It shows methods of gingival retraction and its recent advances. gingival retraction is done prion to tooth preparation or impression making to widen the gingival sulcus for easy access to the margin around tooth that is prepared.

1. GINGIVAL RETRACTION
AND
RECENT ADVANCES
Presented by-
Dr. Ayesha Burugpalli

2. INTRODUCTION
• RESTORE AND MAINTAIN HEALTH, FUNCTIONAL
COMFORT AND AESTHETIC APPEARANCE.
• CERVICAL FINISH LINES.
• ACCURATE IMPRESSIONS.

3. DEFINITION
GPT 8
“THE DEFLECTION OF THE MARGINAL GINGIVA AWAY FROM
A TOOTH.”

4. TERMINOLOGY
• THE PROCEDURE TO EXPOSE THE SUB-GINGIVAL FINISH
LINES OF PREPARATION MAY BE TERMED AS
• GINGIVAL DISPLACEMENT, (HOLMES HM, 1968),
• GINGIVAL RETRACTION,
• GINGIVAL DEFLECTION AND
• GINGIVAL TISSUE DEFLECTION.

5. NEED
• TO WIDEN THE GINGIVAL SULCUS.
• HELPS IN OBTAINING THE PERFECT DIE WITH ACCURATE
MARGINS RESTORATION.
• IT INDIRECTLY PREVENTS MARGINAL CARIES, PLAQUE
ACCUMULATION AND MARGINAL GINGIVITIS.

6. NEED
• HELPS IN BLENDING OF THE RESTORATION WITH THE
UNPREPARED TOOTH SURFACE.
• TO ENHANCE ACCESS AND TO PREVENT DAMAGE TO
THE SOFT TISSUE DURING CAVITY PREPARATION.
• WHILE CEMENTATION IT HELPS IN EASY REMOVAL OF
CEMENT WITHOUT TISSUE DAMAGE.

7. REQUIREMENTS
• THE GINGIVAL TISSUES MUST BE HEALTHY AND FREE OF
INFLAMMATION.
• CERVICAL MARGINS SHOULD BE PLACED IN THE APPROPRIATE
POSITION.
• THE OPTIMUM POSITION OF THE MARGINS IS 0.5 MM
FROM THE HEALTHY FREE GINGIVAL MARGINS OR 3-4 MM
FROM THE CREST OF THE ALVEOLAR BONE.

8. • IMPRESSION MATERIAL SHOULD HAVE A GOOD TEAR
STRENGTH.
• THE CRITICAL SULCULAR WIDTH SHOULD BE APPROX.
0.2 MM.
• QUALITY PROVISIONAL RESTORATION.

9. TECHNIQUES
• TECHNIQUE FOR GINGIVAL DISPLACEMENT CAN BE
CLASSIFIED AS:
• MECHANICAL,
• CHEMICAL,
• SURGICAL,
 ROTARY GINGIVAL CURETTAGE (GINGETTAGE).
 ELECTRO SURGICAL METHODS.
• COMBINATION OF ALL.

11. 1. MECHANICAL
• MECHANICAL METHODS OF GINGIVAL DISPLACEMENT
WERE AMONG THE FIRST DEVELOPED.
• THESE METHODS INVOLVED PHYSICAL DISPLACEMENT OF
THE GINGIVAL TISSUE BY PLACEMENT OF MATERIALS
WITHIN THE GINGIVAL SULCUS.

12. • THE VARIOUS MATERIALS USED ~>
A. HEAVY WEIGHT RUBBER DAMS.
B. COPPER BANDS.
C. ALUMINUM SHELL.
D. MECHANICAL PACK OF ZINC OXIDE EUGENOL.
E. ROLLED COTTON OR SYNTHETIC CORD.

13. A. HEAVY WEIGHT RUBBER DAM
• THE RETRACTION IS PRODUCED WHEN THE HEAVY WEIGHT RUBBER
DAM COMPRESSES THE TISSUE.
• ACCORDING TO GILMORE, IT CAN BE CALLED “GUM COMPRESSION”
RATHER THAN GUM RETRACTION.
• LIMITED NUMBER OF TEETH IN ONE QUADRANT ARE BEING RESTORED
AND IN SITUATIONS IN WHICH PREPARATION DO NOT HAVE TO BE
EXTENDED VERY FAR SUB GINGIVALLY.
• SHOULD NOT BE USED WITH POLYVINYL SILOXANE IMPRESSION

14. B. COPPER BAND
• IT SERVES AS A MEANS OF CARRYING THE IMPRESSION MATERIAL
AS WELL AS A MECHANISM FOR DISPLACING THE GINGIVA.
• ONE END OF THE TUBE IS FESTOONED, OR TRIMMED TO FOLLOW
THE PROFILE OF THE GINGIVAL FINISH LINE, WHICH IN TURN
OFTEN FOLLOWS THE CONTOURS OF THE GINGIVAL MARGIN.

