This document discusses various techniques for gingival retraction during dental impressions for implants. It begins with introductions to implant dentistry and the need for gingival retraction during impressions. The document then compares the peridental and peri-implant tissues. It reviews the requirements and goals of gingival retraction as well as various retraction techniques including mechanical, chemomechanical, and surgical approaches. The document also discusses some recent advancements in gingival retraction techniques such as Expasyl, Magic Foamcord, and Gingitrac which aim to provide retraction with less trauma to tissues.
The document discusses soft tissue management and fluid control during fixed prosthodontic procedures. It covers saliva control methods like rubber dams, high-volume evacuation, cotton rolls, and anti-sialagogues. It also discusses gingival tissue displacement techniques like copper bands filled with impression material, displacement pastes, temporary restorations, and retraction cords. Retraction cords are classified based on configuration, surface finish, chemical treatment, number of strands, and thickness. Proper soft tissue management and fluid control are critical for making accurate impressions of prepared teeth during fixed prosthodontic treatments.
The document discusses various concepts of occlusion for fixed partial dentures, including bilaterally balanced occlusion, unilaterally balanced occlusion, and mutually protected occlusion. Bilaterally balanced occlusion aims for simultaneous contact on both sides but is difficult to achieve, while unilaterally balanced occlusion distributes forces to multiple teeth on the working side only. Mutually protected occlusion relies on anterior guidance to prevent posterior contact during excursive movements. The concepts vary in their distribution of forces and indications depending on a patient's needs.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
An impression is required to fabricate a fixed dental prosthesis. It must include the prepared teeth as well as surrounding structures. Various impression materials and techniques have been developed over time. Today, alginate, polyether, addition silicone and polyvinyl siloxane are commonly used. Proper tray selection and customization is important to obtain an accurate impression. Impression making requires isolation, tissue retraction and meticulous technique to ensure detail and avoid imperfections.
Full mouth rehabilitation (FMR) involves extensive restorative procedures to modify the occlusal plane and accomplish equilibration. The goals of FMR are to establish a static centric occlusion in harmony with centric relation, evenly distribute stresses during function, and restore normal masticatory function. FMR is indicated for impaired occlusion, preserving remaining teeth, maintaining periodontal health, improving esthetics, and resolving pain. Diagnostic tools include study models, radiographs, photographs, and diagnostic wax-ups to develop the treatment plan.
This document provides an overview of maxillofacial prosthetic materials. It begins with definitions and introduces various materials used, including acrylic resins, vinyl plastisols, polyurethane, silicones, and newer materials. Each material is described in terms of its composition, advantages, and disadvantages. The document also discusses ideal properties, classifications, a literature review on the history of materials, physical properties comparisons, processing techniques, and concludes with an introduction to newer developments in materials science.
This document provides an overview of periimplantitis, including its definition, classification systems, epidemiology, etiology, pathogenesis, diagnosis, and treatment. Periimplantitis is defined as an inflammatory process involving both soft and hard tissues around a dental implant, resulting in loss of supporting bone. It is distinguished from peri-implant mucositis, which only involves inflammation of soft tissues. The document discusses various classification systems for periimplantitis and reviews potential etiologic factors such as plaque, biomechanical overload, genetic factors, and iatrogenic causes. Diagnosis involves clinical parameters like bleeding, probing depth, and radiographic bone loss. Treatment aims to eliminate infection and may include nonsurgical and surgical
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
The document discusses soft tissue management and fluid control during fixed prosthodontic procedures. It covers saliva control methods like rubber dams, high-volume evacuation, cotton rolls, and anti-sialagogues. It also discusses gingival tissue displacement techniques like copper bands filled with impression material, displacement pastes, temporary restorations, and retraction cords. Retraction cords are classified based on configuration, surface finish, chemical treatment, number of strands, and thickness. Proper soft tissue management and fluid control are critical for making accurate impressions of prepared teeth during fixed prosthodontic treatments.
The document discusses various concepts of occlusion for fixed partial dentures, including bilaterally balanced occlusion, unilaterally balanced occlusion, and mutually protected occlusion. Bilaterally balanced occlusion aims for simultaneous contact on both sides but is difficult to achieve, while unilaterally balanced occlusion distributes forces to multiple teeth on the working side only. Mutually protected occlusion relies on anterior guidance to prevent posterior contact during excursive movements. The concepts vary in their distribution of forces and indications depending on a patient's needs.
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
An impression is required to fabricate a fixed dental prosthesis. It must include the prepared teeth as well as surrounding structures. Various impression materials and techniques have been developed over time. Today, alginate, polyether, addition silicone and polyvinyl siloxane are commonly used. Proper tray selection and customization is important to obtain an accurate impression. Impression making requires isolation, tissue retraction and meticulous technique to ensure detail and avoid imperfections.
Full mouth rehabilitation (FMR) involves extensive restorative procedures to modify the occlusal plane and accomplish equilibration. The goals of FMR are to establish a static centric occlusion in harmony with centric relation, evenly distribute stresses during function, and restore normal masticatory function. FMR is indicated for impaired occlusion, preserving remaining teeth, maintaining periodontal health, improving esthetics, and resolving pain. Diagnostic tools include study models, radiographs, photographs, and diagnostic wax-ups to develop the treatment plan.
