Gingival tissue management
Contents :◼
INTRODUCTION
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DEFINITION
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GOALS
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INDICATIONS OF GINGIVAL RETRACTION
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TECHNIQUES OF GINGIVAL RETRACTION.
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SUMMARY
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CONCLUSION
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REFERENCES
Introduction
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Gingiva is retracted to obtain maximum exposure of
finish line and to atraumatically allow access for the
impression material beyond the abutment margin.
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To create space in order to provide sufficient thickness
of impression material in gingival sulcus region so that it
can better withstand the tearing forces encountered
during removal of impressions.
.
DEFINITION
Gingival displacement is defined as the deflection of
marginal gingiva away from the tooth.
(GPT 8)
GOALS
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Maintaining DRY CLEAN ENVIRONMENT.
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Improves ACCESS AND VISIBILITY.
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Improves the PROPERTIES OF DENTAL MATERIALS.
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PROTECTING the adjacent soft tissues.
TECHNIQUES OF GINGIVAL
RETRACTION
Classification
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Mechanical methods
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Chemical mechanical methods
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Surgical
Dent Clin N Am 48 (2004) 433–444
MECHANICAL METHODS
OF
GINGIVAL RETRACTION
MECHANICAL METHODS
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Mechanically displaces gingival tissues
outwards and apically away from the tooth
surface.
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Indicated in cases where gingiva is normal.
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Provides minimal gingival retraction.
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Copper band
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Retraction cord
COPPER BAND
COPPER BAND
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It is used to carry the impression material
as well as to displace the gingiva to
expose the finish line.
TECHNIQUE OF COPPER
BAND
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Copper band is a welded tube corresponding to
the size of the prepared tooth.
One end of the tube is trimmed to follow the
outline of the gingival finish line.
After positioning and contouring the prepared
tooth it is filled with modeling compound and the
impression is made.
DISADVANTAGE OF COPPER BAND
Causes injury to the gingival tissues
RETRACTION CORD
Gingival retraction cord.
- retracts gingival tissues and controls
GCF/small amounts of bleeding.
TYPES OF RETRACTION CORD
1) Cotton
2) Synthetic
1) Braided
2) Twisted
3) Woven
1) Coarse
2) Fine
1) Impregnated
2) Non-impregnated
Cord may be saturated with solution
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Prior to insertion.
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Placed dry, solution applied.
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Previously impregnated by manufacturer.
Desirable qualities of cord
◼
Dark color to maximize contrast with tissues and
tooth.
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Absorbent to allow for uptake of wet
medicament.
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Available in different diameters to accommodate
varying morphologies of gingival sulcus.
IDEAL REQUIREMENTS OF
CHEMICALS USED FOR GINGIVAL
RETRACTION CORDS
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Should produce effective gingival displacement and
haemostasis
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It should not produce any irreversible damage to gingiva
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It should not have any systemic side effects
CHEMICALS USED FOR GINGIVAL
RERACTION
They are generally local vasoconstrictors which produce
gingival shrinkage.
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8 % racemic epinephrine
Aluminium chloride(15-29%)
Alum(aluminium potassium sulphate) (100%)
Aluminium sulphate
Ferric sulphate (13-20%)
TECHNIQUE OF USING
RETRACTION CORD
◼
The cord can be
packed with a
special instrument
like Fischer
packing instrument
or a DE plastic
instrument .
CHEMICO-MECHANICAL
METHODS OF GINGIVAL
RETRACTION
Single cord
technique
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For making impression of multiple
prepared teeth
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When tissue health is compromised
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When procedure delay is not possible
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Small diameter cord is placed
Cut the ends… so that they can exactly abut
against each other
Cord is left in sulcus during impression making
If cord is short, it may impregnate in impression,
that cause difficulty in pouring and trimming of
the die
After careful preparation of cervical
margin
◼ Control hemorrhage using specially
designed dentoinfusor with the ferric
sulphate medicament
◼ 20% ferric sulphate is preferred
because it is less acidic
◼ Infuser is carried circumferentially
3600 around the sulcus
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Anterior tooth preperations cord placement may result is
strangulation of gingival papilla & eventually loss of
papilla
This creates unaesthetic black triangle in embrasure
area
Place the retraction cord at the most distal prepared
tooth
No cord is placed around the prepared tooth mesial to
this tooth
SURGICAL METHODS OF
RETRACTION
SURGICAL METHODS OF GINGIVAL
RETRACTION
Surgical methods are:
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GINGETTAGE
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ELECTROSURGERY
Rotary curettage
Gingettage
ROTARY CURETTAGE
(GINGETTAGE)
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It is a toughing technique , wherein a portion of the
epithelium within the sulcus is removed to expose the
finish line.
