Sources of fluids while working in the oral cavity and their management for a better result describing gingival retraction in detail.

1. FLUID CONTROL AND
GINGIVAL RETRACTION
PRESENTED BY:
DR . SAYALI RAUT
1ST MDS
DEPARTMENT OF PROSTHODONTICS

2. CONTENTS:
INTRODUCTION
FLUID CONTROL
•OBJECTIVES
•SOURCES OF MOISTURE IN CLINICAL ENVIRONMENT
•MECHANICAL METHOD OF FLUID CONTROL
•CHEMICAL METHODS OF FLUID CONTROL
GINGIVAL RETRACTION
•DEFINITON
•AIMS AND OBJECTIVES
•PRE RETRACTION ASSESSMENT OF GINGIVAL TISSUES
•METHODS:
A) Mechanical
B) Chemical
C) Chemo-mechanical
D) Surgical
RECENT ADVANCES
LITERARTURE REVIEW
CONCLUSION

3. INTRODUCTION
Control of
fluids
Appropriate
displacement
of gingiva
Accurate
impressions

4. FLUID CONTROL

5. FLUID CONTROL
• Objectives:
Obtain a dry
clean operating
field
Enhance
operating
visibility and
patient comfort.
Improve the
properties of
restorative
material.
Protect from
swallowing and
aspirating
foreign bodies
Improve the
operating
efficiency

6. SOURCES OF MOISTURE IN ORAL CAVITY
Salivary glands-
parotid,
submandibular
sublingual
AVERAGE
SALIVARY FLOW:
0.3 – 0.4 ml /
min
SALIVA
Inflamed
gingival tissues
Iatrogenic
damage
BLOOD
0.05 to 0.20 µL
per minute
GINGIVAL
CREVICULAR
FLUID Rotary instruments,
three way syringe,
etchants,irrigant
solutions
On a average high
speed rotatory cutting
instruments have
water flow of 30 mL
per minute
WATER/ DENTAL
MATERIALS

7. METHODS OF FLUID MANAGEMENT
MECHANICAL METHODS:
1. Rubber dam
2. Suction devices
3. High volume vacuum
4. Saliva ejector
5. Svedopter
6. Cotton rolls
• CHEMICAL METHODS:
1. Anti – sialogouges
2. Local anaesthetics
3. Clonidine (anti-hypertensive
drug)

8. Mechanical methods of Fluid
Management

9. RUBBER DAM ISOLATION
INTRODUCED BY S. C. BARNUM, 1864

10. RUBBER DAM ISOLATION
INDICATIONS
• For core build up, pattern
fabrication
• Impression making of inlays
and onlays
• Removal of old restoration and
caries
• For cementation
CONTRAINDICATIONS
• Should not be used with poly-
vinyl siloxane as interferes with
polymerization
• Patients allergic to latex.
• Patients suffering from asthma

11. RUBBER DAM ISOLATION
ADVANTAGES:
• Isolate one/more teeth
• Eliminates saliva from operating
site
• Retracts soft tissue
• Provides protection to patient and
dentist
• Improves efficiency of the
treatment
DISADVANTAGES:
• Time consuming and patients objection
• Unusual tooth shapes or positions that cause
inadequate clamp placement Partially erupted
or Broken down teeth
• Communication with patients may be difficult
• Mouth breathers
• Incorrect use of clamps can damage the
porcelain crowns/ crown margins/ traumatize
the gingival tissues

12. RUBBER DAM EQUIPMENT
Rubber dam clamps
Rubber dam forceps
Rubber dam sheet
Rubber dam frame
Rubber dam template
Rubber dam accessories
Rubber dam punch

13. EVACUATORS
USE SUCTION OR VACUUM

14. Importance of suction devices

15. SALIVA EJECTOR
• Low volume suction devices
• 300 ml/ min is the suction rate
• Adjunct to high volume vacuum/
rubber dam/cotton rolls.
• Removes saliva from the floor of
mouth

16. REUSABLE SALIVA EJECTORS
• Steel
• Saliva ejector with tongue guards

17. SUCTION TIPS/ SALIVA EJECTORS
Disposable coloured
saliva ejectors
Mirror vac
Hygoformic saliva
ejector

18. SVEDOPTER
Metal saliva ejector with a tongue
retractor
• Used for mandibular arch
• Most effective when patient is in
a nearly upright position.