15. • IMPRESSION COMPOUND AND ELASTOMERIC MATERIALS.
• COPPER BANDS ARE ESPECIALLY USEFUL FOR
SITUATIONS IN WHICH SEVERAL TEETH HAVE
BEEN PREPARED.
• THE USE OF COPPER BANDS CAN CAUSE
INCISIONAL INJURIES OF GINGIVAL TISSUES.

16. C. ALUMINUM SHELL
• ALUMINUM SHELL OF CORRECT SIZE IS SELECTED, TRIMMED TO
CONFORM TO THE GINGIVAL CONTOURS AND THE
MARGINS ARE SMOOTHENED.
• IT IS FILLED WITH COMPOUND OR GUTTAPERCHA AND PLACED
ON THE TOOTH UNDER THE OCCLUSAL PRESSURE.
• THE EXCESS MATERIAL FROM GINGIVAL END WILL DISPLACE
THE FREE GINGIVA.

17. D. MECHANICAL PACK OF ZOE
• THE MECHANICAL PACK IS MADE FROM SLOW-SETTING ZOE
PASTE.
• FINE STERILE TWILLS OF COTTON ARE TWISTED TOGETHER
AND ROLLED IN PASTE THEN PLACED IN THE GINGIVAL
SULCUS.
• FOR A MINIMUM OF 48 HOURS.
• NON-SURGICAL PERIODONTAL PACK MAY ALSO BE USED.

18. E. ROLLED COTTON OR SYNTHETIC CORD
• THIS IS THE METHOD OF CHOICE AS THE AVAILABILITY IS NOT
A PROBLEM AND THE APPLICATION IS EXCEEDINGLY EASY.
• PLAIN COTTON THREAD, UNWAXED FLOSS, COTTON
SYNTHETIC CORD, UNTREATED SURGICAL SILK, AND ELASTIC
RETRACTION RINGS .
• WET OR DRY.
• THINNER GRADE CORD IS USED AROUND THE ANTERIOR
TEETH AND THICKER ONE AROUND THE POSTERIOR TEETH.

19. • THREE VARIETIES OF CORDS ARE GENERALLY AVAILABLE.
• LOOSE TWISTED
• BRAIDED
• KNITTED.
• BRAIDED AND KNITTED VARIETY DOES NOT SEPARATE WHEN
THEY ARE PUSHED INTO THE SULCUS AND SO
THEY ARE EASIER TO USE.

21. 2. CHEMICO-MECHANICAL
• THIS METHOD AIMS AT COMBINING CHEMICAL ACTION WITH
PRESSURE PACKING, ENLARGEMENT OF THE GINGIVAL SULCUS
AS WELL AS CONTROL OF FLUIDS SEEPING FROM THE
WALLS OF THE GINGIVAL SULCUS.
• CHEMICALS USED ARE BROADLY CLASSIFIED AS:
• VASO CONSTRICTORS.
• DRUGS WITH STYPTIC ACTION.
• ASTRINGENTS.

22. VASO CONSTRICTORS:
• PHYSIOLOGICALLY RESTRICT THE BLOOD SUPPLY BY DECREASING THE
SIZE OF THE BLOOD CAPILLARIES.
• THE AGENTS USUALLY USED ARE 1:1000 EPINEPHRINE AND HIGHER
CONCENTRATIONS OF EPINEPHRINE.
• THE RETRACTION IS ACHIEVED IN 10 MINUTES.
• USE SHOULD BE VERY LIMITED BECAUSE….

23. • IT IS CONTRAINDICATED IN SOME OF THE CONDITIONS
SUCH AS:
 PATIENTS WHO ARE HYPERSENSITIVE TO EPINEPHRINE.
 PATIENTS WITH CARDIOVASCULAR DISORDERS.
 PATIENTS WITH PACEMAKERS.
 HYPERTHYROIDISM.
 PATIENTS ON DRUGS SUCH AS;
 RAUWOLFIA COMPOUND.
 GANGLIONIC BLOCKERS.
 EPINEPHRINE POTENTIATING DRUGS.

24. • STYPTICS:
• BIOLOGIC FLUID COAGULANTS LOCALLY COAGULATE BLOOD
AND TISSUE FLUIDS CREATING THE SURFACE LAYER WHICH IS
AN EFFICIENT SEALANT AGAINST BLOOD AND CREVICULAR
FLUID SEEPAGE.
EG: 1. 100% ALUM SOLUTION (POTASSIUM ALUMINUM
SULFATE).
2. 5 – 25% ALUMINUM CHLORIDE.
3. 10% ALUMINUM POTASSIUM SULFATE.
4. 15 – 25% TANNIC ACID.

25. • OTHER CHEMICALS THAT ARE USED FOR GINGIVAL
RETRACTION ARE:
• MEROCEL.
• NEGATAL.
• FERRIC COMPOUND EG: SULPHATES.
• FERRIC SUBSULFATE (MONSEL’S SOLUTION).
• TETRAHYDROZOLINE HCL 0.05%.
• OXYMETAZOLINE 0.05%.
• PHENYLEPHINEPHRINE HCL 0.25%.
• NEOSYNEPHRINE.
• LEVOEPINEPHRINE 4% FOR 10 MINUTES .

