1

CONTENT
 Definition
 Types of retraction
 Various phases of gingival displacement
 Need for gingival retraction
 Indication
 Criteria
 Methods of gingival management(Classification)
1) Mechanical
2)Chemico-mechanical
3)Rotary curettage
4)Electro-surgery
5)Surgical method
6)Newer retraction methods
 Conclusion
 References
2
 DEFINITION
Gingival retraction or displacement is the
deflection of the marginal gingiva away
from the tooth. ‘tissue dilation’
Glossary of Prosthodontic Terms

3
 TYPES OF RETRACTION
 LATERAL:
Displaces the tissue so that adequate bulk of the impression
material can be interfaced with the prepared tooth.

 APICAL/VERTICAL:
Exposes the uncut portion of the tooth apical to the finish
line. May cause trauma of the gingival tissues followed by
recession.

4
“RETRACTION” is the downward and outward
movement of the free gingival margin

“RELAPSE” is the tendency of the gingival cuff to go

back to its original position.

“DISPLACEMENT” is a downward movement of the

gingival cuff that is caused by heavy-consistency
impression material bearing down on unsupported
retracted gingival tissues.

“COLLAPSE” is the tendency of the gingival cuff to

flatten under forces associated with the use of closely
adapted customized impression trays

Gingival Retraction Techniques for Implants vs Teeth.

5 Bennani V, Schwass D, Chandler N. J Am Dent Assoc.2008;139:1354-63.
 VARIOUS PHASES IN GINGIVAL DISPLACEMENT
During tooth preparation (Preparatory phase ) :-
 plans the position of the cervical finish line in relation to the gingiva
prior to tooth preparation to give a clear view of the cervical area

During impression making ( working phase ) :-

 Displaces the gingiva apically and laterally to provide space for the
impression material to flow and record details.

Maintenance phase :- ( During Cementation of Restoration )

 Gingiva adjacent to the finish line must be displaced prior to
cementation to evaluate marginal fit and also to remove excess
cement after cementation

6
 NEED FOR GINGIVAL
RETRACTION
 Contour of the future restoration

 Patient’s comfort

 Efficiency of impression material

 Operators access and visibility

7
 INDICATIONS

 Sub-gingival Extensions Of Margins

 Control Of Gingival Hemorrhage Or Fluid Flow
 Increase length of clinical crowns
 Enhancing Restoration
 Recording Preparation Margins During Impressions
 Removal Of Gingival Overgrowth

8
CRITERIA FOR SELECTION OF A GINGIVAL
RETRACTION MATERIAL
3 criteria that must be satisfied by a gingival retraction material:

- Effective in gingival retraction and to achieve hemostasis if necessary.

- There should be absence of systemic effects

- No irreversible damage to gingival tissues with the material selected.

Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

9
 METHODS OF GINGIVAL
MANAGEMENT

1)Mechanical 1)Mechanical
2)Mechanical‐Chemical 2)Chemico‐Mechanical
1) Physico‐mechanical
3)Surgical 3)Rotary curettage
2) Chemical
-Electrosurgery 4)Electrosurgery
3) Electrosurgical
-Gingettage
4) Surgical

10
 I. MECHANICAL METHODS
-Wooden wedges
-Rolled cotton twills
-Copper band
-Rubber dam
-Oversized temporary
-Gingival retraction cords

11
  Advantage
- Inexpensive
 Disadvantages
• Rapid collapse of sulcus after removal
• Trauma to epithelial attachment
• No hemostasis
• Time- consuming
• Risk of sulcus contamination
• Painful

12
 MECHANICAL METHODS
1)WOODEN WEDGES:
Mechanically depresses the interproximal gingiva

Retraction
TYPES OF WEDGES:
-Wooden wedges
1. Triangular
2. Round
-Plastic wedges

13
 MECHANICAL METHODS
2) ROLLED COTTON TWILLS:
Cotton is rolled into twills the size of dental floss.

Absorbs gingival fluids and causes eversion of gingiva.