19. HIGH VOLUME VACUUM
• Powerful suction device
• Uses 10mm diameter HVE tips and a suction
pump set
• Evacuates 1L/min of fluid
• Apparatus also removes small operatory
debris
• Excellent lip retractor
Disadvantage:
• Cannot be used for impression & cementation
procedure

20. ISOLITE ILLUMINATED DENTAL ISOLATION SYSTEM
The Isolite is a new dental device that simultaneously delivers
continuous throat protection, illumination, retraction and isolation

21. The findings
• Neither device to effectively
reduce aerosols and splatter
• There was no significant
difference in the reduction of
aerosols and splatter
between the two devices
Holloman JL, Mauriello SM, Pimenta L, Arnold RR. Comparison of suction device with saliva ejector for aerosol and spatter reduction during ultrasonic
scaling. J Am Dent Assoc. 2015 Jan;146(1):27-33.
Literature review

22. Literature review
In a study by the ADA comparing HVE and a saliva ejector,
results showed the HVE device to reduce up to 90% of particles
reaching the clinician’s breathing space over the saliva ejector
alone .
Through his extensive research, Stephen Harrel concludes that a
standard HVE tip removes 90-98% of aerosols regardless of the
source and proves an effective solution to aerosol containment
and reducing the risks of contamination.

23. ABSORBENTS

24. COTTON ROLLS
• Controls small amounts of moisture
and retracts cheek and tongue
• Provides acceptable dryness for
procedures like
Cementation
Impression making
• Two types
BraidedWrapped

25. COTTON ROLL HOLDER
• Holds cotton rolls in place
• Advantages
Cheek and tongue are slightly
retracted
Enhances visibility

26. DRY TIPS [MOISTURE ABSORBING CARDS]
• Keeps parotid gland in check for 15 minute
• Absorbs more moisture compared to cotton rolls

27. REFLECTIVE SHIELDS
• Mirror-like reflective film - allows illumination
• Checks saliva control for parotid gland
• Ideal for sealant and dental hygiene procedures

28. Chemical Methods Of Fluid
Management

29. DRUGS USED FOR
FLUID CONTROL
Administer for patient with
excessive salivation
Anti- sialagogues
Local anesthetics
Antihypertensives

30. ANTI SIALAGOGUES
• Gastrointestinal anti cholinergic drugs that inhibit action of myo-epithelial cells
of salivary gland
• Common drugs
Atropine 1 tablet of 0.4mg per day
Rosenstiel SF; Contemporary Fixed Prosthodontics; 2014; 4th edition; India; pp: 370

31. MECHANISM OF LOCAL ANAESTHETICS
Action of local
anaesthetics
Pain control needed for tissue displacement
Nerve impulse from the periodontal ligament
regulates the salivary flow
Reduces salivary flow

32. ANTI-HYPERTENSIVES
DRUG: Clonidine
hydrochloride
DOSAGE: 0.2 mg
1 hour before
the treatment.
SIDE EFFECTS:
drowsiness and
sedation

33. Gingival Retraction
TISSUE MANAGEMENT

34. PRE RETRACTION
ASSESSMENT OF
GINGIVAL TISSUES
Forces involved with retraction of
peri-dental tissues:
COLLAPSING
RELAPSING
RETRACTION
DISPLACEMENT
Adnan, Samira & Agwan, Muhammad Atif. (2018). Gingival Retraction Techniques: A Review. Dental update. 45.10.12968/denu.2018.45.4.284.

35. PRE RETRACTION ASSESSMENT OF GINGIVAL TISSUES
CLINICAL ASSESSMENT:
• Colour – pink Consistency – firm Bleeding on probing
• BIOTYPE –Thin gingival biotypes are adversely affected with a sub
gingivally placed restoration.

