This document discusses fluid control and soft tissue management in fixed prosthodontics. It covers sources of moisture in the clinical environment and various methods for controlling moisture, including mechanical methods like rubber dams and retraction cords, chemical methods using drugs to reduce saliva, and chemicomechanical methods combining chemicals and pressure. It also discusses classification systems for retraction techniques and procedures for single cord gingival retraction.

1. FLUID CONTROL
AND SOFT TISSUE
MANAGEMENT IN
FPD
BY- DR.SWETHA.S
2ND YEAR PG

2. TABLE OF CONTENTS
■ INTRODUCTION
■ SOURCE OF MOISTURE IN CLINICAL ENVIRONMENT
■ CLASSIFICATION
■ METHODS OF MOISTURE CONTROL
MECHANICAL
CHEMICAL
CHEMICOMECHANICAL
SURGICAL
 RECENT ADVANCEMENTS IN RETRACTION
 CONCLUSION
 REFERENCES

3. Sources of moisture in clinical
environment
1.Saliva
■ Salivary glands-parotid, submandibular, sublingual
■ The mean flow rate (+/- SD) of unstimulated saliva was 0.26 +/- 0.16 ml/min
and that of saliva while chewing six different foods was 3.6 +/- 0.8 ml/min.
2.Blood Inflamed gingival tissues/Iatrogenic damage
3.Water/dental materials
Rotary instruments, triplex syringe, etchants, irrigant solutions On a average a
high speed rotatory cutting instrument is 30 mL per minute
4.Gingival crevicular fluid - 0.05 to 0.20 µL per minute

4. How is moisture control important?
1.Patient related factors
 Provides comfort.
 Protects from swallowing or spirating foreign bodies.
2. Task/technique being performed
 Dental materials are moisture sensitive, success of adhesion and
physical properties relies on a dry field.

5. 3. Operator related factors
■ Infection control to minimise aerosol production
■ Increased accessibility to operative site
■ Improves visibility of the working field
■ Less fogging of the dental mirror.
■ Prevents contamination.

6. Classification
■ 1.Barkmier W.W. and Williams H.W(1978)
a. Surgical Retraction
Gingivectomy and Gingivoplasty
Electrosurgery
Rotary Gingival Curettage
b. Non-Surgical Retraction
Rubber dam and clamps
Retraction cords
impregnated and non-impregnated
Retraction rings
copper bands

7. ■ 2. Thompson M.J.(1959)
1.Conventional
2.Radical
■ 3. B.W.Benson et al (1986)
1.Mechanical method
2.Mechanico-chemical method
3.Rotary gingival curettage
4.Electrosurgical methods.

8. Rubber dam
■ Introduced by S C Barnum 1864
USES
■ For core build up, pattern fabrication
■ impression making of inlays and onlays
■ Removal of old restoration and caries
■ For cementation
Contraindication
■ Should not be used with poly-vinylsiloxane interferes with polymerization
Patients allergic to latex

9. Advantages
■ Isolate one/more teeth
■ Eliminates saliva from operating site
■ Retracts soft tissue
Disadvantages
■ Time consuming and patients objection
■ Unusual tooth shapes or positions that cause inadequate clamp placement
■ Partially erupted teeth
■ Broken down teeth
■ Patients suffering from asthma

10. Rubber dam set
■ Rubber dam
■ Rubber dam punch
■ Rubber dam clamps
■ Rubber dam clamp forceps
■ Rubber dam frame/holder

11. FERRIER’S CLAMP
CERVICAL
RETRACTING
CLAMP

12. High volume vacuum
■ Powerful suction device, use of 10mm diameter tips, and a properly
functioning suction pump set to evacuate one liter per minute of fluid
Uses
■ Apparatus also removes small operatory debris
■ Excellent lip retractor
Disadvantages
■ Cannot be used for impression & cementation procedure

13. Saliva ejector
• Low volume suction devices
• 300 ml/ min is the suction rate
• Adjunct to high volume vacuum/ rubber dam/cotton rolls
Uses
Removes saliva from the floor of mouth
Removes water slowly