It is indicated in cases not requiring rubber dam.

It is used when eversion needed is modest and for a short time.

14
 MECHANICAL METHODS
3) COPPER BAND/ TUBE:
Acts as a means of carrying the
impression material and a mechanism
for gingival retraction.
VARIOUS IMPRESSION MATERIALS USED:
Impression compound, elastomeric
material, Gutta-percha or
auto polymerizing resin.
DISADVANTAGES:
•Incisional injuries to the gingival tissues
•Excess pressure tends to stripple the
tissue from the tooth
ADVANTAGE:
•Good method to confirm gingival margins
e.g. in multiple abutments
15
 MECHANICAL METHODS
4) RUBBER DAM:
 introduced by S. C. Barnum (1864)
 used when a limited number of teeth in one quadrant
have been prepared.
Limitations :
•Should not be used with polyvinyl siloxane
impression material, because the rubber dam
will inhibit its polymerization.
•Cannot be used to record subgingival
preparation and full arch models cannot be
made
16
 MECHANICAL METHODS
5)TEMPORARY CROWN FILLED WITH THERMOPLASTIC
MATERIAL:
1. Correct size is selected, trimmed to confirm to the gingival
contour and the margins are smoothened.
2. Fill it with compound. Under occlusal pressure it is forced into
the predetermined position.
3. The excess material from gingival end will displace the free
gingiva.
4. The excess material is trimmed without excessive pressure
(blanching).
5. Cement it with temporary cement for 24 hours
6. Final impression made in the next appointment

17
 MECHANICAL METHODS
6) GINGIVAL RETRACTION CORDS:
It physically pushes the gingiva away from the finish line. Its
effectiveness is limited because pressure alone will not control
sulcular hemorrhage
Diameter
• SMALL- to be used in anterior teeth, where
thin firmly tissue is present
• MEDIUM- indicated where greater bulk is
encountered e.g. posterior teeth
• LARGE- should be used with caution as can
produce soft tissue trauma
18
 Classification of cords
Depending on the configuration
 Plain
 Twisted
 Braided or Knitted Twisted cord
Depending on the surface finish
 Waxed
 Unwaxed
Depending on the chemical treatment Knitted cord
 Non-impregnated
 Impregnated

19
Braided cord
II. CHEMICO-MECHANICAL METHOD
-INTRODUCTION
-MATERIALS USED TO CARRY CHEMICAL
-DESIRABLE QUALITIES OF CORD
-TIME OF PLACEMENT
-CLASSIFICATION OF CHEMICAL USED
-CORD PACKING INSTRUMENT
-FORCE REQUIRED WHILE PLACING
-TECHNIQUES FOR CORD PLACEMENT

20
II. CHEMICO-MECHANICAL METHODS
INTRODUCTION:
The Mechanical aspect involves placement of a string into the
gingival sulcus to displace the tissues.

The Chemical aspect involves treatment of the string with one

or more number of chemical compounds that will induce
i) Temporary shrinkage of the tissues &
ii) Control the hemorrhage & fluid seepage

21
 Materials to carry chemicals
Cords
Drawn cotton rolls
Cotton pellets
1. RETRACTION CORDS
Used To Keep Chemicals In Contact With Tissue &
Confine Them To Application Site
TYPES OF RETRACTION CORD

MATERIAL DESIGN CHEMICAL

1) Braided 1)Impregnated
1) Cotton 2) Twisted 2)Non-
2) Synthetic 3) Woven impregnated
22
 DESIRABLE QUALITIES OF CORD
1)Dark Color To Maximize Contrast With Tissues,Tooth& Cord
2)Absorbent To Allow For Uptake Of Wet Medicament
3)Available In Different Diameters To Accommodate
Varying Morphologies Of Gingival Sulcus

CORD MAY BE SATURATED WITH SOLUTION

A) Prior To Insertion

B) Placed Dry, Solution Applied

C) Previously Impregnated By Manufacturer

23
 TIME OF PLACEMENT OF RETRACTION
CORDS
 Untreated string/cord is safe for placement for periods from
5-30 min, when bleeding and seepage not a problem.>30
mins, causes permanent soft tissue changes.
 •Strings saturated with chemicals are recommended for use
from 5 –10 min , <20 min.
 •After 30 min, impregnated cords caused injury to the
sulcular epithelium, these healed with in 10 days.