26. ARMAMENTARIUM
• EVACUATOR
• SCISSORS
• COTTON PLIERS
• MOUTH MIRROR
• EXPLORER
• FISCHER ULTRAPAK PACKER (SMALL)
• DE PLASTIC FILLING INSTRUMENT IPPA
• COTTON ROLLS
• RETRACTION CORD
• HEMODENT LIQUID
• DAPPEN DISH
• COTTON PELLETS
• 2 X 2 GAUZE SPONGES

28. TECHNIQUES
• SINGLE CORD TECHNIQUE.
• DOUBLE CORD TECHNIQUE.
• INFUSION TECHNIQUE.
• THE “EVERY OTHER TOOTH” TECHNIQUE.

29. 1. SINGLE CORD TECHNIQUE
• THE OPERATING AREA MUST BE DRY.
• A LENGTH OF GINGIVAL RETRACTION CORD IS SELECTED TO
SPECIFICALLY MATCH THE ANATOMY OF EACH INDIVIDUAL
GINGIVAL SULCUS.

30. • IF A TWISTED CORD IS USED, GRASP THE ENDS
BETWEEN THE THUMB AND FOREFINGER OF EACH HAND.
• HOLD THE CORD TAUT AND TWIST THE ENDS TO PRODUCE
A TIGHTLY WOUND CORD OF SMALL DIAMETER.
• IF BRAIDED OR WOVEN CORD IS USED TWISTING
IS NOT NECESSARY

31. • RETRACTION CORD SHOULD BE MOISTENED BY DIPPING IT IN
BUFFERED 25% ALUMINUM CHLORIDE SOLUTION IN A DAPPEN
DISH.
• FORM THE CORD INTO A ‘U’ AND LOOP IT AROUND
THE PREPARED TOOTH.
• HOLD THE CORD BETWEEN THE THUMB
AND FOREFINGER AND APPLY SLIGHT TENSION
IN AN APICAL DIRECTION.

32. • GENTLY SLIP THE CORD BETWEEN
THE TOOTH AND GINGIVA IN THE
MESIAL INTER-PROXIMAL AREA
WITH A CORD PACKING
INSTRUMENT.
• CORD PLACEMENT IS A FINESSE
MOVE, NOT A POWER PLAY.
• ONCE THE CORD HAS BEEN TUCKED
IN ON THE MESIAL, USE THE
INSTRUMENT TO LIGHTLY SECURE IT
IN THE DISTAL INTER-PROXIMAL
AREA.

33. • PROCEED TO THE LINGUAL SURFACE
AND BEGIN WORKING FROM THE
MESIO-LINGUAL CORNER AROUND TO
THE DISTO-LINGUAL CORNER.
• THE TIP OF THE INSTRUMENT SHOULD
BE INCLINED SLIGHTLY TOWARDS THE
AREA WHERE THE CORD HAS ALREADY
BEEN PLACED; I.E. THE MESIAL.
• IF THE TIP OF THE INSTRUMENT IS
AWAY THEN THE CORD MAY BE
DISPLACED AND PULLED OUT.

34. • GENTLY PRESS APICALLY ON THE
CORD WITH THE INSTRUMENT
DIRECTING THE TIP SLIGHTLY
TOWARDS THE TOOTH.
• SLIDE THE CORD GINGIVALLY ALONG
THE PREPARATION UNTIL THE FINISH
LINE IS FELT THEN PUSH THE CORD
INTO THE CREVICE.
• CUT OFF THE LENGTH OF THE
SULCUS PROTRUDING FROM HE
MESIAL SULCUS AS CLOSELY AS

35. • CONTINUE PACKING THE CORD
AROUND THE FACIAL SURFACE,
OVERLAPPING THE CORD IN THE
MESIAL INTER-PROXIMAL AREA.
• PACK ALL BUT THE LAST 2 MM OR 3
MM OF CORD SHOULD BE LEFT.
• THIS TAG CAN BE GRASPED FOR
EASY REMOVAL.

36. • AFTER THE CORD IS IN PLACE, THE TOOTH PREPARATION IS
CAREFULLY INSPECTED TO ASCERTAIN THAT THE ENTIRE
CERVICAL MARGIN CAN CLEARLY BE VISUALIZED AND THAT
THERE IS NO SOFT TISSUE IMPEDIMENT TO EASY INJECTION OF
THE IMPRESSION MATERIAL TO CAPTURE ALL OF THE CERVICAL
MARGIN DETAIL.

37. • WAIT 8 TO 10 MINUTES BEFORE REMOVING THE CORD AND
MAKING THE IMPRESSION.
• THE CORD NEEDS TIME TO EFFECT ADEQUATE LATERAL
DISPLACEMENT, AND THE MEDICAMENT NEEDS TIME
TO CREATE HEMOSTASIS AND CREVICULAR
FLUID CONTROL.

