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What is Gingival Retraction, Different

Materials and Methods used
+| | Prosthodontics | No comments

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Gingival Retraction is an important aspect of

Prosthodontic and Conservative procedures
performed such as Retraction of the Gingiva to
expose the Finish lines in Tooth Preparation
before taking an Alginate or Putty Impression,
in case of Cavity preparation Gingival
Retraction is useful in Class II cavity
preparation where the base of the cavity is near
to gingiva or in Cervical Abrasion cases where
it is necessary to get Gingival Retraction for
proper restoration.

Techniques for Gingival Retraction

Gingival retraction can be achieved in several
ways, not just by using any physical material
but also by using certain chemico-mechanical
materials which can help achieve Retraction.
Following are the few techniques to retract the
gingival tissue which are divided into three
types based on the type of material used.

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Mechanical Techniques

Copper Band
Retraction Cord
Rubber Dam

Chemico-Mechanical Techniques

8% Racemic Epinephrine
Aluminum Chloride
Alum (Aluminum Potassium Sulphate)
Aluminum Sulphate
Ferric Sulphate

Surgical Techniques

Gingettage
Electrosurgery

The mechanical and chemico-mechanical

techniques are even a few other than these,
though these are the commonly used
techniques.

Importance of Finish Line Exposure:

Finish Line is an important aspect of any Case

restoration or tooth preparation to make sure
that perfect retention and marginal integrity is
achieved. The Gingival tissue which is to be
retracted needs to be free of any inflammation.
This helps in attaining Marginal Integrity.

Mechanical Methods of Gingival Retraction

Copper Band
Used to carry the impression material as well
as to displace the gingival to expose the finish
line.

Technique

The copper band is welded to form a 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
Position and contour the tube over the prepared tooth
The tube is filled with modeling compound
The filled tube is seated carefully in place along the path
of insertion of the tooth preparation
Impression is made

Note: The disadvantage of this technique is

that it can cause injury to the gingival tissues.

Retraction Cords
Pressure packing the retraction cord into the gingival
sulcus provides sufficient gingival retraction.
Retraction cords should be made of absorbent materials
like cotton.
They are inserted into the gingival sulcus with special
instruments.

The technique of using Retraction Cord

The operating area should be dry

Fluid control should be done with an evacuating device
and the quadrant containing the prepared tooth is
isolated with cotton rolls
Retraction cord is drawn from the dispenser bottle and a
piece of approximately 5cm is cut off
The cord is twisted to make it tight and small
The retraction cord should be dipped in a 25% aluminum
chloride solution in a dappen dish
The cord is looped around the tooth and held tightly with
the thumb and forefinger
The cord is packed into the gingival sulcus starting from
the mesial surface of the tooth
Force should be applied in a mesial direction during cord
placement so that the packed preceding segment does
not get dislodged
The cord should be stabilized near the distal end of the
tooth
After 10 minutes, the cord should be removed slowly in
order to avoid bleeding
If active bleeding persists, a cord soaked in ferric sulfate
should be placed in the sulcus and removed after 3
minutes
The impression should be made only after cessation of
bleeding

Note: Important points to consider

The cord can be packed with special instruments like

FISCHER PACKING INSTRUMENT or a DE PLASTIC
INSTRUMENT IPPA.
Occasionally it may be necessary to hold the cord with
one instrument while packing with another.
The instrument used for packing should be angled slightly
towards the root to facilitate the sub-gingival placement
of the cord.
The instrument is inclined at an angle towards the tooth
surface. If it is held parallel to the long axis of the tooth,
the cord will rebound.
Excess cord is cut off near the inter-proximal area such
that a slight overlap of the cord occurs in this region. If
the overlap occurs on the facial and lingual surfaces, the
gingival finish line in that area may not be replicated
properly in the impression.
At least 2-3 mm of the cord is left protruding outside the
sulcus so that it can be grasped for easy removal.
The retraction cord must be slightly moist before removal.
Removing dry cord from the crevice can injure the delicate
epithelial lining of the gingival.

Chemico-Mechanical Methods of Gingival

Retraction
Retraction cord soaked in a chemical will
provide better gingival retraction compared to
a plain retraction cord – the principle behind
the chemico-mechanical method of gingival
retraction. It is a method of combining a
chemical with pressure packing, which leads to
enlargement of the gingival sulcus as well as
control of fluids seeping from the sulcus.

NOTE: The most commonly used chemicals are

already mentioned in the above flow chart.
These chemicals are generally local
vasoconstrictors which produce
transient(temporary) gingival shrinkage.

Ideal Requirements for Chemicals used with

Retraction Cord

Should produce effective gingival displacement

Should produce hemostasis
Should not produce any irreversible damage to the
gingival
Should not have any systemic side effects

Contraindications for Epinephrine

Epinephrine is one of the most commonly used

chemicals for retraction. Hence, knowing its
contraindications is very important.

CVS disease
Hypertension
Diabetes
Hyperthyroidism
Known hypersensitivity to epinephrine

Surgical Methods of Gingival Retraction

Rotary Curettage / Gingettage

It is a troughing technique, wherein a portion

of the epithelium within the sulcus is removed
to expose the finish line. It should be done only
on a healthy gingival tissue.

The following criteria should be fulfilled for

gingettage:

The absence of bleeding upon probing from the

gingival
The depth of the sulcus is less than 3mm
Presence of adequate keratinized gingiva

What is Gingettage – Procedure:

Usually done simultaneously along with finish

line preparation.

The torpedo diamond point is carefully extended into the

gingival sulcus to half of its depth to remove a portion of
the sulcular epithelium
The handpiece should be run at low speed to improve the
tactile sensation
Abundant water should be sprayed during the procedure
A retraction cord impregnated with aluminum chloride
can be used to control bleeding

Disadvantages

Technique sensitive
Can potentially damage the periodontium

Electrosurgical Retraction

Electrosurgery denotes surgical reduction of sulcular

epithelium using an electrode to produce gingival
retraction.
It is a high-frequency radio transmitter that uses either a
vacuum tube or a transistor to deliver a high-frequency
electrical current of at least 1.0 MHz.
The procedure is also called as SURGICAL DIATHERMY.

Indications

In areas of inflamed gingival tissues

In cases with gingival proliferation around the prepared
finish lines

Contraindications

Patients with cardiac pacemakers

The use of topical anesthetics should be avoided when
electrosurgery is to be used

Advantages

Sophisticated technique
Can be done in cases with gingival inflammation
Produces little to no bleeding
Quick procedure

Disadvantages

Very technique sensitive

Excess pressure may cause tissue damage
Cannot be done in a dry field

Types of Current Used for Electro Surgery

Unrectified, damped current

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Partially rectified, damped current

Fully rectified current

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Article by Varun Pandula
I am Varun, a Dentist from
Hyderabad, India trying my
bit to help everyone
understand Dental problems
and treatments and to make Dental
Education simplified for Dental Students
and Dental fraternity. If you have any
doubts feel free to contact me or
comment in the post, thanks for visiting.

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Welcome to Juniordentist
I am Varun, a Dentist from
Hyderabad, India trying my bit to
help everyone understand Dental
problems and treatments and to
make Dental Education simplified for Dental
Students and Dental fraternity.
If you have any doubts feel free to contact me
or comment in the post, thanks for visiting.

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