36. PRE RETRACTION ASSESSMENT OF GINGIVAL TISSUES
RADIOGRAPHIC EXAMINATION:
• peri-apical
• bitewing radiographs
a greater chance of
recession
gingiva is
traumatically
displaced to
record
subgingival
margins
Underlying
defiecinet
bone
Unsupported
soft tissue

37. DEFINITIONS
Gingival displacement
is the deflection of the
marginal gingiva away
from a tooth – GPT 9
Gingival retraction is a
process of exposing
margins when making
impression of prepared
teeth. – Rosensteil

38. OBJECTIVES OF GINGIVAL RETRACTION
Isolation of cavity prepared close to the gingival margin
Control of haemorrhage during restorative material placement
Recording subgingival margins during impression for indirect restorations
Protection of the gingiva during preparation of tooth with subgingival margins
Better visualization of the margins
Diagnosis of subgingival caries

39. CLASSIFICATION OF METHODS OF GINGIVAL
DISPLACEMENT
SURGICAL:
1. Gingivectomy and
gingivoplasty
2. Periodontal flap
procedures
3. Electrosurgery
4. Rotary gingival curettage
NON- SURGICAL:
1. rubber dam and clamps
2. retraction cord-
impregnated/non-
impregnated
3. retraction rings
4. copper bands
(Barkmeier and Williams 1978)
Jain A. Gingival retraction in prosthodontics - A review. Journal of Phmacy Research. 2017: 11(12) ; 1451-61.

40. CLASSIFICATION OF METHODS OF GINGIVAL
DISPLACEMENT
Conventional
Radical
Jain A. Gingival retraction in prosthodontics - A review. Journal of Phmacy Research. 2017: 11(12) ; 1451-61.
(Thompson M.J 1959)

41. Mechanical
Chemo
mechanical
Rotary
gingival
curettage
Electrosurgery
CLASSIFICATION OF METHODS
OF GINGIVAL DISPLACEMENT
(Benson et al., 1986)
Jain A. Gingival retraction in prosthodontics - A review. Journal of Phmacy Research. 2017: 11(12) ; 1451-61.

42. NON SURGICAL METHODS
OF GINGIVAL RETRACTION

43. MECHANICAL METHODS OF RETRACTION:
• Matrix band and wedges
• Gingival protector
• Retraction crown/sleeve
• Copper ring technique
• Anatomic retraction caps
• Rubber Dam
• Retraction cords
• Special cords

44. MATRIX BANDS AND WEDGES
• Placed inter proximally
• Uses
1. Depresses gingiva
2. Matrices with gingival
extension provides
displacement of gingiva

45. GINGIVAL PROTECTOR
• This has a crescent shaped tip on
an adjustable ball joint attached to
a metal handle
• Can be placed and adjusted
according to the contour of the
gingival tissues
• Protects the Gingiva during
preparation of tooth structure
close to the gingival margin
• USES:
1. Veneer preparation
2. Finishing porcelain/resin
3. Sub gingival caries
4. Check fitting of margins of crown
Thomas MS, Joseph RM, Parolia A. Nonsurgical gingival displacement in restorative dentistry. Compend Contin Educ
Dent. 2011 Jun;32(5):26-34; quiz 36, 38.

46. RETRACTION CROWN OR SLEEVE
Temporary crown filled with thermoplastic stopping material or bulky temporary cement
Excess
material is
removed
Crown placed
on prepared
tooth
Excess of
temporary
material lined
on the finish
line
Temporary
crown
adapted to
the finish line
Thomas, Manuel & Joseph, Robin & Parolia, Abhishek. Nonsurgical gingival displacement in restorative dentistry. Compendium of continuing
education in dentistry (Jamesburg, N.J. : 1995). 32. 26-34; quiz 36, 38.

