Gum retraction and Tissue Management

Indications
Subgingival 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

Methods for gingival retraction

Mechanical

ChemicoMechanical

Rotary curettage

Electrosurgery

Mechanical method

Mechanical method
Mechanically displace gingival tissue outwards and

apically away from the tooth surface.

Indicated in cases where gingiva is normal

healthy with

ade!uate attached gingiva.

"rovides minimal gingival retraction

Commonly used material

Copper band retraction cord rubber dam #ooden wedge

Copper band
Is use as a means of carrying impression material Mechanism for displacing the gingiva

Technique
Copper $and is welded to form a tube corresponding to

the si%e of the tooth

&n end is trimmed' to follow gingival finish line (ube is filled with modeling compound

seated along

path of insertion

Indication

) Situations in which several teeth have been prepared

*dvantages

)Minimal recession
+isadvantages

)Incisional in,uries Excessive pressure on the tissue

Retraction cord
"ressure pac-ing into the gingival sulcus provide

sufficient gingival retraction

ChemicoMechanical

It is a method of combining a chemical with pressure

pac-ing
It enlarge the gingival sulcus as well as controlling fluids

seeping from the sulcus

Types of retraction cord

Cotton Synthetic

$raided (wisted #oven. -nitted

Coarse /ine

Impregnated 0on)impregnated

1nitted cord si%es

2333 233 23 24 25
$raided cord

(wisted 267 233 287 23 297 24 2437 25

267233 28723 29724 243725

Factors to consider
+ar- color to maximi%e contrast with tissues' tooth

cord
*bsorbent to allow upta-e of wet medicament *vailable in different diameters to accommodate varying

morphologies of gingival sulcus

Commonly used chemicals

*luminum chloride *luminum potassium sulphate /erric sulfate 8: racemic epinephrine

CRITERIA F R !I"!I#A$ RETRACTI " MATERIA$

Effectiveness in gingival displacement

hemostasis.
*bsence of irreversible tissue damage. Should not produce harmful systemic effects.

Technique
&perating area should be dry and the !uadrant of the

prepared tooth should be isolated

(he cord is twisted to ma-e it tight and small Cord should be dipped in the solution on a dapen dish

;ooped around the tooth

and pac-ed into the gingival sulcus starting from the mesial surface and establish near the distal end

%ac&ing material

Instrument should be

angled slightly towards the root to facilitate subgingival placement of the cord
*fter 43 minutes the cord

should be removed slowly to avoid bleeding

Rotary curretage

It is a troughing techni!ue' wherein a portion of the

epithelium within the sulcus is removed to expose the finish line

Should be done only on healthy gingiva

Indications
*bsence of bleeding upon probing +epth of the sulcus is <=Mm "resence of ade!uate -eratini%ed gingiva

Technique "rior to rotary curettage' a

shoulder finish line is formed at the level of the gingival crest using flat)end tapered diamond

>and piece should be run at slow speed *bundant water supply should be sprayed during

procedure
Retraction cord is impregnated to control bleeding Cord is removed after ?)8 mins and sulcus thoroughly

irrigated with water

Electrosurgery

*lso -nown as Surgical +iathermy "roduces controlled tissue destruction to achieve a

surgical result

Indication
*reas of inflammation in gingival tissue where the

retraction cord cannot be used

@ingival proliferation around the prepared finish line Enlargement of gingival sulcus

control of hemorrhage

to facilitate impression ma-ing

Contraindication
"atients with cardiac pacema-ers

Technique
"rofound anesthesia "lace a drop of aromatic oil on upper lip Chec- the e!uipment for all connections Ase a very light pressure and !uic- deft stro-es +o not push electrodes through the tissue

Ensures smooth passage of electrode without dragging or

charring of tissue

T'A"( ) *+