This document discusses fluid control and gingival displacement techniques which are important for accurate impressions and cementation of restorations. It describes various methods for fluid control including cotton rolls, rubber dams, high and low vacuum suction, and antisialogogues. Methods for gingival displacement include mechanical techniques like rubber dams and retraction cords, as well as surgical methods like electrosurgery and lasers. Retraction cords work by both mechanically separating tissue and chemically providing hemostasis, while lasers provide benefits like hemostasis, reduced post-operative pain and less gingival recession. Mastering these techniques helps produce quality restorations with proper fit.

1. FLUID CONTROL AND SOFT TISSUE
MANAGEMENT
Dr Anil Koruthu
Reader
Royal Dental College

2. Control of fluids and appropriate displacement of gingiva are
essential during tooth preparation to obtain accurate impressions
and for cementation
INTRODUCTION
 They enhance operator visibility
 Increase patient comfort
 Aid in impression and cementation processes
The various procedures used in fluid control and gingival displacement
are discussed in the seminar

3. FLUID CONTROL

4. OBJECTIVES
Primarily to remove fluids, isolate and retract oral tissues.
 To enhance operator visibility and patient comfort during
procedures
 To prevent injury to patient’s oral tissues
 To prevent aspiration of fluids along with restorative debris
 To isolate specific areas and ensure dry operating field for
impression and cementation procedures

5. METHODS
1) Cotton rolls
2) Rubber dams
3) High vacuum suction
4) Saliva ejector ( Low vacuum suction)
5) Svedopter
6) Antisialogogues

7. COTTON ROLLS

8.  Simplest method
 Maxillary arch - Single roll at opening of parotid duct
 Mandibular arch – Multiple rolls Both on buccal and lingual sides
Alternatively, a single long role can be placed in the mucobuccal
fold.
 A low vacuum suction is commonly used along with.

9. HIGH VACUUM SUCTION

10.  Used during tooth preparation
 Powerful instrument
 Can be used to retract lip

11. LOW VACUUM SUCTION / SALIVA EJECTOR

12.  Used during impression and cementation process
 Can be used without assistance

13. SVEDOPTER

15.  Flange type of saliva ejector made of metal
 Used for fluid removal and tongue retraction
Can be used with patient in an upright position, without assistance
 Access to lingual surface of mandibular teeth may be limited
 May injure floor of mouth
 Contraindicated in case of mandibular tori

16. ANTISIALOGOGUES
 ANTICHOLINERGIC DRUGS: Atropine, Dicyclomine, Propantheline
 They are given one hour prior to procedure
 Contraindicated in cases of glaucoma, asthma, obstructive
conditions of g.i.t, CCF
 CLONIDINE : Anti hypertensive drug.
 Safer than other anticholinergics but may cause drowsiness
 LOCAL ANAESTHETICS : Block impulses from PDL ligament that
regulate salivary flow

17. DRUG DOSE
Atropine sulphate 0.4 mg
Dycyclomine HCl 10 - 20 mg
Propanthelene bromide 7.5 – 15 mg
Clonidine 0.2 mg

18. GINGIVAL DISPLACEMENT
Deflection of marginal gingiva away from tooth (GPT8)

19. INDICATIONS
 To provide adequate reproduction of finish lines
 To accurately duplicate subgingival margins
 To provide best possible condition for impression material,
fluid control
 To fabricate accurate restorations thereby prevent periodontal
problems

20. OBJECTIVES
 To expose prepared finish line
 To control GCF
 To evaluate depth and uniformity of finish line
 Allow refinement of finish line without laceration of soft tissue
 Provide access for impression material to record accurately the
finished margins and a apart of unprepared tooth beyond the
finish line.

21.  Helps to obtain accurate marginal fit which will reduce
marginal leakage and subsequent deterioration of tooth.

22. METHODS
Methods of gingival
retraction
Mechanical
Rubber dam
Cotton threads
Copper band
Magic foam
Mechanical-
Chemical Retraction cords
Surgical
Rotary curettage
Electrosurgery
Soft tissue lasers
Chemical EXPASYL

23. MECHANICAL
1) Rubber dam
2) Cotton thread
3) Copper band
4) Magic foam

24. COPPER BAND

26.  Carries impression material and displaces gingiva
 Materials used : Impression compound and elastomeric
impression materials.
 No longer used routinely.
 May be indicated with multiple abutments
 Can cause injury to gingiva and retraction is also minimal.