47. Other method:
Custom temporary
restorations with
blunt gingival ends
Covered with bulky
temporary cements
like ZOE
(periodontal packs)
left in place until
the next
appointment when
the final
impression is made

48. Recession of gingiva in case it is placed for more than 12
hours
Delayed impression
Cervical region of teeth becomes sensitive and
susceptible to caries
Disadvantages of retraction crowns/ sleeves

49. Copper band technique
• Means of carrying the impression material and a mechanism for
gingival retraction.

50. Copper band technique
Gingival margins are crimped to adapt to gingival contour

51. Copper band technique
copper band is filled with modelling compound or elastomeric impression
material, and seated on the prepared tooth along the path of insertion.

52. Temporary acrylic resin coping constructed
Tray adhesive applied
Filled with elastomeric impression material and
reseated
Tissue displacement occurs
Full arch impression made
TEMPORARY ACRYLIC COPING

53. Anatomic compression cap
Anatomic
compression
caps placed on
patient’ s teeth
Instruct the
patient to bite
on it

54. RUBBER DAM AND CLAMPS
• The use of heavy, extra heavy
and special heavy rubber dam
• with specialized clamps
Ferrier 212
Brinker’s clamp B5, B6

55. Chemo mechanical methods of
retraction

56. RETRACTION CORD
• Gingival retraction cord is a tapered
diameter cord that can be wrapped
several times about a tooth that
causes flared gingival crevice

57. CLASSIFICATION OF
RETRACTION CORDS
ACCORDING TO DIFFERENT FACTORS

58. 1) Depending on the
configuration
Twisted:
Allow the dentist to
customize the cord as
individual strands can be
removed
Knitted:
Interlocking loops
Longitudinally elastic AND
Transversely resilient
Braided:
Firm
Flexible
Multistrand

59. 2) DEPENDING
ON SURFACE
FINISH
WAXED
UNWAXED
3) DEPENDING
ON CHEMICAL
TREATMENT
PLAIN
IMPREGNATED
4) DEPENDING
ON NUMBER OF
STRANDS
SINGLE
STRINGED
DOUBLE
STRINGED

60. Depending on the thickness:
Black - 000
Yellow - 00
Purple - 0
Blue - 1
Green - 2
Red - 3

61. 000 00 0 1 2 3
Anterior
teeth (with
thin gingival
biotype)
Preparing and
cementing
veneers
Lower anteriors.
Second cord for
"two-cord"
technique
Tissue control and/or
displacement when soaked
in coagulative hemostatic
solution prior to and/or
after crown preparations
Upper cord for
"two-cord"
technique
Areas that have
fairly thick
gingival tissues
where a Significant
amount of force is
required
Double
packing,
lower cord
in the "two-
cord"
technique
Restorative
procedures
dealing with
thin, friable
tissues
When luting near
gingival and
subgingival
veneers, Class III,
IV and V
restorations
Protective "pre-
preparation" cord on
anteriors
Protective
"pre-
preparation"
cord on
anteriors
Upper cord for "two-
cord" technique
INDICATIONS OF DIFFERENT RETRACTION CORD
THICKNESSES

62. Cinthya M, Taciana E, Taciana M F, Carlos M A. Gingival retraction: thickness measurement and comparison of different cords, Brazillian Dent Sci,
2015: 18(2) ; 50-57.

63. Conclusion of this study:
• The mean thickness found for the evaluated cords demonstrated
that the similar sizes assigned by the manufacturers mismatched
the real dimensions
• Only similar thickness was seen for the brands Ultrapack and
Retraflex at size 000 and brands Ultrapack and Retractor at size 0.
Cinthya M, Taciana E, Taciana M F, Carlos M A. Gingival retraction: thickness measurement and comparison of different cords,
Brazillian Dent Sci, 2015: 18(2) ; 50-57.