24
 CHEMICALS USED
CLASSIFICATION
Marzouk Thompson

25
 COMMONLY USED CHEMICALS
A)8%Racemic Epinephrine
B)Aluminium Chloride
C)Alum(Aluminium Potassium Sulphate)
D)Aluminium Sulphate
E)Ferric Sulphate

26
27
 EPINEPHRINE
 A catecholamine hormone secreted by the adrenal medulla
and a CNS neurotransmitter released by some neurons
 It appears to act primarily on the walls of small arterioles
and to a lesser degree on the walls of capillaries venules and
large arterioles
STRENGTHS USED
 Various Strengths Of RacemicEpinephrine Used In
Gingival Retraction – 2%, 4%, 8%,16% & 32%

 8 % Racemic Epinephrine ‐Most Commonly Used

( Donovan & Shaw Et Al)

28
 EPINEPHRINE
LOCAL EFFECT
Produces
 Hemostasis Transitory Gingival
 Local Vasoconstriction Shrinkage
SYSTEMIC EFFECTS

29
 EPINEPHRINE
1)CARDIOVASCULAR DISEASE
2)HYPERTENSION
3)DIABETES
CONTRAINDICATION 4)HYPERTHYROIDISM
5)EPINEPHRINE HYPERSENSTIVITY
6)PATIENTS ON RAUWOLFIA
COMPOUNDS OR RAUWOLFIA DRUGS

EPINEPHRINE SYNDROME
1)tachycardia These Effects May Appear After
2) Increased Blood Pressure Cord Has Been In Place For A Few
3) Nervousness Mins / Some Time After Removal Of
4) Anxiety Cord
5) Increased Respiration Also known as EPINEPHRINE
6) Post Operative Depression REACTION
30
 CORD PACKING INSTRUMENTS:
Fischer’s cord Packers

Serrated cord packer

Non-serrated cord packer

31
 CORD PACKING INSTRUMENTS:

Standard Packing
Circlet Packing Plain
Plain

Circlet Packing Standard Packing

Serrated Serrated
32
FORCE REQUIRED WHILE PLACING THE CORD
INTO THE GINGIVAL SULCUS
 Epithelial attachment resistance: 1 N/mm²
 Pressure exerted in periodontal probing: 1.31- 2.41N/mm²
 Pressure exerted to insert the cord: 2.5-5 N/mm²
 Hence for a marginal gingival opening of 0.5 mm in adults, a 0.1 N/mm² pressure is
required.

Barendregt DS. Van Der Velden U. Reiker L. Loos BG.

33 Journal of Clinical Periodontology 2001
 TECHNIQUES FOR GINGIVAL
DISPLACEMENT USING
RETRACTION CORDS
1. Single cord technique
2. Double cord technique
3. Infusion technique
4. The ‘every other tooth’ technique

34
1) SINGLE CORD TECHNIQUE
•Simplest & least traumatic technique

•Indication
- When gingival tissue are healthy & do not bleed.
- For making impressions for 1 to 3 prepared teeth.

Procedure :-
 Isolate the quadrant
 Suitable length / diameter of cord selected.
 Dip the cord in astringent solution and squeeze out the excess with gauze square

 Push cord between tooth & gingiva on mesial aspect

Continue packing on lingual, distal & buccal aspects.
 Leave 2 mm of cord in excess
 Kept in place for 10 min
35
Krammer et al;DCNA 2004
36
2) DOUBLE CORD TECHNIQUE
Indication
- impression of multiple teeth
- when tissue health is compromised.
- excess gingival fluid exudates.
- can be used routinely
Disadvantage - healing & re-attachment - unpredictable.