27. One end of copper band is trimmed to follow the contours of
gingival margins. Top part is plugged with resin or compound. A
vent is placed to allow the escape of excess impression material.
Dental floss is threaded through the vent to facilitate easy band
removal. The tube is filled with impression material and is placed
parallel to the tooth such that the trimmed margins coincide with
free marginal gingiva gently displacing them.

28. RUBBER DAMS

29. Used when limited number of teeth are being restored in one
quadrant and when preparations do not have to extend
subgingivally
Addition silicones must be avoided as rubber interferes with its
setting.

30. COTTON THREADS
Plain cotton threads have been used.
Retraction achieved is purely physical without any haemostasis,
very less and transient

31. MAGIC FOAM

32.  It consist of ‘COMPRECAP’ – a hollow cotton and ‘MAGIC
FOAMCORD’- a polyvinyl siloxane material
 Prior to impression making, a suitably sized COMPRECAP is
selected.

33.  MAGIC FOAMCORD is injected around the preparation and
inside the COMPRECAP and is placed over the prepared tooth.
 Patient is asked to gently bite the COMPRECAP .

34. Easy to use with less trauma
 Less retraction than cord
 Haemostasis must be established prior to retraction

35. MECHANICAL - CHEMICAL
RETRACTION CORDS

36. A displacement / retraction cord is used for mechanically
separating the tissue from prepared margin and is impregnated
with a chemical for astringent action and/ or haemostasis and
impressions are made.

37. IDEAL REQUIREMENTS
 Dark in color and never red
 Be made of absorbent material
 Strong enough to resist displacement and should not snap
 It should be available in different diameters

38. CHEMICALS USED
1) Ferric sulphate (Fe2[SO4]3) 20-25 %
2) Aluminium chloride (AlCl3) 15- 29 %
3) Racemic epinephrine 8 %

39. CLASSIFICATION
Plain
Impregnated
Twisted
Braided
Knitted
Lubricated
Non lubricated

40. KNITTED CORDS
BRAIDED CORDS

41. TECHNIQUES
SINGLE CORD TECHNIQUE : One cord is placed in sulcus and
impression is made immediately following retraction after cord is
removed
DOUBLE CORD TECHNIQUE : One thinner cord is packed deep
into the sulcus and is left there while making the impression whereas
the larger second cord is removed.

42. SINGLE CORD TECHNIQUE
1) Cut about 2 inches of cord
2) If impregnated, moisten cord intraorally, or else dip in the
solution.
3) Form a ‘U’ shape and loop it around prepared tooth.
4) Use cord packing instrument to secure the cord into the
sulcus

43. Retraction cord may be dipped in
appropriate haemostatic agent prior to
placement
A loop of retraction cord is formed
around the tooth and held tautly with
thumb and forefinger

44. Cord grasped from lingual side
Placement of retraction cord is begun by
pushing it into sulcus on the mesial
surface of tooth

45. Instrument must be angled slightly toward the
root to facilitate subgingival placement of cord
Cord packer angled
towards the tooth

46. 5) Excess cord is cut leaving a small tag
6) After 10 min, moisten the cord with saline and remove it.

47. DOUBLE CORD TECHNIQUE

48.  Double cord technique is indicated when making impression of
multiple prepared tooth and when the tissue health is slightly
compromised with more than normal bleeding anticipated.
 A small diameter cord is placed first.
 A second cord is placed over it soaked in haemostatic agent.
 8 – 10 minutes after placement, the second cord is removed.
 1st cord is left in the sulcus while making impression

49. CHEMICAL METHOD
EXPASYL is used.
 It is composed of Aluminium chloride containing paste.

50. The paste is left in the sulcus for 3 – 4 min and then washed off to
make impression.
It achieve good haemostasis with less trauma but produce much less
retraction

51. SURGICAL
1 ) Rotary curettage ( Gingettage)
2 ) Electrosurgery

52. ROTARY CURETTAGE
 It was described by Amsterdam in 1954
 It is a gingival troughing technique.
 Epithelial tissue in the sulcus is removed by a rotary instrument
while finish line is being created.

