusion
◆ References
 INTRODUCTION

Gingival retraction or dilation is an important procedure in the

fabrication of fixed prostheses as the final Result is dependent on
health & level of surrounding gingival tissues .

The Key To Success Is Effective Soft Tissue Management & Goal Is

To Provide Healthy Gingival Tissues Covering Sound Smooth
Restorative Margins

GPT : Gingival retraction or displacement is the deflection of the

marginal gingiva away from the tooth.
 Need & Importance of Displacement

◆ Adequate access to the prepared tooth.

◆ Reproduction of the finish line.

◆ For accurate duplication of the sub gingival

margins.

◆ Precision of the restoration for prevention of

periodontal disease.
 Requirements of Gingival Retraction

◆ It should provide the maximum exposure of the

operating site.

◆ It should expose the finish line margins of the

preparation completely such that it allows the
recording the impression & provides marginal
integrity for the restoration.

◆ It should provide space for sufficient bulk of the

impression material so that impression does not
tear on its removal.

◆ It should permit completion of the preparation &

cementation of the restoration.
Types of Displacement

◆ LATERAL: Displaces the tissue so that

adequate bulk of impression material can be
interfaced with the prepared tooth.

◆ APICAL/ VERTICAL: Exposes the uncut portion

of the tooth apical to finish line & may cause
trauma to the gingival tissues followed by
recession.
 Methods of Gingival Retraction
MARZOUK
 TYLMAN
• Physio mechanical •Mechanical
• Chemical •Mechanical Chemical
• Electrosurgical •Surgical
• Surgical

SHILLINGBURG GILMORE
•Mechanical • Retraction cords
•Chemico-mechanical • Surgical
•Rotary curettage • Chemical
•Electrosurgical
 Mechanical Methods

◆ Mechanically displaces gingival tissues outwards &

apically away from the tooth surface.
◆ Indicated in cases where gingiva is normal & healthy
with adequate attached gingiva.
◆ Provides minimal gingival retraction

◆ 1) WOODEN WEDGES:
 2) RUBBER DAM

◆ In 1864, S C Barnum, Introduced

the rubber dam in dentistry.

• Dry Clean field

• Improved accessibility & visibility.
• Improves the properties of dental
materials
• Improves the operators efficiency.

• Time consuming & patient objection.

• Useful only when limited [Link] teeth in one
quadrant are being restored.
• Used in simple preparations with minimal sub
gingival preparations.
◆ 3) HIGH VOLUME VACCUM

◆ 4) SALIVA EJECTOR

◆ 5) TEMPORARY ACRYLIC RESIN COPING

◆ 6) SVEDOPTER:

DISADVANTAGES:
• Access to lingual surface of mandibular teeth
is limited.

• Since, it is metallic device care must be

taken to avoid injury to the floor of mouth.

• Presence of mandibular tori precludes its use.

7) COPPER BAND/TUBE
 ADVANTAGES:

Good method to confirm gingival margins

e.g. in multiple abutments

DISADVANTAGES:

• It can cause the injury to the

gingival tissues.

• Excess pressure tends to

stripple the tissue from the
tooth.
CHEMICO MECHANICAL METHODS

◆ The mechanical aspect involves placement of

a string into gingival sulcus to displace
tissues.

◆ The chemical aspect involves treatment of the

string with one or more [Link] chemical
compounds that cause
Temporary shrinkage of tissues.
Control the haemorrhage & fluid seepage.

e.g.: RETRACTION CORDS

 RETRACTION CORDS

◆ Retraction cords are used to keep chemicals in contact

with tissue & confine them to application site.

TYPES OF RETRACTION CORD

Cotton
Braided Coarse Impregnated
Synthetic
Twisted Fine
Woven Non Impregnated
 NON IMPREGNATED [Link]

◆ Plain cord which is used for sulcus

enlargement by physically pushing the
gingiva away from the finish line.

◆ Its effectiveness is limited bcoz the use of

pressure alone will not control the
sulcular hemorrhage.
CHEMICALLY IMPREGNATED CORDS

◆ THE CORDS ARE USED TO KEEP THE

CHEMICALS IN CONTACT WITH TISSUE
AND CONFINE THEM TO APPLICATION
SITE.

◆ BY COMBING THE CHEMICAL ACTON

WITH PRESSURE PACKING,
ENLARGEMENT OF GINGIVAL SULCUS
AS WELL AS FLUID CONTROL IS MORE
READILY ACCOMPLISHED.
 CHEMICALS USED ARE

A) 8% Racemic Epinephrine


B) Aluminium Chloride


C) Alum (Aluminium Potassium Sulphate )

D) Aluminium Sulphate


E) Ferric Sulphate
Techniques fo retraction cords.
SINGLE CORD TECHNIQUE

2
 5

6
 Double cord technique

Indications:
◆ Impression of multiple prepared teeth
◆ when tissue health is compromised.