Procedure :
• 1st cord of small diameter is placed 0.5 mm
below finish line for 5 min;
• 2nd larger diameter impregnated cord is placed above
it for 8-10 mins for hemostasis.
• The 2nd cord is removed just before the impression is injected.
• 1st cord removed after temporization & cementation- to remove any
residual impression material in sulcus.

37 Krammer et al;DCNA 2004

38
39
3) INFUSION TECHNIQUE
 Effective ancillary technique for control of hemorrhage
when using the single cord technique
 2 concentrations of ferric sulfate
15% ( Astringedent)
20% ( Viscostat) preferred
Steps:
 After preparation of the margins,
hemorrhage is controlled Using a special
dental Infusor with Ferric sulfate
medicament 15% 0r 20%.
 The infusor is used with a burnishing
action, 360 deg. around the sulcus.
 Recommended time 1-3 mins.
 Cord is removed and impression made.
40
4)THE ‘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

Can be used with the single or double cord technique.

Retraction cord is placed around the most distal prepared
tooth.
No cord is placed around the prepared tooth mesial to this
tooth
Retraction Procedures Are Completed On Alternate Teeth
41
 2) DRAWN COTTON ROLLS
 Soft, loose cotton rolls can be readily rolled to a desired diameter to be
introduced into the sulcus.
 can accommodate more chemicals than cords.
Advantages:
 Because of its looseness, it can be compacted in the sulcus easier than the cords.
Disadvantages:
 Part of the coagulated surface layer may get deeply incorporated in cotton and
when the cotton is removed, the coagulated sealing membrane may be pulled
out initiating bleeding and fluid seepage called as “cotton roll burn”.

3) COTTON PELLET
These are used to carry the chemicals to the already compacted, inserted
cords or drawn cotton rolls.
If they are allowed to remain on top of the cord/cotton they provide a
continuous source of chemical.
42
 III. ROTARY CURETTAGE
-INTRODUCTION
-DISADVANTAGE
-CRITERIA
-TECHNIQUE
-COMPARISION OF EFFICACY & WOUND
HEALING OF ROTARY CURRETAGE WITH
CONVENTIONAL TECHNIQUES

43
 ROTARY GINGIVAL CURETTAGE
I N T RO D U C T I O N
 Also known as GINGITTAGE or troughing
 A technique of using rotary diamond instruments to enlarge the sulcus.
 It involves preparation of the tooth sub-gingivally while simultaneously
curetting the inner lining of the gingival sulcus.
 The goal is to eliminate the trauma from pressure packing and the need
for electrosurgical procedures
Disadvantage:
Uncontrolled procedure. Hence may cause overextention and
excessive bleeding.  Absence of bleeding from probing.
 Sulcus depth less than 3 mm.
Criteria for gingittage  Presence of adequate keratinized
44 gingiva.
 TECHNIQUE
Prior to rotary curettage , a shoulder finish line is
formed at the level of gingival crest using flat end
tapered diamond

Torpedo nosed diamond is used to extend finish line

apically(1/2–2/3o fsulcular depth) and convert it to
chamfer

A generous water spray is used while preparing finish

line and curetting adjacent gingiva . A cord is placed
in troughened sulcus for hemostasis .Cord is removed
after 4-8 min and sulcus irrigated throughly .
45
 COMPARISION OF EFFICACY & WOUND
HEALING OF ROTARY CURRETAGE WITH
CONVENTIONAL TECHNIQUES
KAMANSKY et al
Reported less change in gingival height with rotary curettage than
with lateral gingival displacement using retraction cord.

TUPAC & NEACY

Found no significant histologic differences between retraction cord
& Rotary curettage.