38. 2. DOUBLE CORD TECHNIQUE
• THE DOUBLE CORD TECHNIQUE IS ROUTINELY USED WHEN
MAKING IMPRESSIONS OF MULTIPLE PREPARED TEETH AND
WHEN MAKING IMPRESSIONS WHEN TISSUE HEALTH IS
COMPROMISED.
• SOME CLINICIANS USE THIS TECHNIQUE ROUTINELY FOR ALL
IMPRESSIONS.

39. • A SMALL-DIAMETER CORD IS PLACED IN
THE SULCUS.
• THE ENDS OF THIS CORD SHOULD BE CUT
SO THAT THEY EXACTLY ABUT AGAINST
ONE ANOTHER IN THE SULCUS.

40. • A SECOND CORD, SOAKED IN THE
HEMOSTATIC AGENT OF CHOICE, IS
PLACED IN THE SULCUS ABOVE THE
SMALL-DIAMETER CORD.
• THE DIAMETER OF THE SECOND
CORD SHOULD BE THE LARGEST
DIAMETER THAT CAN READILY BE
PLACED IN THE SULCUS.

41. • AFTER WAITING 8 TO 10 MINUTES AFTER PLACEMENT OF THE
LARGE CORD, THE SECOND CORD IS SOAKED IN WATER AND
REMOVED.
• THE PREPARATION(S) ARE DRIED, AND THE IMPRESSION IS
MADE WITH THE PRIMARY CORD IN PLACE.
• AFTER SUCCESSFULLY MAKING THE IMPRESSION, THE SMALL
CORD IS SOAKED IN WATER AND REMOVED FROM THE
SULCUS.

42. 3. INFUSION TECHNIQUE
• DAN E FISHER IN 1981 INTRODUCED A NEW CONCEPT FOR HEMOSTASIS KNOWN
AS THE INFUSION TECHNIQUE.
• THE INFUSION TECHNIQUE FOR GINGIVAL DISPLACEMENT USES A SIGNIFICANTLY
DIFFERENT APPROACH FROM THE SINGLE OR DOUBLE CORD TECHNIQUES.
• AFTER CAREFUL PREPARATION OF THE CERVICAL MARGINS IN AN INTRA-
CREVICULAR POSITION, HEMORRHAGE IS CONTROLLED USING A SPECIFICALLY
DESIGNED DENTO-INFUSORTM
WITH A FERRIC SULFATE MEDICAMENT.
DCNA 48:2004;433-44.
UltradentprodoctsInc

43. • TWO CONCENTRATIONS OF
FERRIC SULFATE, 15% AND
20% ARE AVAILABLE.
• THE INFUSOR IS USED WITH A
BURNISHING MOTION IN THE
SULCUS AND IS CARRIED
CIRCUMFERENTIALLY 3600
AROUND THE SULCUS.
Viscostat

44. • THE MEDICAMENT IS
EXTRUDED FROM
THE SYRINGE/INFUSOR AS
THE INSTRUMENT IS
MANIPULATED AROUND THE
GINGIVAL SULCUS.
• WHEN HEMOSTASIS IS
VERIFIED, A KNITTED
RETRACTION CORD IS
SOAKED IN THE FERRIC
SULFATE SOLUTION AND

45. • TECHNIQUE RECOMMENDED THE CORD BE IN PLACE 1 TO 3
MINUTES.
• THE CORD IS REMOVED, THE SULCUS IS RINSED WITH WATER,
AND THE IMPRESSION IS MADE.
• THE DENTO-INFUSOR AND THE 20% FERRIC SULFATE HAVE
PROVEN TO BE AN EFFECTIVE ANCILLARY TECHNIQUE
FOR CONTROL OF HEMORRHAGE WHEN USING THE SINGLE
CORD TECHNIQUE.

47. 1. ROTARY CURETTAGE
• THE WAS DESCRIBED BY AMSTERDAM IN 1954, AND
SUBSEQUENTLY MODIFIED BY INGRAHAM.
• ROTARY CURETTAGE IS A “TROUGHING” TECHNIQUE, ALSO
CALLED AS “GINGITAGE”, IS TO PRODUCE LIMITED REMOVAL OF
EPITHELIAL TISSUE IN THE SULCUS.
• THE TECHNIQUE, IS USED WITH THE SUBGINGIVAL PLACEMENT
OF RESTORATION MARGINS.

48. PROCEDURE
• IT IS USUALLY DONE SIMULTANEOUSLY ALONG WITH FINISH
LINE PREPARATION.
• A TORPEDO NOSED DIAMOND OF 150 TO 180 GRIT IS USED TO
EXTEND THE FINISH LINE APICALLY.
• BUR SHOULD BE EXTENDED INTO THE
GINGIVAL SULCUS TO REMOVE A PORTION
OF THE SULCULAR EPITHELIUM.