TECHNIQUE:
First retraction of small diameter is placed in [Link]
which second retraction cord of larger diameter is placed
for 4 [Link] that the second cord is removed and
impressions are made with first [Link] in place.

ADVANTAGES:
•Reduces tendency of gingval cuff to recoil & displace the
impression material.
•It prevents tearing of gingval epithelium.
 Infusion Technique
Procedure

[Link] preparation of the

margins, hemorrhage is controlled
Using a special dental Infusor with
Ferric sulfate medicament 15% 0r
20%.
2. The infusor is used with a
burnishing Action, 360 deg.
Around the sulcus.
3. Recommended time 1-3 mins.
4. Cord is removed and
impression made.
 Every other tooth Technique

Indications:

1. Multiple anterior teeth impression, where any

damage to the gingival tissue will lead to recession. 


2. Teeth with root proximity- placing cords around

all the teeth simultaneously will cause
strangulation of the gingival papilla, leading to
unaesthetic black triangles .

 SURGICAL METHOD

ROTARY CURETTAGE

◆ It is also called as Gingettage or Troughing

technique in which the reduction of epithelium
within the sulcus is done to expose the finish
lines . It is only done on healthy gingival tissues.

DISADVANTAGES:

• It is technique sensitive.

• It can damage the periodontium.

 ELECTROSURGERY

In this method surgical reduction of sulcular epithelium is done

with an electrode to produce the gingival retraction.

It is also called as surgical diathermy.

INDICATIONS:


• Area of inflammation & granulation tissue around the tooth.

• In cases where it is impossible to retract gingiva.

• To enlarge the sulcus and to control hemorrhage.

• Crown lengthening.

CONTRAINDICATIONS:

Patients with the cardiac pacemakers

 RECENT ADVANCES
MAGIC FOAM

Crown preparation Apply Magic Foam Cord

prior to retraction

Pre-fit one Comprecap per

Remove after 5 minutes result is a wide open sulcus
crown preparation
 ADVANTAGES & DISADVANTAGES

ADVANTAGES:

• Not technique sensitive , flows

directly into the sulcus. DISADVANTAGES:

• Easy to use • No Hemostatic action

• Atraumatic

• Rising not required

• More efficient when used for multiple

preparations
 MEROCEL

Merocel retraction strips

Tooth is prepared
of about 2mm thick

Merocel strips are placed around

Pressure is maintained for
the tooth and provisional
10 mins by asking the pt
restoration is placed.
to bite over the cotton roll
 STAY PUT

Stay-put is so pliable
that it stays where you
put it. Stay-put is a
unique combination of
softly braided retraction
cord and an ultra fine
copper filament

Stay-put impregnated cord stops bleeding quickly

and effectively and does not need to be replaced.
It is quick, efficient and gives improved results.

 EXPASYL RETRACTION PASTE

Canula Is Pressed Against Tooth & Angled Until It Comes Into Contact
With The Sulcus Lining Of The Gingival Edge.
Expasyl is injected into the Left for 1-2 minutes
sulcus & marginal gingiva
blanches
 Removal of product by air & Keep suction close to
water spray Expasyl for clean removal.

After rinsing, Expasyl leaves sulcus open & dry & impressions are made

Expasyl 15% [Link] controls bleeding and crevicular seepage.

 LASERS

Laser is preferred for resection of the oral soft tissues and can be used
successfully without local anesthesia for gingival retraction prior to
impression making, particularly in the presence of hypertrophied tissue.


Method :
The tip of the fiber is kept in touch with the soft tissue and is moved in
the same way as a conventional scalpel. The laser technique is a little
slower than using a scalpel but produces a very controlled tissue removal
free of hemorrhage and pain. Healing is rapid and uneventful with
lasers.


Overuse of laser energy causes shrinkage of the tissue and unwanted
exposure of the crown margins
CONCLUSION

Transient displacement of the gingiva is an important

step in the impression procedure for the fabrication of
crowns and fixed partial denture. Several techniques
have been established for the retraction of the gingiva.
Each technique has its own advantages and
disadvantages. Recently, techniques have also been
developed for the retraction of gingiva without the use of
cords. Clinicians should choose material & technique
most suitable for the patient.
 REFERENCES

◆ Gingival tissue retraction - A Review.S Shujaulla

etal. JIDENT , Issue1, Vol 1, October 2012

◆ Advances in soft tissue management - A Review.P

Adhapure, J Bhandari, J shinde. International
Journal of Basic & Applied medical Sciences
2015(3), Vol 5 Sept - Dec

◆ Advances in tissue displacement - A review. R R

[Link] of Dental Specialty Vol. 2; Issue 3.
July – Sept 2014
◆ Gingival retraction methods for Fabrication of
Fixed Partial Dentures - A Literature Review.
Safari S etal .Journal of Dental Biomaterials.
2016;3(2)

◆ Tissue management & Gingival Retraction- A

Review of techniques. International Journal of
Dental 7 Applied Medical Research Vol 1,
Issue 3 Sept 2017