53. The technique can be used only if there is
Absence of bleeding upon probing
 Sulcus depth less than 3 mm
 Presence of adequate keratinized gingiva

54. A shoulder is formed at the
level of gingival crest prior to
rotary curettage
Epithelial tissue in the sulcus is
removed by a Torpedo diamond
bur while creating the finish
line

55. Gingival retraction
produced by creating a
trough around finish
line
There is chance for deepening the sulcus due to poor tactile sensation
 It has the potential for destruction of periodontium in inexperienced
hands

56. ELECTROSURGERY
High density current from a small cutting electrode will produce a
rapid rise of temperature at the point of contact with the tissue. The
cells in contact with the electrode are destroyed by this rapid rise in
temperature.

57. INDICATIONS
 Gingival sulcus enlargement and haemostasis
 Gingivectomy
 Crown lengthening

58. CONTRAINDICATIONS
 Patients with electronic medical device : Pacemaker, insulin pump
 Patients with delayed healing due to debilitating disease or radiotherapy
 Thin attached gingiva
 Not to be used with metal instruments, prefer plastic mouth mirrors and
suction tips
 Should not be used in presence of flammable substances – topical
anaesthetics like ethyl chloride or other aerosols, nitrous oxide analgesia as
electrosurgery can produce sparks during use

59. UNIT
ELECTRODES
GROUNDING PLATE
HANDPIECE

60. UNIT : A high frequency oscillator or radio transmitter that
generates heat
HANDPIECE : Holds the electrode
ELECTRODES : Used for cutting or coagulation. Small straight
electrode is used for gingival displacement.
GROUNDING PLATE : Completes circuit and prevents burns.

62. Gingiva prior to surgery Enlarged sulcus after procedure

63. The working electrode should be angled at 15 – 20 degree.
The tip is carried through the tissue until it rests on tooth and a wedge
of tissue is removed.
In case of thin gingiva, electrode is angulated parallel to tooth.
It must be moved at a speed of 7mm/sec to prevent lateral heat
penetration.

64. No stroke should be repeated immediately and if needed, a time
lapse of 5 sec should be provided.
The sequence is lingual, facial, mesial and finally distal.
High volume suction should be kept to prevent foul odour.

65. SOFT TISSUE LASERS

67. Different types of dental soft tissue lasers:
1) Carbon dioxide laser
2) Er: YAG laser
3) Er: YSGG laser
4) Nd: YAG laser
5) Diode laser
6) Argon laser

68. INDICATIONS
1) Frenectomies
2) Ablation of lesions
3) Incisional and excisional biopsies
4) Gingivectomy
5) Gingivoplasty
6) Soft tissue tuberosity removal
7) Operculum removal
8) Coagulation of graft donor site
9) Crown lengthening procedures
10)Gingival displacement and retraction

69. ADVANTAGES
1) Excellent haemostasis
2) Good visibility with pen style holding
3) Efficient and effective soft tissue removal
4) Safe around implants
5) Typically needs no topical anesthesia
6) No periodontal pack or suturing is required
7) Reduced post operative pain
8) Reduced swelling and discomfort
9) Reduced gingival recession following margin exposure.

70. CONCLUSION
Gingival displacement is an important procedure for fabricating
indirect restorations, especially when subgingival finish lines are
used. It is simple and effective when dealing with healthy
gingival tissue and when margins are properly placed.

71. REFERENCE
1) Rangarajan V, Padmanabhan T V Textbook of Prosthodontics, 2ND
Edition, Elsevier Publications, New Delhi, 2017
2) https://www.dentalacademyofce.com/courses/1779/PDF/SoftTissu
eLasersandProcedures.pdf