64. How to select the impression
cord?
CASE SPECIFIC

65. If a dry field has been achieved
Non Impregnated cord left in
place for a sufficient time
Extreme narrow sulci Wool like cords which can
be flattened for initial
displacement
Given a choice, always choose impregnated cords over plain cords
unless contraindicated
As a rule, the thickest cord that is accepted by the sulcus should be
used

66. ARMAMENTARIUM
Evacuator
(saliva ejector,
Svedopter)
Scissors and
Cotton pliers
Mouth mirror Explorer
Fischer
Ultrapak Packer
(small)
DE plastic filling
instrument
IPPA
Cotton rolls Retraction cord
Hemodent
liquid
Dappen dish Cotton pellets
2 x 2 gauze
sponges
Shillingburg HT; Fundamentals of Fixed Prosthodontics; 2012; 4th edition ; Quintessence publications; USA; pp: 275

67. Fischer ultrapakpackers
• Small Packer (45 degrees to handle)
• • Small Packer (90 degrees to handle

68. Techniques of gingival retraction

69. Single cord technique
Retraction cord drawn
from bottle
Twisting of retraction cord

70. Single cord technique:
Looping of gingival cord Cord placement from
mesial surface

71. Single cord technique
Lightly secure the distal
interproximal area
Proceed to the lingual surface
from mesial to distal

72. Single cord technique
Occasional use of extra
instrument to hold the cord and
packing with other
The cord is gently pressed
apically with the instrument,
directing the tip slightly
towards the root

73. Single cord technique
Excess cord cut off in the mesial
area as closely as possible to the
interproximal area
Pack all but the last 2.0 or 3.0 mm
of cord

74. If the instrument is directed totally in an
apical direction, the cord will rebound
off the gingiva and roll out of the sulcus

75. If cord rebounds from a particularly tight area
of the sulcus
DO NOT TO DO
do not apply greater force maintain gentle force for a longer time
still rebounds
change to a smaller or more pliable cord (ie,
twisted rather than braided)

76. Normal Deep Shallow

77. DOUBLE CORD TECHNIQUE
Indications:
• Multiple prepared teeth
• Compromised tissue
health
• Too deep gingival sulcus
• Subgingival margins

78. DOUBLE CORD TECHNIQUE
A smaller diameter cord soaked with haemostatic
agent placed into the depth of the sulcus
Causes some lateral tissue displacement but
primarily controls hemorrhage.
The second larger diameter cord is then packed into
the sulcus, causing further lateral tissue
displacement for 8-10 mins
The first deeper placed cord stays in place when the
impression is made, after removal of the top, larger
diameter cord

79. INFUSION TECHNIQUE
Indications – Controls haemorrhage
Fill the syringe with Fe2(SO4)3 solution and
attach the infuser tip
This hollow
metal tip
contains a cotton
filament to help
control flow of
the medicament.

80. INFUSION TECHNIQUE
• Rub the tip back and forth
for approximately 30 secs
over the hemorrhaging
area• Slowly replenish the solution
by continuous injection

81. INFUSION TECHNIQUE
Irrigate the area
with an air-water
syringe and
gently air dry.
Inspect to
determine if
bleeding has
diminished.
Repeat several
times, if
necessary
Retraction cord is
placed in the
conventional
manner

82. EVERY OTHER TOOTH TECHNIQUE
Rationale
Anterior tooth
preparation
when the
roots are in
proximity
Placing the
retraction
cord
simultaneousl
y around all
teeth
Strangulation
of interdental
papillae
Impair
gingival health
and can cause
black inter-
dental
triangles.
Every other
tooth
technique
(Prevents this
collapse of
gingival
papilla)

83. EVERY OTHER TOOTH TECHNIQUE
Sudhapalli S. Sectional Impressions and 'Every Other Tooth' Technique in FPD. J Clin Diagn Res. 2017 Jan;11(1):ZD18-ZD20.