49. • CORD IMPREGNATED WITH ALUMINUM CHLORIDE OR ALUM IS
GENTLY PLACED TO CONTROL HEMORRHAGE.
• THE CORD IS REMOVED AFTER 4 TO 8 MINUTES,
AND THE SULCUS IS THOROUGHLY IRRIGATED WITH
WATER.
• THIS TECHNIQUE IS WELL SUITED FOR USE WITH
REVERSIBLE HYDROCOLLOID

50. • DISADVANTAGES:
• THERE IS POOR TACTILE SENSATION WHEN USING DIAMONDS
ON SULCULAR WALLS, WHICH CAN PRODUCE DEEPENING OF
THE SULCUS.
• THE TECHNIQUE ALSO HAS THE POTENTIAL FOR DESTRUCTION
OF PERIODONTIUM IF USED INCORRECTLY, MAKING THIS
METHOD THAT IS PROBABLY BEST USED BY
EXPERIENCED DENTISTS.

51. 2. ELECTROSURGERY
• D’ ARSONVAL, EXPLAINED IN 1891 THAT ELECTRICITY AT HIGH
FREQUENCY WILL PASS THROUGH A BODY WITHOUT
PRODUCING A SHOCK, INSTEAD PRODUCED AN INCREASE IN
TEMPERATURE.
• “INTENTIONAL PASSAGE OF HIGH FREQUENCY WAVEFORMS OR
THE CURRENTS THROUGH THE TISSUES OF THE BODY TO
ACHIEVE A CONTROLLABLE EFFECT.”

52. • WHEN THESE WAVEFORMS PASS THROUGH IT, INTENSE
INTRACELLULAR HEAT IS PRODUCED WITHIN THE TISSUES
CONTACTED BY ACTIVE ELECTRODE TIP.
• THIS HEAT VOLATIZES CELLS AND AS THE ELECTRODE IS
GUIDED THROUGH THE TISSUE, IT LEAVES A PATH OF CELL
DESTRUCTION IN THE PATH OF AN INCISION OR SURFACE
COAGULATION.

53. • BY VARYING THE MODE OF THIS CURRENT, THE CLINICIAN CAN
USE ELECTRO-SURGICAL UNIT FOR CUTTING OR
COAGULATION OF SOFT TISSUES.
• THE USE OF ELECTRO-SURGERY HAS BEEN RECOMMENDED FOR
ENLARGEMENT OF THE GINGIVAL SULCUS AND CONTROL OF
HEMORRHAGE AND TO FACILITATE IMPRESSION MAKING.

54. ELECTRO-SURGERY UNIT:
• IT IS A HIGH FREQUENCY OSCILLATOR OR A RADIO-TRANSMITTER
THAT USES EITHER A VACUUM TUBE OR A TRANSISTOR TO DELIVER
HIGH–FREQUENCY ELECTRICAL CURRENT AT ATLEAST 1.0 MHZ.
• IT GENERATES HEAT IN A WAY THAT IS SIMILAR TO
A MICROWAVE OVEN OR A DIATHERMY MACHINE
PRODUCING HEAT IN MUSCLE TISSUE FOR PHYSICAL
THERAPY.
• ELECTRO-SURGERY HAS BEEN CALLED SURGICAL DIATHERMY.

55. • ELECTRO-SURGERY PRODUCES A 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 THE POINT OF CONTACT WITH TISSUE.
• FIVE COMMONLY USED ELECTRO-SURGICAL ELECTRODES.
• COAGULATING
• DIAMOND LOOP
• ROUND LOOP
• SMALL STRAIGHT
• SMALL LOOP

56. USES
• ELECTRO-SURGICAL CURRENTS ARE USED FOR…….
• ELECTRO-SECTION OR INCISION
• COAGULATION
• FULGURATION
• DESICCATION

57. PROCEDURE
• ELECTRO-SURGICAL SCALPEL IS PLUGGED INTO THE ACTIVE
OUTLET.
• PLACE A DROP OF PLEASANT SMELLING AROMATIC OIL AT THE
VERMILION BORDER OF UPPER LIP.
• ELECTRODES OF DIFFERENT TYPES CAN BE USED, LIKE:
A. COAGULATING
B. DIAMOND LOOP
C. ROUND LOOP
D. SMALL STRAIGHT
E SMALL LOOP

58. • THE WORKING ELECTRODE MUST BE CLEAN.
• CUTTING ELECTRODE MUST BE APPLIED WITH VERY LIGHT
PRESSURE AND SHOULD BE GUIDED, NOT PUSHED THROUGH
THE TISSUE.
• TO PREVENT LATERAL PENETRATION OF HEAT INTO TISSUE WITH
SUBSEQUENT INJURY, THE ELECTRODE SHOULD BE KEPT
MOVING AND NO STROKE IS REPEATED IMMEDIATELY.
• AT LEAST 5 SECONDS OF GAP TO BE GIVEN BEFORE REPEATING THE

59. • HIGH VOLUME TIP MUST BE PLASTIC TO PREVENT BURNS.
• FOR A PROPER TECHNIQUE, THE FOLLOWING
ARE IMPORTANT:
1. PROPER POWER SETTING
2. QUICK PASSES WITH THE ELECTRODE
3. ADEQUATE LINE INTERVAL BETWEEN STROKES

60. • THE WIRE IS PARALLEL TO THE LONG AXIS OF THE TOOTH
SO THAT THE TISSUE IS REMOVED FROM THE INNER WALL
OF THE SULCUS
• THE WHOLE TOOTH SHOULD BE ENCOMPASSED IN FOUR
SEPARATE MOTIONS:, FACIAL, MESIAL LINGUAL AND DISTAL

61. • A COTTON PELLET DIPPED IN HYDROGEN PEROXIDE
IS USED TO CLEAN DEBRIS FROM THE SULCUS.
• THE TISSUE HEALING IS RAPID, THE ‘SUBGINGIVAL TROUGH’
HEALS IN 5–7 DAYS.

