GINGIVAL RETRACTION

[Anonymous]

METHODS OF GINGIVAL RETYRACTION:
1)Physicomechanical methods—-to be used only when gingiva is healthy,need minimal retraction, it displaces the gingiva laterally and apically from the tooth surface.

eg: rubber dam
wooden wedges
rolled cotton twills
retraction cords- braided, non-braided [sizes 000, 00 , 0 , 1 , 2 ,3]

2)Chemicomechanical methods—-Provides safe and prediatable gingival retraction.

eg:Vasoconstrictors
Astringents–alum,Al chloride, Fe sulphate, Tannic acid
Tissue coagulants–Zn chloride, Silver nitrate

STEPS TO BE FOLLOWED::
Keep operating area dry.Select the proper size of cord and cut a suitable length in order to surround the tooth entirely, circumferentially.
Soak the cord in Al chloride or Ferric sulphate.Place the cord into the gingival sulcus using a cord packer, blunt with serrations.Start gently pushing the cord at an axial angle of the tooth, next proceed to the lingual surface, packing it against the tooth surface.
Proceed till it overlaps the previous end.Leave the cord in place for 5-10 mins for adequate retraction.To avoid injury on removal, slightly moisten the cord.
Follow this with recording the impression.

3)Chemical methods
Provide minimal retraction
Use trichloroacetic acid for 1min that helps to achieve hemostasis.

The slightly more extensive methods of achieving retraction include
ROTARY CURETTAGE
SURGICAL METHODS
ELECTROSURGICAL METHODS—rapid ,atraumatic removal with bloodless cutting, sterilises the wound immediately, creates dry field as well as heals by primary intention.

LATEST METHODS::

1]LASERS
Advantages are -bloodless,painless incision, controlled tissue removal and rapid healing.
However it is slow and expensive.

2]RETRACTION BY DILATATION OF GINGIVAL SULCUS
This uses the gingifoam technique by using modified silicone elastomer available in base and catalyst paste.
After mixing the 2 pastes, a foam formation happens that leads to expansion of the gingival sulcus,, due to release of hydrogen gas.
Another method employs aluminium chloride paste with kaolin and water, which as a paste is inserted into the sulcus and leads to retraction

        

[drsushant]

Gingival bleeding during impression taking or crown cementation is a deal breaker. If the restorative process cannot be accomplished in a moisture-controlled environment, it will fail. The same situation arises during the restoration of deep Class IIs and Class Vs. In addition to the problem of hemorrhage, the continual flow of crevicular fluid also tends to disrupt dental procedures. Gingival hemostasis has long utilized various sulphur compounds, despite the complication that even trace amounts of this additive can interrupt the polymerization of the commonly used vinyl siloxane impression materials. Septodont has recently introduced Racegel, a thermally dynamic hemostatic agent that features faster control of bleeding, precise placement, and rapid cleanup. It also absorbs crevicular fluid, guaranteeing a dry peridental operating field. Racegel’s active ingredient is 25% aluminum chloride, a proven astringent that has no effect on impression materials. Its thermodynamic properties make it a liquid at room temperatures that applies easily to gingival surfaces; oral temperatures of 35°C increase its viscosity so that it stays in place until the impression sets. The thermal effect is completely reversed by rinsing with room temperature water. Racegel’s convenient prebent tip syringe makes it easy to dispense precisely and its bright orange color ensures that it is completely rinsed away prior to taking the impression without tissue discoloration or irritation. Racegel can be used in combination with a retraction cord, directly applied to both the single- and double-cord techniques, to make margins visible and readily accessible. It facilitates crown and bridge impressions and cementations, deep direct restorations, as well as periodontal scaling. Racegel makes hemostasis and crevicular fluid management much easier and far more predictable.
 

        

[drsushant]

 Tissue Management

Gingival retraction cords are used by most dentists, and are claimed by many dental laboratory technicians to be the most adequate of tissue management techniques (as observed in impressions from their dentists). The double-cord technique is the most reliable cord technique, since usually it reduces bleeding significantly more when compared to the previously taught one-cord procedure. Two popular and effective cord examples are Ultrapak (Ultradent Products) and Stay-Put (Roeko). The Stay-Put cord contains a small copper wire for stability, and it does stay in place most of the time. Both options are cost-effective and provide excellent choices for quick and easy tissue management.

Some dentists strongly prefer to avoid cords. Diode lasers have become increasingly popular in the past few years, primarily due to their decrease in cost. When used properly, they provide excellent hemostasis and can assist in tissue management for difficult situations. One of the most popular diode lasers has been the Odyssey Navigator (Ivoclar Vivadent). However, with the introduction of newer lasers at more affordable costs, other brands are becoming more popular. These include the cordless NV Microlaser (Discus Dental), the ezlase 940 (BIOLASE Technology), and the low-cost Picasso (AMD LASERS). A low-cost alternative to a diode laser technology is electrosurgery. One of the most popular electrosurgery units is the Sensimatic 700SE Electrosurg (Parkell).

Styptic-containing clay products have gained popularity and can provide great retraction, but at a higher cost per crown. Expasyl (Kerr) and Traxodent (Premier Dental Products) are very viable alternatives.

It is important to note that at this time, excellent tissue management is necessary for taking either conventional impressions or digital impressions. For some intraoral imaging systems, tissue management is even more essential, due to the longer amount of time required for scanning when compared to injecting conventional impression material. There are possibilities in the developmental stages that may change the concept in the near future, and tissue management may not be as important as it is currently.

        

[Author]

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