Gingival Retraction

- Must for a Dentist

Introduction
 Tissue Displacement

 Change in the form or position of tissues as

a result of pressure
 Deflection of marginal gingiva away from a
tooth
 Synonyms
 Gingival retraction
 Gingival displacement
 AIMS & OBJECTIVES

 Reflect gingiva and produce enlargement or

dilation of gingival sulcus
 To obtain 0.2 - 0.4 mm of horizontal
displacement of marginal gingiva
 To achieve 0.5 mm of vertical exposure of
unprepared portion of tooth
 METHODS

Mechanical
Mechano-chemical
Surgical
 Mechanical Methods

 Rubber dam
 Retraction cords - Plain
 Copper band
 Temporary acrylic resin coping
Rubber Dam
Retraction Cords
 Classification
 Surface texture - Wet or Dry
 Configuration - Twisted, knitted
or plain
 Surface finish - Waxed or
unwaxed
 Thickness (colour
coded) - Black 000
(extra small)
Yellow 00 (small)
Purple 0
Blue 1
Green 2
Red 3 (extra large)
 Chemical treatment - Plain or

impregnated
 Number of strands - Single or
Double
string
 IDEAL REQUIREMENTS
 Safe locally , and systemically
 Effective for its intended use
 Effects should be spontaneously reversible
 Absorbent
 Provide hemostasis
 No Physical & chemical injury to gingival
tissues
 Advantages
(Plain cord)

 Tissue recovery is excellent

 Provide pressure hemostasis
 Ease of manipulation
 Commonly used
 Disadvantages

 Poor in its ability to displace gingiva

 Trauma and recession from packing
pressure
Copper Band
Gingival Tissue Displacement due to Copper Band
 Advantages
 To retrieve the localised impression defect in
multiple preparation

 Disadvantages
 Incisional injury
 Inaccuracy
 Mechano-chemical method

 Chemical action + pressure pack- enlargement

of gingival sulcus

 Materials used-retraction cord &

medicaments
Criteria
 Effectiveness of gingival displacement and
hemostasis
 Absence of irreversible damage to gingiva
 Paucity of untoward systemic effects
 Techniques

 Single string technique

 Deknatel technique / double string
technique
 Selective double string
ARMAMENTARIUM
Packing Instruments
DOUBLE CORD TECHNIQUE
Selective Double String
 Epinephrine 0.1 & 8%
 Recommended time & Mechanism of action
 5-10 min Pronounced vasoconstriction
 Advantages
 Good displacement & hemostasis
 Tissue Recovery
 Fair
 Disadvantages
 Systemic reactions
 Contraindications – Cardiovascular disease,
hyperthroidism, hypersensitivity to epinephrine
 Epinephrine syndrome – Increased heart rate, respiratory
rate and BP.
 Alum (100%)Potassium Aluminium
Sulphate
 Recommended time & Mechanism of action
 10 – 20 min. Precipitation of protein and inhibiting
transcapillary movement of plasma protein
 Advantages
 Minimal tissue loss
 Extended working time
 Tissue Recovery
 Good
 Disadvantages
 Less displacement and haemostasis
 Aluminium Chloride 5%-25%
Aluminium sulphate 25%
 Recommended time & Mechanism of action
 10 mins. Weak Vasoconstrictor
 Advantages
 Minimal tissue loss
 Good haemostasis
 Tissue recovery
 Good
 Disadvantages
 Local tissue destruction > 10%concentration
 Ferric Sulphate 13.3%
 Recommended time & Mechanism of action
 1 – 3 minutes

 Advantages
 Good tissue response
 Compatible with Aluminium Chloride

 Tissue recovery
 Good
 Disadvantages
 Not compatible with epinephrine
 Transient tissue discoloration
 Ferric sub Sulphate
(Monsel’s Solution)
 Recommended time & Mechanism of action
 3 mins
 Advantages
 Good displacement
 Tissue recovery
 Good
 Disadvantages
 Highly acidic and messy to work
 Zinc Chloride 8% & 40%
 Advantages
 Good displacement
 Tissue recovery
 8% - Fair
 40% - Fair

 Disadvantages
 Tissue necrosis and permanent tissue injury
 Methods Available
 Moisture control
 Haemostasis /Sulcular cleansing

 Tissue Management
 Mechanical
 Mechano-Chemical

Surgical
Rotary Curettage
 HISTORY:

 1954 – Amsterdam described

concept.
 Hansing described the technique and

later modified by Ingraham.

 INDICATIONS:

 Absence of bleeding on probing.

 Sulcus depth less than 3mm.

 Presence of adequate keratinized

gingiva.
 PRINCIPLE:

The removal of sulcular epithelium

by rotary curettage & producing a
chamfer finish line on the tooth.
 TECHNIQUE:
 Shoulder finish line is prepared at the
level of the gingival crest.
 Torpedo nose diamond is used to extend
finish line apically & do gingival
curettage.
 Generous water spray used.
 Aluminum chloride or alum impregnated
cord is packed to control hemorrhage.
Flat end tapering

Torpedo
 ADVANTAGES:

 It is easy to perform
 It does not require any special

equipment.
 DISADVANTAGES :

 Poor tactile sensation.

 Can produce deepening of sulcus.

 Can produce potential damage to the

periodontium.
Electro
Surgery
 HISTORY:
 1891- d’Arsonval & Telsa
 1924 - William Clark- He is also
known as the Father of American electro
surgery.
 1924 - Wyeth introduced
endothermic knife.
ELECTROSURGERYUNIT:
 Principle
 It produces controlled tissue destruction
to achieve a surgical result.
 Current flows from a small cutting
electrode that produces a high current
density and a rapid temperature rise at its
point of contact with tissue leading to
tissue destruction.
 The circuit is completed by contact
between the patient and ground electrode
that will not generate heat in the tissues
because its large surface area produces a
low current density even though the same
amount of current passes through it.
Grounding of electrode:
 TYPES OF CURRENT:

1.Unrectified,damped. 2.Partially rectifed,damped (half

wave modulated).