62. • REMOVAL OF AN EDENTULOUS CUFF
• CROWN LENGTHENING

63. ADVANTAGES
• EXCELLENT VISION OF MARGINS.
• IMMEDIATE HEMOSTASIS.
• PREDICTABLE HEALING OF THE TISSUES.
• IMPROVED ACCURACY OF THE IMPRESSION BY PROVIDING MORE BULK OF
MATERIAL AT THE MARGINS.
• DECREASED CHAIR TIME AND STRESS FOR THE DENTIST AND THE PATIENT.
• ABILITY TO REMOVE IRREGULAR OR EXCESS TISSUE AROUND THE TEETH.
• MINIMAL POSTOPERATIVE DISCOMFORT FOR THE PATIENT.
• DECREASED CROSS INFECTION.

64. PRECAUSIONS
• TOOTH AND ADJACENT AREA ARE TO BE PROPERLY ISOLATED
WITH ONLY MINIMAL MOISTURE CONTENT.
• USE ONLY FULLY, RECTIFIED, UN-DAMPED, FILTERED CURRENT
WITH THE MINIMUM ENERGY OUTPUT REQUIRED FOR THE
DESIRED PURPOSE.
• ONLY SHALLOW PART OF THE SULCULAR EPITHELIUM SHOULD
BE INVOLVED, THE CREST OF THE FREE GINGIVA
SHOULD NOT BE INVOLVED IN THE CUTTING LINE OF THE
ELECTRODE.
• FOR COAGULATION, SPECIALLY SHAPED BULKY ELECTRODES
ARE USED WITH A PARTIALLY RECTIFIED, PARTIALLY DAMPED
OUTPUT FROM THE APPARATUS.

65. • THE TOOTH METALLIC RESTORATIONS SHOULD NOT BE TOUCHED.
THIS CAN CREATE A SHORT CIRCUIT THROUGH STRUCTURES NOT
INTENDED FOR INVOLVEMENT.
• THE ATTACHED GINGIVA OR PERIODONTAL LIGAMENT SHOULD
NEVER BE APPROACHED. THE SEPARATION THAT MAY OCCUR WILL BE
PERMANENT.
• THE DEBRIS FROM THE ELECTRODES SHOULD BE CLEANED USING
ALCOHOL SOAKED GAUZE.
• A FAVORABLE ENVIRONMENT FOR HEALING OF THE PERIODONTIUM
MUST BE CREATED.

66. CONTRAINDICATIONS
• PATIENTS WITH CARDIAC PACE MAKERS.
• SHOULD NOT BE USED IN CONJUNCTION WITH FLAMMABLE GASES
AND ALSO THE USE OF TOPICAL ANESTHETICS SUCH AS
ETHYL CHLORIDE.
• PATIENTS WITH EXPECTED ABNORMAL HEALING PROCESS SUCH AS
DIABETES MELLITUS, AND BLOOD DYSCRASIAS.
• IRRADIATED PATIENTS.
• PATIENTS WITH COLLAGEN DISTURBANCES

67. Recent
Advances

68. RECENT ADVANCES
• GINGIFOAM.
• EXPASYL TM.
• AFFINIS/MAGIC FOAM CORD.
• MEROCEL
• GEL-CORD.
• STAY-PUT RETRACTION CORD.
• COMPRECAP.
• Z-TWIST WEAVE.
• LASERS.

69. GINGIFOAM
• PRINCIPLE: DILATION OF THE GINGIVAL SULCUS BY EXPANSION.
• MARTIGNONI AND FEINMAN HAVE PATENTED A MODIFICATION
OF SILASTIC, WHICH IS CAPABLE OF DILATING THE GINGIVAL
SULCUS PRIOR TO IMPRESSION MAKING.
• GINGIFOAM IS A SILICONE ELASTOMER THAT VULCANIZES AT
ROOM TEMPERATURE; IT IS COMPOSED OF TWO COMPONENTS.
• POLY-DIMETHYL SILOXANE BASE.
• CATALYST BASED ON TIN.

70. • GINGIFOAM HAS THE CHARACTERISTIC OF INCREASING ITS
VOLUME BY FOUR TIMES AFTER ITS POLYMERIZATION.
• IT IS TOTAL FREE OF IRRITANT QUALITIES AND THE ABILITY TO
ABSORB LIQUIDS RENDERING THE MATERIAL PARTICULARLY
USEFUL FOR INSERTION INTO THE GINGIVAL MARGIN.