14. Suction tips/ saliva ejectors
■ Disposable saliva ejectors
■ Transparent [ plastic]
■ Multi coloured [ plastic]
■ Hygoformic saliva ejector

15. Cotton rolls
■ Commonest and cheap
■ Controls small amounts of moisture and retracts cheek and tongue
■ Keeps its shape and does not fall apart when full of saliva
■ Provides acceptable dryness for procedures
■ Cementation
■ Impression making Uses
Different types of cotton rolls
Wrapped
Braided

16. Reusable saliva ejectors
■ Saliva ejector with tongue guards
■ Steel

17. Svedopter
■ Metal saliva ejector with a tongue retractor
■ Used for mandibular arch
■ Most effective when patient is in a nearly upright position.

19. PINK
PETAL

20. CHEMICAL METHODS

21. Gastrointestinal anti cholinergic drugs that inhibit action of myo-epithelial cells of
salivary gland
1.Common drugs
• Bromide (Banthine) 50 mg 1 hr before procedure
• Propantheline bromide (Pro-Banthine) 15mg 1 hr before procedure
• Clonidine hydrochloride (Antihypertensive) 0.2mg 1 hr before procedure
• Atropine 1 tablet of 0.4mg per day
ANTI SIALAGOGUES

22. Contraindication of anti-sialogogues
a. Methantheline and propanthelin contraindication
Hypersensitivity to drugs
Glaucoma
Asthma
Congestive heart failure
Obstructive condition of GI tracts or urinary tracts
b. Clonidine hydrochloride
• Its an anti hypertensive drug hence should be given cautiously
• Causes drowsiness

23. GINGIVAL
RETRACTION

24. DEFINITION
■ Gingival retraction is the deflection of marginal
gingiva away from the tooth.(tissue dilatation)- GPT
■ Gingival retraction is a process of exposing margins
when making impression of prepared teeth.

25. IMPORTANCE OF FINISH LINE
EXPOSURE
 The finish line must be reproduced in the
impression.
 The marginal integrity is very important in
preventing recurrent caries and gingival
inflammation.
 So, the finish line must be exposed temporarily
to reproduce the entire preparation.

26. When a gingival
retraction technique is utilized, forces act in
four directions on the gingival tissues. These
are the retraction, displacement, collapsing
and relapsing forces .
1. Retraction is the downward and outward
force exerted on the gingival tissues by the
retraction technique or material;
2. Displacement is the downward force
resulting from excessive pressure during
retraction or in unsupported gingival tissues;
3. Relapse is when the gingival tissues rebound
to their original position; and
4. Collapse is when the gingival tissues
are further compressed towards the tooth
as a result of using close-fitting trays for
impression.

27. MECHANICAL METHOD
■ Copper ring technique
■ Matrix band and wedges
■ Gingival protector
■ Anatomic retraction caps
■ Retraction cords

28. Copper ring technique
■ This method involves the use of a copper band or ring, with the
gingival margins festooned according to the gingival contours.
■ This is useful for impression of an indirect restoration with
subgingival margins, where the copper band is filled with
modelling compound or elastomeric impression material, and
seated on the prepared tooth along the path of insertion.
■ This method physically displaces the tissue, which stays retracted
when the copper band is removed, so that the subsequent
impression records the subgingival tooth structure.
■ This technique may result in damage to the gingival tissues during
placement, as the assembly is difficult to remove once set due to
the presence of undercuts.

29. COPPER BAND TECHNIQUE

30. Matrix band and wedges
■ Matrix bands can provide retraction of gingiva and isolation when used for
cervical or subgingival restorations.
■ Wedges placed inter-proximally physically depress the gingival for retraction,
and can protect the gingiva during preparation of the tooth.