INGRAHAM et al
Reported slight differences in healing among rotary curettage,
pressure packing & electro-surgery at different time intervals.
46
 IV. ELECTROSURGERY
- Introduction
- Indication
- Contraindications
- Mechanism
- Surgical electrodes
- Type of current
- Type of action
- Technique
- Considerations
- Advantages & disadvantages
47
 ELECTROSURGERY
INTRODUCTION
•Also called ‘Troughing’ and ‘Gingival dilation’/surgical
diathermy.
HISTORY
1891- Arsonval and Telsa: found that high frequency oscillating can be
passed through the body without muscular response .
1924- William Clark: used dessication current for removal of carcinomatous
growths. He was known as father of American Electrosurgery.

•Produces controlled tissue

destruction to achieve a
surgical result
48
 INDICATIONS
1. Areas of inflammation and granulation
tissue around tooth.
2. In cases where it is impossible to retract
the gingiva.
3. To enlarge the sulcus and also to control
hemorrhage.
4. To remove irritated tissue that has
proliferated over the finish line.
5. Crown lenthening
6. Removal of edentulous cuff.

49
 CONTRAINDICATIONS
1. Patients with cardiac pace makers, TENS, Insulin pump.
2. Very fine marginal gingiva with little or no attached gingiva.
3. Presence of inflammable anesthetics or agents.
4. Delayed healing due to debilitating disease, radiation therapy.

50
 Electrosurgery unit : High frequency oscillator or radio
transmitter -uses either a vacuum tube or a transistor to
deliver high frequency electrical current of at least 1.0
MHZ .
MECHANISM

• Small cutting electrode produces high current

1 density

• Rapid temperature rise at point of tissue contact

2

• Cells directly adjacent to the electrode are

3 destroyed by temperature rise

51
 SURGICAL ELECTRODES
 An electrosurgical probe comprises of a shank and a cutting
edge.
 The shank may be either straight or j-shaped.
 Numerous cutting edge designs are available but the most
commonly used ones are:
A) COAGULATING
B) DIAMOND LOOP
C) ROUND LOOP
D) SMALL STRAIGHT
E) SMALL LOOP

52
TYPES OF CURRENT
Fully Rectified current (modulated)
 continuous flow of current

 good cutting characteristics

 enlargement of gingival sulcus

Fully Rectified current (filtered)

 continuous current wave

 excellent cutting characteristics

 less injury than modulated current

53
Partially rectified current (damped)
 Considerable tissue destruction

 Slow healing.

 Used for spot coagulation

Unrectified current (damped)

 Recurring peaks of current that rapidly diminish

 Causes intrinsic dehydration and necrosis

 Slow and painful healing

 Not used in dental surgery

54
 TYPE OF ACTION
1) Electrosection:
-Cutting current
-Bloodless with minimal tissue involvement
-Used for gingival troughing and planing tissues
2) Electrocoagulation:
-Creates Coagulation Of Tissues, Their Fluids & Oozed
Blood
- Effect Is Due To Thermal Energy Introduced
- If Overdone causes Carbonization.

55
 TYPE OF ACTION
3) Fulgeration :
- Deeper tissue involvement
- Always accompanied by carbonzation

4) Dessication:
- Massive Tissue Involvement
- Unlimited & Uncontrolled Action Of All
Fulgeration& Dessication–
Limited Use In Gingival Tissue Management