71. TECHNIQUE
 Chamfer preparations with no bevel
 Some putty material is prepared

72.  Putty is adapted to prepared area,
and patient is asked to close firmly
 Incisal view of matrix

73.  Gingifoam is injected with a syringe
around the gingival margins
 Immediate application of matrix
before Setting reaction occurs

74.  Matrix removed and position of gingifoam can be noted

75.  Preparations prior gingifoam
application
 Preparations after gingifoam
application

76. • SINGLE TOOTH RETRACTION

77. EXPASYL
TM
• IS AN INNOVATIVE SYSTEM FOR ACCESS TO THE GINGIVAL
MARGIN.
• IT CONTAINS A PASTE THAT OPENS THE SULCUS PHYSICALLY
DISPLACING THE TISSUES AND LEAVING THE FIELD DRY, READY
FOR IMPRESSION MAKING OR CEMENTATION.
• THE PASTE HAS TO BE PLACED IN SULCUS FOR 2 MINUTES AND
RINSED.

78. Compend Contin Educ Dent. 2002 Jan;23(1 Suppl):13-7;18-9.

79. Compend Contin Educ Dent. 2002 Jan;23(1 Suppl):13-7;18-9.

80. Compend Contin Educ Dent. 2002 Jan;23(1 Suppl):13-7;18-9.

81. AFFINIS
AFFINIS/MAGIC FOAMCORD
• UNIQUE EXPANDING A SILICONE
‘FOAM’ FOR SULCUS ENLARGEMENT
WITHOUT CORD OR
INSTRUMENTATION.
• SIMPLE, NON INVASIVE, TECHNIQUE
GIVES EXCELLENT PATIENT
ACCEPTABILITY.
• SULCUS ENLARGED QUICKLY TO
GIVE A PERFECT “MARGIN” AND
IMPRESSION.
• EASY APPLICATION WITH

82. MEROCEL
• MEROCEL WAS EVALUATED IN A CLINICAL TRIAL WITH 10
SELECTED ABUTMENTS, EACH SELECTED ABUTMENT REQUIRED
AN ANTERIOR SINGLE UNIT.
• THE MAIN ADVANTAGE OF MEROCEL RETRACTION MATERIAL IS
THAT IT IS CAPABLE OF INNOCUOUSLY EXPANDING THE
GINGIVAL SULCUS.
• THIS PRELIMINARY STUDY SUGGESTED THAT A MEROCEL STRIP
WAS A PREDICTABLE RETRACTION MATERIAL IN CONJUNCTION
WITH IMPRESSION PROCEDURES.
J ProsthetDent,March1996Vol 75, No.3,242-247.

83. MEROCEL
J ProsthetDent,March1996Vol 75, No.3,242-247.

84. MEROCEL
J ProsthetDent,March1996Vol 75, No.3,242-247.

85. MEROCEL
J ProsthetDent,March1996Vol 75, No.3,242-247.

86. GEL-CORD TECHNIQUE
• OFFERS ULTIMATE IN HEMOSTASIS AND SULCULAR FLUID CONTROL DURING
NUMEROUS OPERATIVE PROCEDURES.
• THE APPLICATOR TECHNIQUE DOES NOT INVOLVE THE USE OF A
DEDICATED APPLICATOR DEVICE.
• THIS TECHNIQUE UTILIZES PROFILED DISPOSABLE SYRINGES
FOR CASE OF USE AND CONTAMINATION CONTROL.

87. TECHNIQUE
• PRE-FILLED DISPOSABLE SYRINGE
• APPLICATION OF THE GEL

88. • PLACEMENT OF THE RETRACTION CORD
• COMPLETED IMPRESSION

89. ADVANTAGES
• VISCOUS GEL DOES NOT DRIP AS COMPARED TO LIQUID
HAEMOSTATIC AGENTS.
• TECHNIQUE DOES NOT REQUIRE DEBRIDING DEVICE.
• EASY TO USE FOR TISSUE MANAGEMENT, OFFERING THE FIELD FOR
PERFECT IMPRESSION.
• MAKES GINGIVAL RETRACTION EASIER ACTING AS A LUBRICANT TO
AID IN PLACEMENT OF CORD.

90. STAY-PUT RETRACTION CORD
TM
• IT IS A REVOLUTIONARY CORD.
• STAY–PUT IS A UNIQUE
COMBINATION OF SOFTLY
BRAIDED RETRACTION CORD
AND ULTRA FINE COPPER
FILAMENTS.
• WHEN THE STAY–PUT CORD IS
SHAPED, IT REMAINS IN
SHAPE AND DOES NOT DEFORM.

91. ADVANTAGES
• CAN BE EASILY ADAPTED.
• CAN BE PREFORMED.
• DOES NOT LIFT IN THE SULCUS.
• DOES NOT UNRAVEL.
• NO OVERLAPPING REQUIRED.
• NON-IMPREGNATED, BUT CAN BE IMPREGNATED WITH AN ASTRINGENT
OR HAEMOSTATIC SOLUTION AS REQUIRED.