31. Gingival protector
■ This is a small instrument with a crescent-shaped tip, which can be placed and
adjusted according to the contour of the gingival tissues physically to protect
the gingiva during preparation of tooth structure close to the gingival margin.
■ They are useful during subgingival cavity removal and cavity preparation,
finishing veneer and other indirect restoration margins and to check the
proper seating of crowns with subgingivally placed margins

32. Anatomic retraction caps
■ The retraction caps follow the same principle as the copper bands, except that they
are pre-shaped, for easy placement between adjacent teeth and, once in place, the
patient bites on it.
■ The physical pressure arrests haemorrhage and opens the sulcus for the final
impression.

33. CHEMICOMECHANICAL METHODS OF
GINGIVAL RETRACTION
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.

34.  It should produce effective gingival
displacement and hemostasis
 It should not produce any irreversible damage
to the gingiva
 It should not have any systemic side effects.
Ideal Requirements for Chemicals
Used
with Gingival Retraction Cord

35. Chemico-mechanical Methods
They combine chemical action with pressure packing.
Abandoned caustic chemicals.
■ Sulfuric acid.
■ Trichlor acetic acid.
■ Negatol (49% condensation product of metacresol sulfonic acid and
formaldehyde).
■ Zinc chloride.
Chemical action
■ Vasoconstrictors  shrinkage of tissue.
■ Biologic fluid coagulants.
■ Surface layer tissue coagulants.

36. Chemicals Used In gingival
retraction
The following chemicals are generally local
vasoconstrictors which produce transient gingival
shrinkage.
 0.1-0.8 % Racemic epinephrine.
 5- 25%Aluminium chloride.
 100% Alum. (Aluminium potassium sulphate)
 Aluminium sulphate.
 Ferric subsulphate (monsel solution)
20-100% tannic acid
45% negatol
8-40% zinc chloride sol
13.3% ferric sulpate sol

37. Mechanism of action
• Epinephrine and nor-
epinephrine
Vasocostrictors
• Aluminium chloride,
tannic acid, alum.
Biologic fluid
coagulants
• Zinc chloride and
silver nitrate.
Surface layer
tissue
coagulants

38. ■ EPINEPHRINE
■ 0.1%-8% racemic epinephrine is used
■ 0.2 mg -1 mg of epinephrine per inch of cord
Contraindications of epinephrine
Cardiovascular disease
Hypertension
Diabetes
Hyperthyroidism
Known hypersensitivity to epinephrine
Patients taking
Tricyclic depressants
Ganglionic blockers
Cocaine

39. Astringent
■ Mechanism of action
Precipitation of protein
Inhibit transcapillary movement of plasma protein
Act as caustics at low concentration & irritants in moderate
concentration.
Low cell permeability.

40. Alum (Potassium aluminium sulfate)
■ 100% of alum soaked in retraction cord
■ Advantages
Safer and fewer systemic effects than epinephrine
Good tissue recovery
Can be placed inside the sulcus safely for 20 min
Disadvantages
0.1% of crestal bone loss
less gingival dispacement

41. Aluminum chloride
■ Mechanism
Precipitate protein
Constrict blood vessels
Extract fluid from tissues
Used in 5-25% concentration for 10 min
Least irritating
Disadvantage
Interferes with the setting of PVS materials

42. Ferric sub-sulfate
■ Also known as monsel’s solution
• More effective than epinephrine
• Good tissue recovery
•Recommended time- 3 min
Disadvantages
Solution is messy
Corrosive and injurious to soft tissues
Stain teeth
High acidity

43. Ferric sulfate
■ 13- 20%
■ Provides hemostasis on exposed connective tissue
■ Recommended packing time-1-3 min
■ Disadvantages Modify setting reaction of polyvinyl siloxane
■ Stains gingival tissue yellow-brown to black
Tannic acid
■ 20-100%
Recommended time- 10 min
■ Good tissue recovery

44. ZINC CHLORIDE (bitartarate) 8% - 40%
■ 8% =displacement = epinephrine.
■ it can cause severe necrosis of the tissues that did not heal in 60
days
■ 40% =displacement > epinephrine. Is very caustic and is termed
as a chemical cautery agent.
■ These sol. are not recommended for use as they are Eschariotic
and cause permanent injury to soft tissue and even bone.