3.Fully rectified (full wave modulated). 4. Fully rectified (filtered).

 INDICATIONS:
 Finish line exposure
 Before insertion of permanent

prosthesis.
 Removal of edentulous cuff.

 Crown lengthening purposes.

 Areas of inflammation and

granulation tissues
 Finish line close to epithelial

attachment.
 CONTRAINDICATIONS:

 Patients with cardiac pace-makers.

 In the presence of flammable agents

such as ether, ethyl chloride &
oxygen.
 TECHNIQUE:
 Profound anesthesia.
 Pleasant aromatic oil is applied at the
vermillion border of the lip (to mask the
unpleasant odor).
 Small, straight or J-shaped electrode is
selected
Electrode Tips
 TECHNIQUE….

 Connections are checked, cutting

electrode should be completely seated in
the hand piece.
 Plastic evacuator tip, mouth mirror.
Plastic Instruments
 TECHNIQUE….

 Plastic evacuator tip should be placed close

to the cutting electrode to remove the odor.
 Electrode tip is kept parallel to the long
axis of the tooth.
Orientation Of the tip
Removal of Edentulous Cuff

Pre OP Electrosurgery
 Removal of
Edentulous Cuff

Post OP
 TECHNIQUE….

 Very light pressure and quick and deft strokes.

 Electrode should move at a speed of 7mm/sec
 Tooth should be encompassed in four
separate motions (facial, mesial, lingual,
distal).
 TECHNIQUE….
 8 to10 seconds before proceeding to the
next area.
 Clean the electrode tip after each stroke.
 Sulcular debris are removed using cotton
pellet dipped in hydrogen peroxide.
Pre-op Post op
 Disadvantages
 Production of offensive odor .
 Improper use leads to excessive elimination of
tissues.
 Permanent marginal tissue recession by faulty
positioning of electrode.
 Retarded healing if not used carefully .
 Should be used with great care in the thin
labial gingivae of upper anterior (canines).
 Three important points

1. Proper power setting

2. Quick passes with the electrode
3. Adequate time interval between
strokes .
 Methods Available

 Moisture control
 Haemostasis /Sulcular cleansing

 Tissue Management
 Mechanical
 Mechano-Chemical


Surgical
 Tissue Friendly
Retraction material -
Expasyl
 Expasyl – a unique paste system
specifically designed for gingival
retraction that ensures separation of
the gingival margin and drying of the
sulcus.
Injectable retraction method to detach
the marginal gingiva without injuring
the epithelial attachment with
additional quality of haemostasis.
System consists of injectable
material that contains a haemostatic
agent, a specially designed gun,
and tips prepackaged in a carpule.
Armamentarium
Components
-- a highly viscous organic binder,
kaolin, essentially a clay (responsible for
the rigidity) which is mixed with a small
amount of Aluminium chloride to act as a
haemostatic agent, also to keep the
working field dry.
 PROCEDURE:

 The viscous paste is dispensed into the

sulcus with the special syringe or
cotton pellet or microbrush.
USING SYRINGE
USING COTTON PELLET
USING MICROBRUSH
 Care to be taken to place the tip of
the syringe parallel to the long axis of
the tooth to achieve successful apical
and lateral deflection of the gingiva.
 The paste to introduced into the
sulcus very slowly at a rate of app.
2mm/sec.
 When dispensing, the sulcus should
be filled with paste and the tissue
should blanch which ensures
adequate filling of the sulcus.
 The material holds its body after it is
injected into the sulcus.
 It is left in place for app. 1 to 2
minutes depending on the tonicity or
fragility of the gingival margin.
 Normal time is upto 2 minutes. Thin
and friable tissue should be treated
only for 1 minute.
 Also if used along with epithelial
detachment via rotary curettage or
with an electro surgical unit, required
time is only 30 secs.
Material is thoroughly rinsed
with air and water.
Preparation now made ready for impression
 PRECAUTIONS:
 Material is water soluble and begin
to lose its body and effectiveness to
retract the gingiva if wetted by
saliva or water.
 Tip of the
syringe to be
parallel to the
long axis of the
tooth and not to
be placed
subgingivally.
 Ideally, the material should be used
with any polyvinyl siloxane
impression material.
 When using hydrocolloid impression
or polyether materials, the material
should be thoroughly rinsed to avoid
any potential reaction between the
aluminium chloride and the material.
 Advantages:
The overall positive effects are:
Minimal trauma to the
periodontium– delivery of the material
is gentle, hence the risk of damage to
the epithelial attachment, gingival
recession and bone resorption is
greatly reduced
 Excellent haemostasis and good
sulcular moisture control to provide a
dry field ready for impression or
cementation.
 Can be with the single-cord
technique to access the margin.
 Reduced chair time and more
convenient– quick and easy procedure.
 Painless procedure and hence
anesthesia not required.
 No chemical reaction or material
expansion.
 Yield stress of Expasyl- higher than
the force exerted on the tooth by the
gingiva helping it to keep the sulcus
open- Reduces when it becomes wet.
 Force exerted 20 times less than a
single cord and 50 times less than
double-cord technique.
EXPASYL– Definitely
The Process Of
Managing The Tissue
Made Easy
My sincere thanks to

Dr. SANJANA NAYAR, M.D.S

Guide & Professor
Meenakshi Ammal Dental College &
Hospital