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It should be done only on the healthy gingival tissue
CRIETERIA TO BE FULLFILLED FOR
GINGETTAGE
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There should be no bleeding on probing
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The depth of the sulcus should be minimum of 3 mm
TECHNIQUE OF GINGETTAGE
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It is usually done simultaneously along with finish line
preparation
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Portion of sulcular epithelium is removed using a torpedo
diamond bur.
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To improve tactile sense headpiece is run very slowly
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Abundant water should be sprayed during the procedure
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A retraction cord is impregnated with AlCl3 can be used
to control bleeding
ELECTROSURGICAL
RETRACTION
ELECTROSURGICAL RETRACTION
◼
It is the surgical retraction of the
sulcular epithelium using an
electrode to produce gingival
retraction
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The procedure is called surgical
diathermy.
SURGICAL ELECTRODE or THE CUTTING
ELECTRODE
 It
is like a probe and produces intense heat during
surgical procedures Current flows from a small
cutting electrode that produces a high current
density and a rapid temperature rise at its point of
contact with the tissue
 The
cells directly adjacent to the electrode are
destroyed by this temperature increase
New materials
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Magic foam cord
Merocel
Expasyl
Laser
Magic foam cord
First Expanding VPS
Material Designed For
Easy & Fast Retraction Of
Sulcus Without Potentially
Traumatic Packing Or
Pressure.
Merocel
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Synthetic Material, Chemically Extracted From A Biocompatible Polymer (HydroxylatePolyvinyl Acetate) That
Creates A Net Like Strip -Capable Of Atraumatic
Gingival)
◼
Used In Strips Of 2mm Thickness That Expand With
absorption Of Selected Oral Fluids
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Commonly Used In E.N.T, Gastric, Thoracic & Oto
neurosurgical Procedures
Expasyl
-
-
-
When homeostasis &
sulcus opening is
required
Has white clay (kaolin),
water, aluminum chloride
Paste is injected into
sulcus with pressure of
0.1N/nm.
Left in place for 1 min
Sulcus opening of 0.5mm
is obtained
Supplied in reusable
capsules, injection
canulas, applicator.
Use of LASERS for
retraction
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Laser is an acronym from
Light amplification by
stimulated emission of
radiation.
Laser systems are
composed of an active
medium, which may be a
solid (Nd:YAG laser and
Er:YAG laser)
or a gas (CO2 lasers).
Summary
◼
Gingival retraction holds an important place during soft tissue
management before an impression is made. Several problems that
can arise from poor marginal fit of fixed dental prostheses can be
prevented if the margins of prepared tooth are recorded after
adequate exposure by any of the mentioned gingival retraction
methods. The choice of technique and material depends on
operator's judgment of the clinical situation apart from availability
and cost of the materials.
References
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Fundamentals of Fixed Prosthodontics, third edn, Herbert T.
Shillinburg
Contemporary Fixed Prosthodontics, Rosenstiel
Clinical Periodontology, 10th edn, Carranza.
Art and Science of operative dentistry- Sturdevant 4th edition
Gingival displacement for impression making in fixed
prosthodontics DCNA 58(2014)45-68.
Gingival retraction techniques. Health sciences.2012;13
A comparison of gingival inflamation related to retraction cords.
J of orofacial science.2010(2)2.
Clinical trial of gingival retraction cords. JPD 1999;81:258-61.
DCNA 2004.
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Gingival retraction methods in fixed prosthodontics.J
Dent Sciences.vol3 issue 1
Gingival displacement in prosthodontics .a critical
review.
Krishna D, Chettan H. gingival displacement in
prosthodontics:A critical review. J interdispilinary
dentistry 2011;1(2):80-6.
Abdulaziz Malbaker. Gingival Retraction - Techniques
and Materials: A Review. Pakistan Oral & Dental
Journal December 2010;30,2: 545-51
Harold N. Tissue management in fixed Prosthodontics. J
Prosthet Dent 1974;31(6):628-36.
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Bowels WH, Tardy SJ. Evaluation of new gingival
retraction agent. J Dent Res 1991;70:1447-49
Weir DJ, Williams BH. Clinical effectiveness of
mechanochemical tissue displacement methods. J
Prosthet Dent 1984; 51:326-29
Shaw DH, Cohen DM. Retraction cords with aluminum
chloride: Effect on Gingiva. Oper Dent 1980;5:138-41.
GINGIVAL RETRACTION PASTES AND GELS
1. Expasyl gingival retraction
paste (Kerr corp.)
Viscous paste
Capsules,
applicator tips,
applicator g
Aluminum
chloride
2. Traxodent hemodent
paste(premier products
company)
Paste
syringe
medicated
3. Gingi trac (centrix)
Gel
Auto mix gun
delivery
Non medicated
4. Gingi trac singles(centrix)
Gel
syringe
Medicated and
astringent
included
5. Magic foam cord (coltene
whaledent)
PVS material
syringe
Not medicated