46. Classification of retraction cords
 Depending on the configuration
Twisted
Knitted
Braided
 Depending on surface finish
Wax
Unwaxed

47. ■ Depending on the chemical treatment
Plain
Impregnated Depending on number strands
Single
Double-string
■ Depending on the thickness (color coded)
Black - 000
Yellow - 00
Purple - 0
Blue - 1
Green - 2
Red - 3

48. ■ Indications of #000
Anterior teeth
Double packing
Substitute for black silk suture as lower cord
in the "two-cord" technique
■ Indications of #00
• Preparing and cementing veneers
• Restorative procedures dealing with thin,
friable tissues

49. ■ Indications of #0
• Lower anteriors
• When luting near gingival and subgingival veneers
• Class III, IV and V restorations
• Second cord for "two-cord" technique
■ Indications of #1
• Tissue control and/or displacement when soaked in
coagulative hemostatic solution prior to and/or after crown
preparations
• Protective "pre-preparation" cord on anteriors

50. ■ Indications of #2
• Upper cord for "two-cord" technique
• Tissue control and/or displacement when soaked in coagulative
hemostatic solution prior to and/or after crown preparations
• Protective "pre-preparation" cord on anteriors
■ Indications of #3
Areas that have fairly thick gingival tissues where a significant amount of
force is required
• Upper cord for those desiring the "two-cord" technique

51. Instruments used for gingival
retraction
• Evacuator
• Scissors
• Cotton pliers
• Mouth mirror
• Explorer
• Fisher ultrapak packer
• DE plastic filling instrument IPPA

52. Fisher ultrapak packer
■ Small Packer (45 degrees to handle)
■ Small Packer (90 degrees to handle)
45 degrees
Heads at 45 degrees
Three packing sides.
Small packer for lower anteriors and upper lateral incisors.
90 degrees
Three sided heads
One of the heads in line with shank
Second is at a right angle to the shank.

54. Techniques of gingival retraction
 Single cord technique.
 Double cord technique.
 Infusion technique of gingival displacement.
 Every other tooth technique.

55. SINGLE CORD TECHNIQUE
■ 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.
■ Next, the retraction cord is drawn from the dispenser bottle with
sterile cotton pliers and a piece of approximately 5 cm (2 inch) long is
cut off.

56. ■ The cord is twisted to make it tight and small
■ The retraction cord should be dipped in 25% AlCl3 solution in a
dapen dish.
■ Haemorrhage can be controlled by using haemostatic agents.
■ The retraction cord is looped around the tooth and held tightly
with the thumb and forefinger.

57. ■ The cord is packed into the
gingival sulcus starting from
the mesial surface of the
tooth. The cord should be
stabilised near the distal end
of the tooth.
■ The cord can be packed with
special instruments like
Fischer Packing instrument or
a DE plastic instrument IPPA.

58. ■ Force should be applied in a
mesial direction during cord
placement so that the packed
preceding segment does not
get dislodged.
■ 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

59. ■ The instrument is inclined at an angle towards the tooth
surface. If it is held parallel to the long axis of the
tooth, the retraction cord will be pushed against the
wall of the gingival crevice, and will rebounce

60. ■ 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.

61. ■ Atleast 2-3 mm of cord is left protruding outside
the sulcus so that it can be grasped for easy
removal.
■ After 10 minutes, the cord should be removed
slowly in order to avoid bleeding.
■ If active bleeding persists, a cord soaked in
ferric sulphate should be placed in the sulcus
and removed after 3 minutes.
■ The impression should be made only after
cessation of bleeding.
■ The retraction cord must be slightly moist before
removal. Removing dry cord from the crevice can
injure the delicate epithelial lining of the
gingiva.