84. Gingival displacement
Medicaments
CHEMICALS USED ALONG WITH
RETRACTION CORDS

85. Vasoconstrictors
0.1%-8% racemic epinephrine
Tetrahydrozoline HCL- 0.05%
Oxymetazoline-0.05%
Phenyl epinephrine HCL-0.05%
Astringents
Alum (Potassium aluminium sulfate)
Aluminum chloride (5 – 25% conc)
Ferric sulfate (13- 20%)
Ferric sub-sulfate (Monsel’s solution)
Tannic acid
Gingival Displacement Medicaments

86. Historic background
• Laufer found – minimum sulcular width of 0.2 mm to prevent
distortion of the sulcular impression
• Caustic chemicals like Sulfuric Acid, Tri choloroacetic acid, Negatol
(45%comdensation product of Metacresol Sulfonic acid and
formaldehyde) and Zinc Chloride – undesirable effect on gingiva –
abandonment
• 1980s - 8% racemic epinephrine most commonly used
Shillingburg HT; Fundamentals of Fixed Prosthodontics; 2012; 4th edition ; Quintessence publications; USA; pp:273

87. Epinephrine contraindications
• Cardiovascular disease
• Hypertension
• Diabetes
• Hyperthyroidism
• Known hypersensitivity to epinephrine
• Patients taking:
1. Mono-amine oxidase
2. Tricyclic depressants
3. Ganglionic blockers
4. Cocaine

88. 1. The pulse rate of patients after application of racemic epinephrine-
impregnated retraction cords depends more on the level of anxiety and stress
than on the level of the epinephrine.
2. Blood pressure is elevated by placement of racemic epinephrine-
impregnated retraction cords upon an exposed vascular bed or lacerated
tissue.
3. 4% racemic epinephrine-impregnated retraction cords cause less elevation of
blood pressure than 8% racemic epinephrine cords.
4. Although the elevations in blood pressure from 8% cord occur within a
narrow range, this range may be hazardous to cardiac patients. Therefore, 4%
racemic epinephrine cord should be used.
5. A desirable amount of tissue retraction is produced by 4% racemic
epinephrine cord.
6. Dry cords do not provide adequate retraction of tissue and are
contraindicated for tissue-retraction purposes.
Pelzner RB, Kempler D, Stark MM, Lum LB, Nicholson RJ, Soelberg KB. Human blood pressure and pulse rate response to racemic epinephrine
retraction cord. J Prosthet Dent. 1978 Mar;39(3):287-92.

89. Historic background
aluminium
chloride
54%
ferous
sulphate
35%
others
11%
0%
Percentage of Prosthodontists
• In 1999, a survey revealed

90. ASTRINGENTS:
Mechanism of action
Precipitation
of protein
Inhibit trans-
capillary
movement of
plasma
protein
Caustics at
low conc. &
irritants in
moderate
conc.
Low cell
permeability

91. Acidity of the Hemostatic agents
• Many of the astringents are active at low pH
• Action on tooth structure and smear layer is of concern.

92. Comparison of
commonly used
agents 10 mins
1-3 min
(20-100%)
(13- 20%)
(5-25%)
10 mins
(100%)
20 mins
(0.1%-8%)

93. Surgical methods of retraction

94. ROTARY CURETTAGE/GINGETTAGE
Rotary curettage is a "troughing" technique, the purpose of which is to
produce limited removal of epithelial tissue in the sulcus while a chamfer finish
line is being created in tooth structure.
The concept of using rotary curettage was described by Amsterdam in 1954.
developed by Hansing and subsequently enlarged upon by Ingraham.
Suitability of gingiva for the use of this method is determined by three factors:
1. Absence of bleeding upon probing,
1.2. Sulcus depth less than 3.0 mm,
2.3. Presence of adequate keratinized gingiva

95. A shoulder finish line is
prepared at the level of the
gingival crest with a flat-
end tapered diamond
A torpedo diamond of 150 to 180
grit is used to extend the finish
line apically, one-half to two-thirds
the depth of the sulcus, converting
the finish line to a chamfer
Cord impregnated with
aluminum chloride4 or alum is
gently placed to control
hemorrhage

96. ELECTROSURGEY
SURGICAL REDUCTION OF SULCULAR
EPITHELIUM USING AN ELECTRODE TO
PRODUCE GINGIVAL RETRACTION

97. ELECTROSURGERY
Passage of a high frequency current
through the tissue from a large electrode
to a small one.
Produces a high current density
Rapid temperature rise at its point of
contact with the tissue.
Induces rapid localized polarity changes
Cell breakdown
The inner epithelial lining of
the gingival sulcus is removed

98. Five commonly used
electrosurgical
electrodes:
A – coagulating
B – diamond loop
C – round loop
D – small straight
E – small loop.