56
 TECHNIQUE
PLACE A DROP OF AROMATIC
OIL ON UPPER LIP

CHECK THE EQUIPMENT FOR ALL

CONNECTIONS

USE ELECTRODE WITH VERY LIGHT

PRESSURE & QUICK DEFT STROKES.
DO NOT PUSH THE ELECTRODE
THROUGH THE TISSUES

ENSURE SMOOTH PASSAGE OF ELECTRODE WITHOUT

DRAGGING OR CHARRING OF TISSUES

HIGH VOLUME PLASTIC VACUUM TIP & WOODEN

TONGUE DEPRESSOR
57 SHOULD BE USED TO PREVENT ANY BURNS.
 CONSIDERATIONS
 Profound soft tissue anaesthesia is mandatory.
 Ensure proper grounding of patient.
 Electrode should move at a speed > 7mm/sec-
To prevent lateral penetration of heat into tissues.
 Avoid using electrode on dessicated tissue.
 Cutting stroke should not be repeated within 5 sec.
 Electrode must be free of tissue fragments.
 Electrodes must not touch any metallic restoration.
 Electrosurgery is not suitable on thin attached gingiva.
(eg: labial tissue of maxillary canines)
 For restorative procedures an unmodulatedalternating current is
recommended.
 If electrode tip drags Instrument is at too low a setting.
 If sparking visible Instrument is at too high a setting.
 During grounding , Ensure that patient does not have metallic keys in pocket
58
 STAGES OF HEALING IN
ELECTROSURGICAL INCISION
 Latent period:- 0 to 18 hrs

 Epithelial migration and wound closture: 18 TO 48 HRS

 Epithelial maturation and connective tissue activity: 30 TO 48

HRS

59
 Adverse healing response
 Heat is generated in tissues adjacent to electrosurgical incision
 Alveolar bone is extremely sensitive to heat
 Greater injury occurred after heating to 530C for a minute
 Heating to 600C or more resulted in obvious bone tissue necrosis
 Theoretical upper limit 560C since alkaline phosphatase is known to denat
at this temperature.

Heat generated depends on

 Waveform of the electrical current
 Duration of current application
 Power of the active tip electrode
 Electrode size
 Depth of electrode penetration

60
 ADVANTAGES & DISADVANTAGES

61
 V. SURGICAL METHOD
 In other terms surgical means can be referred to as “GINGIVECTOMY”.
 Gingivectomy means exicision of the gingiva.
 Done by using a cold shape knife called the Kirkland knife or the Bald-
Parker blades No.–11 and 12 and a pair of scissors.
Indications
 Interfering or unneeded gingival tissue during any impression /
restorative procedures.
 In cases of gingival polyps seen in proximal caries.
 In a Class V restorative procedures.
 For crown lengthening during or cast restoration crown procedures.
 For apical repositioning of whole periodontal attaching apparatus to
create a healthy, safely manipulated, easily retractable free gingiva.

62
 VI. NEWER RETRACTION METHODS
A) Magic Foam Cord
B) Merocel
C) Expasyl
D) Lasers
E) Stayput
F) Gingitrac
G) Stat gel & Gel cord
H)Newer gingival retraction agents
63
 1) MAGIC FOAM CORD
 New non-haemostatic gingival retraction system.
 First expanding vinyl polysiloxane material designed for
retraction of the gingival sulcus without the potential
traumatic and time consuming packing of retraction cord.
 consists of foam and cartridges, mixing and intraoral tips,
comprecaps (3 sizes)
Mode of action
 Main mode of mechanism expansion of silicone foam.
 When comprecap is used to apply pressure the expansion of
magic foam cord occurs in the sulcus.

64
 Advantages
 not technique sensitive
 easy to use
 atraumatic
 rinsing not required
 efficient for multiple preparations

Disadvantages
 no hemostatic action.
Magic foam cord retraction system can be considered more effective gingival
retraction system among the stayput and expasyl retraction systems used in
the study.
Clinical Evaluation of Three New Gingival Retraction Systems: A Research Report
65 J Indian Prosthodont Soc. 2013 Mar; 13(1): 36–42.
 Technique

Initial situation

Prefit one comprecap per

crown preparation

Apply magic foam cord

66
 Technique
Let the patient bite on comrecap and
maintain pressure
• Remove after 5 minutes

Result is wide open sulcus

Comrecap after removal

67
 2) MEROCEL
 Marco Ferrari et al in 1996 found Merocel, a synthetic material
that is specifically chemically extracted by a biocompatible
polymer (hydroxylate polyvinyl acetate) that creates a net like
strip - Capable of atraumatic Gingival Retraction
 Used in strips of 2mm thickness that expand with absorption of
selected oral fluids

Mechanism of action
Merocel Strip expands by
absorbtion of oral fluids and exerts
pressure on surrounding tissue

68
 Method of application:
 Gingival retraction is carried out by inserting a 2 mm thick
Merocel retraction strip and provisional crown is inserted.
Patient is asked to maintain the pressure on artificial crown
and Merocel strip for 10-15 min.