92. GINGI - PAK
TM
RETRACTION MATERIALS
• KUTTER KAP®
,
• ORIGINAL RETRACTION CORDS,
• SOFT-TWIST, &
• Z-TWIST

93. KUTTER KAP®
• GINGI-PAK'S PATENTED PACKAGING DESIGN
INCLUDES THE KUTTER KAP ON EVERY
BOTTLE OF RETRACTION CORD.
• THE KUTTER KAP CUTS THE CORD WITHOUT
THE NEED FOR SCISSORS AND
AUTOMATICALLY HOLDS AND STORES THE
CORD TO PREVENT CROSS-CONTAMINATION.
• THE GINGI-PAK CORDS FEATURE IS TIME-
SAVING, ERGONOMIC FEATURE.

94. Z-TWIST RETRACTION CORDS
• Z–TWIST WEAVE IS A 4TH GENERATION,
STATE OF THE ART RETRACTION
MATERIAL.
• ITS UNIQUE BRAIDED CONFIGURATION
HELPS IN EXCELLENT
HANDLING OF THE 100% COTTON CORD
IN PLACEMENT.
• THE TIGHT WEAVE RESISTS THE
PENETRATION EVEN BY THE
SMALLEST PACKING INSTRUMENT.

95. Z-TWIST RETRACTION CORDS
• THE CORDS ARE AVAILABLE IN DARK COLOURS AND
HENCE CAN BE SEEN IN THE SULCUS.
• AVAILABLE IN FOUR SIZES, STARTING FROM 0.
• Z–TWIST WEAVE IS IDEAL FOR ALL TECHNIQUES
INCLUDING THE TWO-CORD TECHNIQUE.

96. COMPRE CAP
• HOLD THE RETRACTION DEEP IN THE SULCUS, OPENING IT
EVEN WIDER.
• ENSURES A DRY, CLEAN AREA AND WELL-DEFINED GINGIVAL
MARGINS.
• STOPS BLEEDING NATURALLY BY COMPRESSION.

97. • SIMPLE TO USE, AFTER PLACING THE RETRACTION CORD THE
CAP IS PLACED OVER THE PREPARED TOOTH AND PUSHED
INTO THE SULCUS.
• THE PATIENT BITES ON THE CAP FOR 3-5 MINUTES AND IS
REMOVED CAREFULLY ALONG THE RETRACTION CORD.
• AVAILABLE IN THREE SIZES AND ARE CATEGORIZED FOR-
• INCISORS
• PRE MOLARS
• MOLARS.

98. LASERS
• SOFT TISSUE REDUCTION WITH LASERS IN THE FIELD OF
DENTISTRY HAS BEEN SUBJECTED TO INTENSE SCRUTINIZING IN
RECENT YEARS.
• THE ONLY DENTAL USE OF LASERS APPROVED BY U.S. FOOD
AND DRUG ADMINISTRATION IS IN THE FIELD OF ORAL SOFT
TISSUE PROCEDURES.
• TYPES OF LASERS USED IN DENTISTRY ARE
• CO2
• ND–YAG (NEODYMIUM-YITTRIUM-ALUMINIUM-GARNET).

99. • LASERS WORK THROUGH PHOTO-
ABLATION AND PRODUCE COMPLETELY
BLOOD–FREE INCISIONS FOLLOWED BY
RAPID, PAIN–FREE HEALING WITH NO
UNDERLYING INFLAMMATION.
• THE LASER TECHNIQUE IS A LITTLE SLOWER
THAN USING A SCALPEL BUT PRODUCES A
VERY CONTROLLED TISSUE REMOVAL FREE
OF HEMORRHAGE AND PAIN. HEALING IS
RAPID AND UNEVENTFUL.

100. SUMMERY
• IF THE RESTORED TOOTH AND THE SURROUNDING
PERIODONTAL TISSUE ARE TO SURVIVE IN HEALTH, PROPER
MANAGEMENT OF GINGIVAL TISSUE PRIOR TO, DURING AND
SUBSEQUENT TO THE FABRICATION OF RESTORATION
BECOMES A MATTER OF VITAL IMPORTANCE PARTICULARLY IN
CASES OF SUBGINGIVAL PLACEMENT OF RESTORATION.
• THE MOST COMMON TECHNIQUE USED WITH GINGIVAL
RETRACTION IS THE USE OF RETRACTION CORD WITH A
HEMOSTATIC MEDICAMENT.
• RETRACTION CORD OF SUFFICIENT DIAMETER SHOULD BE
USED TO PROVIDE ADEQUATE LATERAL DISPLACEMENT TO
CREATE A MEAN SULCULAR DEPTH OF 0.2MM.

101. • EPINEPHRINE CONTAINING CORDS SHOULD BE AVOIDED.
• SEVERAL TECHNIQUES HAVE PROVED TO BE RELATIVELY
PREDICTABLE, SAFE AND EFFICACIOUS.
• NO SCIENTIFIC EVIDENCE HAS ESTABLISHED THE
SUPERIORITY OF ONE TECHNIQUE OVER ANOTHER.
• THE CHOICE OF TECHNIQUE DEPENDS UPON CLINICAL
SITUATION NEED & CLINICIAN PREFERENCE