99. Pressure required for electrosurgery
• The pressure required has been described as the same needed to
draw a line with an ink-dipped brush without bending the bristles
Shillingburg HT; Fundamentals of Fixed Prosthodontics; 2012; 4th edition ; Quintessence publications; USA; pp: 285

100. ELECTROSURGERY
Electrosurgical unit
The tip of the electrode is
passed through the
hyperplastic tissue

101. ELECTROSURGERY
Area is irrigated Dried and inspected Cord packing

102. The Cord positioning force
• There may be inadvertent excessive use of force while tucking the
cord in the sulcus, particularly when the patient is anaesthetized
• A study by Van der Velden and De Vries has shown that the
epithelial attachment sustains injuries at a force of 1 N/mm2 , while
it ruptures at 2.5 N/mm2 .
• The cord technique requires almost 2.5 N/mm2

104. Displacement pastes
• Introduced by Satalec Pierre
Rolland
• Composition
1. Aluminum chloride-15%
astringent & hemostatic
agent
2. Kaolin
3. Excipients
Recommended time of application-1-2 min

105. Paste is directed into the
gingival tissues
Completely injected kept
for 1- 2 mins
Paste is removed with
copious amounts of water
Prepared tooth before
impression is made EXPASYL

106. Advantages Disadvantages
Less traumatic to tissues than
cord packing.
Expensive
Faster than traditional cord. Disposable metal dispenser
tips are too large causes
difficulty to express
Easy removal from sulcus by
rinsing.
Less tissue displacement than
with cord
Dispenser tips can bent-
improves intraoral access
Thickness makes it difficult to
express

107. Magic foam
• Developed by Prof Dr. Dumfahrt
• First expanding vinyl polysiloxane
material designed for retraction
of the gingival sulcus
• Mechanism - Expansion of silicon
foam

108. Tooth preparation
complete
Magic foam injected
Pressure applied with
hollow cotton roll
Final result of
retraction
LIMITATIONS:
• Less hemo-static
• No improvement in
speed/quality
compared to cord
• Less effective on
sub gingival margin

109. Gingitrac (Centrix co)
• Mild natural astringent gel
Gingicap Ginigtrac dispensed
Injected around the
tooth
Patient asked to bite Retraction result

110. Occlusal Matrix Impression Technique
Carrier for the
matrix
Matrix made with
elastomeric putty
Facial & palatal sides
are trimmed
Matrix in place in
the mouth.
medium-viscosity
impression material
Seated with light
pressure
Completed
impression.
Livaditis GJ: The matrix impression system for fixed prosthodontics. J Prosthet Dent 79:208, 1998

111. MEROCEL STRIPS
• Synthetic material that is biocompatible
polymer
hydroxylate polyvinyl acetate
• Mechanism of action
Expands by absorption of oral fluids and
exerts pressure on surrounding tissue

112. ADVANTAGES:
Shivasakthy M, Asharaf Ali S. Comparative Study on the Efficacy of Gingival Retraction using Polyvinyl Acetate Strips and
Conventional Retraction Cord - An in Vivo Study. J Clin Diagn Res. 2013 Oct;7(10):2368-71.
• Easily shaped and adapted around
tooth
• Highly effective in absorption of oral
fluids
• Non abrasive
14 maxillary tooth requiring complete metal ceramic restoration
Retraction was done using merocel and conventional method
Mean vertical retraction of gingival cord - 2.02
Mean vertical retraction of retraction strips - 2.78

113. LASERS
• Useful for tissue contouring procedures.
• Controlled tissue removal before impression
making
• ADVANTAGES:
1. Minimum pain and discomfort
2. Less fear ,anxiety and stress
3. Minimum or no anesthesia
4. No drill sounds
5. Less chair time
6. Reduced post operative complications
7. Minimum or no bleeding
Trough
made with
the laser
Impression