Advantages :
 Easily shaped and adapted around tooth.
 Highly effective in absorption of oral fluids.
 Chemically pure and free from fragments and debris, hence
no post surgical complications.
 It is not abrasive and hence provides gentle displacement.
69
 3) EXPASYL
 Expasyl was introduced by Satelac Pierre Rolland.
 Chemo-mechanical Technique For Sulcus Opening (Gingival
Deflection) & Hemostasis.
Mechanism of action:
 Creates and maintains space in the sulcus due to optimal
characteristics of its viscosity which is mainly due to its
kaolin component.
 Achieve hemostasis due to aluminium chloride.
 Time taken for retraction is 2 minutes and sulcus widening
achieved is 0.5mm
70
 Equipment Consists Of:
• Capsules
• Injection Canulas
• Applicator
 Supplied In Syringe As Viscous Paste
 Expasyl Paste Is Injected Into Sulcus, Exerting A Stable, Non-
damaging Pressure Of 0.1 N/Mm.
Composition
1)Kaolin 66.75%
2)Water 23.36%
3)AlCl36.54%
4)Colorant 1.02%
5)Essential oil of lemon 0.33%
71
 Technique
Canula is pressed against the tooth and
angled till it comes in contact with sulcus
lining of the gingival edge

Marginal gingiva blanches as product is

injected into interproximal space

Dry and compact appearance

72
 Technique

Removal of product by
air and water spray

Keep suction close to

the expasyl for clean
removal
73
 Advantages:
 Safe minimal pressure required and no danger of rupturing
epithelial attachment.
 Minimal time and force needed compared with packing cord.
 Controls bleeding and crevicular seepage
Limitations:
 Paste's thickness makes it difficult for some evaluators to express
it into the sulcus.
 Metal dispenser tips are too large for interproximal areas

Precaution:
 Important to rinse thoroughly and verify that Expasyl is totally
removed from the sulcus as residue of the ingredient, aluminum
chloride, may inhibit set of polyether impression materials
74
 4) LASER
Confer minimal damage of collateral tissue through proper
consideration of the use of minimal laser energy of the correct
wavelength.
Types
 Erbium: Yttrium – Aluminum - Garnet (Er:YAG) Lasers
These minimally penetrate the soft tissues, so they are fairly safe
to use.
 CO2 lasers
The prime chromphore for CO2 laser is water, hence it reflects
off surfaces.CO2 lasers absorb little energy near tissue surfaces,
with only small temperature increases (<3ºC) and minimal
collateral damage. Also, these lasers do not alter the structure of
75
the tissues.
 4) LASER
 DIODE AND ND:YAG LASER
Channels laser through a fiber optic light bundle which
incises and cauterizes tissue simultaneously creating
haemostasisas well as a retracted field.

 PULSED ND:YAG LASER IRRADIATION.

Histological findings revealed that with the application of
PULSED ND:YAG LASER the gingival tissues showed faster
healing with less hemorrhage and less inflammatory reaction
in comparison with the Ferric sulphate (13.3%).

76
 LASER RETRACTION

 Compared with other retraction techniques, diode lasers with a wavelength of

980 nanometers and neodymium: yttrium-aluminum-garnet(Nd:YAG) lasers

with a wavelength of 1,064 nm are less aggressive, cause less bleeding and
result in less recession around natural teeth

77
 Advantages
 Reduced tissue shrinkage.
 Relatively Painless procedure
 Sterilizes sulcus
 Excellent hemostasis

Disadvantages
 Healing is delayed.
 Needs experience.