62. Double cord technique Indication
• Impression of multiple prepared teeth
• Impression for compromised tissue health
■ Small diameter cord is placed in sulcus
■ Second cord soaked with hemostatic agent placed over
small cord for 8-10 minutes.

63. Infusion technique Indication
■ Controls hemorrhage
Procedure
■ Retraction cord packed into the sulcus for 1-3 minutes.
■ Infuser used with a burnishing motion in the sulcus
circumferentially 360° around the sulcus

64. EVERY OTHER TOOTH TECHNIQUE
■ In case of multiple anterior tooth preparations with close root proximity,
placing the retraction cord simultaneously around all teeth will result in
strangulation of interdental papillae.
■ This can impair gingival health as well as cause black inter-dental triangles.
■ To avoid this, ‘every other tooth’ technique of gingival displacement in
combination with sectional impressions may be used to provide a better
master cast in multiple tooth preparations.

66. SURGICAL METHODS (Troughing or Tissue
dilatation)
■ Currently, the trough, soft-tissue excision, extends from the height of
the free margin of the gingiva to a point 0.3–0.4 mm apical to the finish
line margin of the tooth preparation.
■ Unlike other methods that provide gingival displacement, the surgical
method removes gingival tissues and thus would require soft-tissue
healing.
■ In this type of surgical gingival tissue management, burs are used to
create a trough in the sulcus around the finish line.
■ It requires local anaesthesia to prevent patients from experiencing
discomfort and can result in bleeding at the site. This method can be
used for both direct and indirect types of restorations

67. ROTARY CURETTAGE
(Amsterdam 1954)
 Troughing technique or “gingettage”
 Produce limited removal of epithelial tissue in the
sulcus while a chamfer finish line is being created
in tooth structure.
Criteria for rotary curettage
Done on healthy and inflammation free tissue to prevent
tissue shrinkage
Absence of bleeding on probing
Sulcus depth less than 3.0 mm
Presence of adequate keratinized gingiva

68. Electro Surgery
■ Electrosurgery denotes surgical reduction of sulcular epithelium using an
electrode to produce gingival retraction
■ Mechanism of action
Controlled tissue destruction.
Current flows through a small cutting electrode
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”

69. TISSUE CONSIDERATIONS
■ Keep electrode in motion.
■ 5-10 seconds between applications.
■ Patient should be properly grounded.
■ Tissue must be moist.
■ Electrode must remain free of tissue fragments.
■ Electrode must not touch any metallic restorations.

70. Types of current
1.Fully Rectified current (modulated)
– continuous flow of current
– good cutting characteristics
– enlargement of gingival sulcus
2.Fully Rectified current (filtered)
– continuous current wave
– excellent cutting characteristics
– less injury than modulated current

71. 3.Partially rectified current (damped)
■ Considerable tissue destruction.
■ Slow healing.
■ Used for spot coagulation.
4.Unrectified current (damped)
■ Causes intrinsic dehydration and necrosis.
■ Slow and painful healing.
■ Not used in dental surgery.

72. ADVANTAGES
Clear operating area without or no bleeding
Healing by primary intension
Less tissue loss after healing
DISADVANTAGES
Unpleasant odour.
Slight loss of crestal bone
Burn mark on the root surface
Not suitable for thin gingiva.
CONTRAINDICATIONS
Patients with cardiac pace maker.
Patients with delayed wound healing.
Patients on steroid therapy.
In the recently irradiated areas.

73. LASERS
Indication
Controlled tissue removal before impression making
Tissue contouring Properties of laser depends on
Wavelength
Waveform
TYPES OF LASERS
Neodymium: yttrium-aluminium-garnet
Erbium: yttrium- aluminum-garnet

74. ■ Advantages
Minimum pain and discomfort
Less fear ,anxiety and stress
Minimum or no anesthesia
No drill sounds
Less chair time
Reduced post operative complications
Minimum or no bleeding
Disadvantage
Overuse causes shrinkage of tissue and also results in exposure of crown margin
■ Disadvantages
■ Er: YAG lasers are not good for producing hemostasis
■ CO2 laser provides no tactile feedback, leading to risk of damage to junctional
epithelium.