114. Stay put retraction cord
• Fine metal filament reinforced
displacement cord
• Impregnated or non impregnated
• Consist of braided retraction cord
and ultrafine copper filaments
• Remains in shape and does not
deform

115. Gingival displacement in digital impressions
• 15% aluminum chloride in an
injectable matrix
• Cords avoided to prevent
artifacts on digital impression
Retraction Capsule

116. Tooth prepared
3M ESPE Retraction
Capsule
Injected around the
tooth
Rinsed after 1 min
Dried
Digital impression
made
Impression

117. Literature review
COMPARISON OF DIFFERENT TECHNIQUES

120. Retraction was done with:
1. Aluminum chloride
2. Tetrahydrozoline
3. Expasyl
Calculated on stereomicroscope under 20x and images were transferred to image
analyser
CONCLUSION:
The amount of gingival retraction obtained by using aluminium chloride as gingival
retraction agent was maximum (148238.33 μm2) compared to tetrahydrozoline
(140737.87 μm2) and Expasyl (67784.90 μm2).

121. Azzi R, Tsao TF, Carranza FA Jr, Kenney EB. Comparative study of gingival retraction methods. J Prosthet Dent. 1983 Oct;50(4):561-5.

122. Tao X, Yao JW, Wang HL, Huang C. Comparison
of Gingival Troughing by Laser and Retraction
Cord. Int J Periodontics Restorative Dent. 2018
Jul/Aug;38(4):527-532.
Comparison between pre
saturated cord and 3 lasers:
1. Nd: YAG
2. Er: YAG
3. Diode lasers
The gingival width and recession
was measured at the time of
treatment after 1 week and after
4 weeks in 108 anterior preps
Conclusion:
1. Lasers resulted in wider sulci
less post treatment
recession, less inflammation
and more patient comfort
2. Er: YAG fast and uneventful
healing as compared to other
lasers

123. Phatale S, Marawar PP, Byakod G, Lagdive SB,
Kalburge JV. Effect of retraction materials on
gingival health: A histopathological study. J Indian
Soc Periodontol. 2010 Jan;14(1):35-9.
• evaluate the effect of Expasyl, Magic Foam Cord, and
impregnated retraction cord on the gingival sulcular
epithelium
Aim
• 30 cases of bilateral premolars which were extracted and
retraction was studied on them
study
• Expasyl or Magic Foam Cord was found to be better than cord as
assessed histologically,
• it respects periodontium
conclusion

124. Gupta A, Prithviraj DR, Gupta D, Shruti DP.
Clinical evaluation of three new gingival
retraction systems: a research report. J
Indian Prosthodont Soc. 2013
Mar;13(1):36-42.
Stayput
Magic foam cord
Expasyl
Magic foam cord retraction system can be
considered more effective
Ease of handling
Time taken for placement
Hemorrhage control
Amount of gingival retraction

125. List of studies included in this review
Tabassum S, Adnan S, Khan FR. Gingival Retraction
Methods: A Systematic Review. J Prosthodont. 2017
Dec;26(8):637-643.
• The most common method used for gingival
retraction was chemomechanical.
• No method seemed to be significantly
superior to the other in terms of gingival
retraction achieved
Method Gingival retraction (in
mm)
Mechanical 0.19 – 0.23
Chemo
Mechanical
0.02 – 0.46
Surgical 0.03 – 0.45

126. CONCLUSION
• Accurate impressions are critical for the success of fixed dental
prosthesis
• Fluid control and Gingival retraction holds an indispensable place during
soft tissue management before an impression is made.
• A wide variety of options are available for tissue management
• The choice of technique and material for gingival displacement depends
on the operator’s judgment of the clinical situation
• Most practitioners use the chemo mechanical method of gingival
retraction
• However, the cordless retraction is the one which causes least harm to
the periodontium

127. THANK YOU