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 5) STAYPUT
 Fine Metal Filament reinforced displacement cord.
 Can be Impregnated/ Non-impregnated.
 When the stay – put cord is shaped, it remains in shape and does
not deform.
 It is a unique combination of softly braided retraction cord and
ultra fine copper filaments.
Advantages
1. Easily adapted.
2. Can be preformed
3. Does not unravel.
4. Non-impregnated, but can be
impregnated with an astringent or haemostatic solution as required.
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 6) GINGITRAC
 Gingitrac is a gingival retraction paste system that uses a preloaded
syringe to apply the paste around the margins.
 Paste contains aluminium sulphate as astringent, and if necessary, a
hemostatic agent can be applied prior to its use.
 For single tooth use, a cap is used to apply pressure for up to 5 minutes
after application of paste. The cap is first filled with the paste, and then
placed over the tooth and paste is syringed around the margins.
 For multiple tooth preparations, a plastic tray is first used with a firm
paste matrix over which the Gingitrac paste is syringed before the tray is
placed over the arch and held in position for 3-5 minutes.
 For both single and multiple tooth preparations, gingival retraction is
achieved through the application of pressure. The paste is removed prior
to impression taking.
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 2) Dispense GingiTrac
1) Make Matrix into the matrix

3) Bite down & wait 4)Ready for impression

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 7)STAT GEL & GEL CORD
 15% ferric sulphate  25% aluminium sulphate
 Aids in hemostasis & tissue gel
retraction  Aids in hemostasis &
tissue retraction

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 8) NEWER GINGIVAL RETRACTION
AGENTS
 Non-prescription nasal decongestants & eye washes show promise as
Gingival Retraction Agents

 - Tetrahydrazoline HCl 0.05% (visine)

- Oxymetazoline HCl 0.05% (afrin)
- Phenylephrine HCl 0.25% (neosynephrine)

 Visine and Afrin Produced -

Produced greater displacement than any other Agents(alum,
racemic epinephrine)
 Neosynephrine-
Is as effective as Epinephrine & Alum in widening the gingival sulcus.
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 CONCLUSION
Tissue displacement has become an integral procedure for the success of an
restorative procedure as it helps in maintaining the equilibrium between the
tissues and the restorations.Various techniques as described are equally
effective in dilating the tissues and it is the operator’s judgement to choose
the technique and material according to the clinical situation.

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 REFERENCE
 Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition
 Ferrari, Crysanti, Ercoli. Tissue Management With A new gingival Retraction Material: A
preliminary Clinical Report. J ProsthetDent 1996;75:242-247
 Gennaro, Landesman, Calhoun. A comparisionof gingival inflammation related to
retraction cords. J ProsthetDent 1982;47:384-386
 Benson, Bomberg, Hatch, Hoffman. Tissue displacement methods in fixed
prosthodontics. J ProsthetDent 1986;55:175-181
 Rajat R. Khajuria,1Vikas Sharma, 2 SunilV.Vadavadgi 3 Rishav Singh ADVANCEMENTS IN
TISSUE DISPLACEMENT- A REVIEW Annals of Dental Specialty Vol. 2; Issue 3. July –
Sept 2014 Pg 100-104
 Dr.Aruna kanaparthy, Dr. Rosaiah Kanaparthy MANAGEMENT OF GINGIVAL TISSUE
IN RESTORATIVE PROCEDURES. ejpmr, 2015,2(6), 73-78
 Krishna D. Prasad, Chethan Hegde, Gaurav Agrawal, Manoj Shetty.Gingival
displacement in prosthodontics: A critical review of existing methods Journal of
Interdisciplinary Dentistry / Jul-Dec 2011 / Vol-1 / Issue-2 Pg 80-87
 Rupali Kamath,Sarandha D.L,Gulab Chand Baid- Advances in Gingival Retraction ,
IJCDS • FEBRUARY, 2011 • 2(1) 2011 Int. Journal of Clinical Dental Science Pg 64-68
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 THANK YOU

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