75. RECENT ADVANCES IN
GINGIVAL RETRACTION

76. EXPASYL RETRACTION PASTE (SDS/KERR) aceteon 2000
COMPOSITION
- kaolin – retracts the tissue
- aluminium chloride- about 15%-
hemostasis
COMPOSITION
- kaolin – retracts the tissue
- aluminium chloride- about 15%-
hemostasis

77. ■ The Expasyl paste is syringed into the crevicular space using a
stable non deliberate pressure of 0.1N/nm.
■ When Expasyl is injected and held in place for a minute, it will
generate sufficient pressure to acquire a sulcus opening of
0.5mm,for two minutes

78. ■ Advantages
Effectively achieves hemostasis.
Effectively retracts gingival tissues
Less traumatic to tissues than cord packing.
Faster than traditional cord.
Easy removal from sulcus by rinsing.
Dispenser tips can bent- improves intraoral access.
Disadvantages
Expensive
Effective under limited conditions.
Disposable metal dispenser tips are too large causes difficulty to express
Thickness makes it difficult to express

79. MAGIC FOAM- Foamcord (Coltene/Whaledent)
■ Developed by Prof Dr. Dumfahrt
Non-hemostatic gingival retraction system (Coltène/
Whaledent)
First expanding vinyl polysiloxane material designed for
retraction of the gingival sulcus

80. ■ Mechanism
• Expansion of silicon foam.
Magic foam cord is a polymeric material which is introduced into
the gingival sulcus and allowed to set.
The patient is advised to bite on a cap (comprecap) while
maintaining the pressure on for 3 minutes.
The material slightly expands during setting and produces
exceptional lateral and vertical displacement. The cap and foam
are removed after 5 minutes and the tooth is set for the final
impression
Limitation
Limited clinical indications
Less hemostatic
No improvement in speed/quality compared to cord
Less effective on sub gingival margin

81. Gingitrac (Centrix co)
Based on vinyl polysiloxane material with aluminium sulfate astringent.
Mild natural astringent gel
Utilizes patient s bite pressure to push material into sulcus and retract gingiva
Consists of
Mixing gun
Gingitrac cartridge
Gingitrac matrix cartridge
Mixing nozzle
Dispensing tips
Gingicap

82. Single-Unit Retraction Technique
Select GingiCap
Dispense GingiTrac into the
GingiCap and around the prep.

83. Bite down and wait 5 minutes
Ready for impression

84. Matrix Impression System(1983,
Livaditis )
Procedure includes three steps.
■ First, a matrix of occlusal registration elastomeric material is done over the
prepared tooth.
■ The retraction cord is removed and a definitive impression is recorded in the
matrix using a high viscosity elastomeric impression material.
■ After the matrix impression is positioned, medium viscosity elastomeric
material is loaded in an impression tray and is seated over the matrix and
remaining teeth to create impression of the entire arch.
■ The design of the matrix also forces the high viscosity impression material along
the preparations and into the sulcus. The matrix impression system uses three
impression materials of different viscosities.

85. ■ Advantages
■ Eliminates chances of tearing of the sulcus
■ Cleans blood and debris from the sulcus area
■ Delivers impression material in the gingival sulcus slowly and with more
accuracy and speed
■ Holds the sulcus open for an increased time.
■ Disadvantages
■ Increased chairside time.

88. Merocel Strips
■ Merocel retractions strips are synthetic material, which are specifically
chemically extracted from a polymer hydroxylate polyvinyl acetate that
creates a net-like strip without debris or free fragments.
■ Placement of Merocel retraction technique does not require use of local
anesthesia.
■ The porous and sponge-like microstructure of Merocel produces a dry field for
the impression to accurately capture the details.
■ The absence of fibers decreases the risk of postoperative problems.

89. Advantages
■ It is shaped easily
■ It effectively absorbs oral fluids
■ The sulcus is clean without the presence of any debris.

90. Stay put
1. IMPREGNATED Combines the advantages of both an impregnated and braided
cord with the adaptability of an ultrafine copper filament.
Aluminum chloride hexahydrate is used for impregnation.
2. Nonimpregnated stay put cord is also available which can be impregnated with
hemostatic agent as needed.
■ Advantages
■ Hemostasis is fast
■ Possible to be preshaped
■ Pliable and can be adapted
■ Relatively safe for cardiac patients.

91. Gel-Cord G
■ Gelcord comprises of- 25% Aluminum Sulfate Gel.
■ Unlike liquid astringents it stays put when placed for maximum hemostasis.
■ The gel is rubbed mildly into the hemorrhaging area.
■ Gelcord is flavored well for greater patient acceptance and brightly colored
for better visualization. It provides enough lubrication for the initial cord to
slide easily into the sulcus.

92. Tissue Goo
■ Tissue Goo is a gel that contains active ingredient is 25% aluminum sulfate
stays put where it is placed and provides ample hemostasis during tissue
management processes.
■ The retraction cord will provide ideal tissue displacement, while absorbing the
goo and deliver hemostasis.

93. G CUFF
■ A Canadian company, named Stomatotech,
launched a disposable plastic collar for gingival
retraction which is inserted on the apical end of
the abutment before the abutment is engaged to
the implant.
■ The plastic collar is found between the apical
part of the abutment and the gingival soft tissue.
■ Once the impression is retrieved from the mouth,
the plastic collar is drawn out and removed
permanently.
■ The plastic creates a valve preventing the liquids
from contaminating the area of the finish line of
the abutment.

94. Retraction Capsule
■ The recently introduced 3M™ ESPE™ Retraction Capsule is 15% aluminum
chloride retraction paste.
■ It is packaged in unit-dose capsules with an extra-fine tip that fits directly into
the sulcus.
■ When compared with retraction cords, the retraction procedure the retraction
procedure with this material can be up to 50% faster.
■ Fine tip of the capsule offers improved access into the sulcus and interproximal
areas.
■ As the tip of the capsule is plastic with round, soft edges, practitioners can use it
with less apprehension about detrimental effects on the tissue and patient
discomfort

95. Traxodent
• Syringe-dispensed 15% aluminum chloride, hemostatic paste
• Ergonomic syringe
• Easy to use
• Disposable and flexible tips
• Each syringe can be repacked for maximum freshness
• Paste with a malleable consistency

96. Racegel
■ Before impression making, it is used to obtain hemostasis and dry field in
the sulcus.
■ Racegel becomes more viscous on tissue contact because of its
thermodynamics.
■ It contains 25% aluminum chloride, oxyguinol, and excipients.
■ Aluminum chloride - astringent.
■ The gel can be used with or without gingival retraction cords.
■ Racegel produces finish line exposure with minimum bleeding.
■ It is easily rinsed, leaving no irritation of the surrounding tissue. Its
thermal effect is reversible when rinsed with water.

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

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

101. References
1. Rosenstiel,Land,Fugimoto
Contemporary Fixed Prosthodontics 3rd edi. The mosby co.
2. Shillingburg H.T etal.
Fundamentals of fixed Prosthodontics.3r edi.quintessence pub.co

102. 1.Donovan T.E. et al: Review and survey of
medicaments used with gingival retraction cords.
J.P.D.1985 vol.58 pg.525-531
2.Miller I.F:Fixed dental prostheses.
J.P.D.1958 vol.8 pg.483-495
3.Ruel J. et al:Effects of retraction procedure on
periodontium of humans.
J.P.D.1980 vol.44 pg.508-514
4.Reiman B.Milford:Exposure of subgingival margins
by non-surgical gingival displacement.
J.P.D.1976 vol.436 pg.649-654

103. 5.barkmier WW ,Williams H.W.:Surgical methods of gingival retraction for
restorative dentistry.
J.A.D.A. 1978,vol.96,pg.1002-1007
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105. THANK YOU