This document provides an overview of maxillofacial prosthetic materials. It begins with definitions and introduces various materials used, including acrylic resins, vinyl plastisols, polyurethane, silicones, and newer materials. Each material is described in terms of its composition, advantages, and disadvantages. The document also discusses ideal properties, classifications, a literature review on the history of materials, physical properties comparisons, processing techniques, and concludes with an introduction to newer developments in materials science.
This document provides an overview of periimplantitis, including its definition, classification systems, epidemiology, etiology, pathogenesis, diagnosis, and treatment. Periimplantitis is defined as an inflammatory process involving both soft and hard tissues around a dental implant, resulting in loss of supporting bone. It is distinguished from peri-implant mucositis, which only involves inflammation of soft tissues. The document discusses various classification systems for periimplantitis and reviews potential etiologic factors such as plaque, biomechanical overload, genetic factors, and iatrogenic causes. Diagnosis involves clinical parameters like bleeding, probing depth, and radiographic bone loss. Treatment aims to eliminate infection and may include nonsurgical and surgical
Gingival retraction is the deflection of the gingiva away from the tooth to provide adequate access and an accurate impression of prepared tooth margins. Traditional methods include mechanical retraction using copper bands or temporary crowns filled with material, as well as chemomechanical retraction using cords impregnated with chemicals like aluminum chloride. Retraction cords are commonly used in single or double cord techniques to displace tissue laterally or vertically. Recent advances include gingival displacement foams and gels that are applied to the sulcus to control bleeding and allow for cord placement. Lasers can also be used to incise and cauterize tissue for retraction. The goal is effective retraction while minimizing trauma to the ging
This document discusses various methods for gingival retraction to expose the tooth structure beneath the gingiva. It describes mechanical, chemico-mechanical, and surgical retraction methods. Mechanical methods include use of retraction cords, while chemico-mechanical methods involve chemically-treated cords to shrink gingival tissue. Recent advances discussed include laser retraction and cordless techniques like Expasyl paste that cause less trauma than cords. Proper technique and material selection are important to effectively retract tissue without damaging the periodontium.
horizontal jaw relation in complete denturedipalmawani91
This document provides an overview of centric relation and how its definition has changed over time. It discusses the significance of centric relation as a reference position and reviews various theories about how it is achieved musculoskeletally. The document also examines the relationship between centric relation and centric occlusion, and describes different methods for recording centric relation, including static, functional, graphic, and physiological techniques. Factors that can influence the accuracy of centric relation records are also reviewed.
This document discusses guided bone regeneration (GBR), a surgical procedure that uses a membrane barrier to exclude soft tissues and promote bone growth in a defect site. It provides background on GBR and guided tissue regeneration, reviews pioneering animal and human studies demonstrating the efficacy of GBR using membranes like e-PTFE, and discusses principles, indications, clinical procedures, and membrane types used in GBR. Key GBR principles include cell exclusion, tenting, scaffolding, stabilization, and framework to support new bone formation.
Retention in complete dentures is influenced by physical, biologic, chemical, psychological, and mechanical factors. Physical factors include adhesion, cohesion, capillarity and atmospheric pressure. Biologic factors involve neuromuscular control, saliva, mucosal health, and ridge characteristics. Denture adhesives are a chemical method to enhance retention. Retentive features like magnets, implants, and ultra suction chambers are mechanical approaches. Proper consideration of all relevant factors leads to optimal complete denture retention.
This document discusses attachments used in prosthodontics. It begins with an introduction to attachments, defining them as mechanical devices used to retain and stabilize prostheses. The document then covers the history, classification, indications, disadvantages, and selection of attachments. It discusses both intracoronal and extracoronal attachments. In summary, the document provides an overview of attachments, their uses in prosthodontics, and factors to consider in selecting the appropriate attachment.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses balanced occlusion for complete dentures. It begins with an introduction that defines occlusion and the goal of reducing trauma to supporting tissues. It then defines various occlusion terms like centric occlusion, eccentric occlusion, functional occlusion, and balanced occlusion. The document discusses theories of complete denture occlusion and various concepts like balanced, monoplane, and lingualized occlusion. It outlines the objectives, characteristics, types, advantages, and factors influencing balanced occlusion. The factors discussed are condylar guidance, incisal guidance, plane of occlusion, cuspal angulation, and compensating curve. The document provides details on each of these factors and their significance in achieving balanced occlusion.
The double cord technique involves placing a small diameter cord in the gingival sulcus first, leaving it in place, and then packing a larger diameter cord over the first cord to provide additional retraction and hemostasis for making impressions of multiple prepared teeth or when the gingival tissues are compromised. The small inner cord provides retraction while the outer cord provides additional hemostasis and tissue displacement needed for accurate impressions.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Journal club presentation on tooth supported overdentures NAMITHA ANAND
This document presents a case report of a full mouth rehabilitation with an immediate maxillary denture and a mandibular tooth-supported magnet-retained overdenture. Specifically:
- A 43-year old female patient presented with missing teeth in the upper back region and multiple missing teeth in the lower arch.
- For rehabilitation, the maxillary teeth were extracted and an immediate denture placed. In the mandible, several teeth were prepared to receive magnetic attachments or copings.
- At the insertion appointment, the remaining maxillary teeth were extracted and the denture was relined. In the mandible, magnets were incorporated into the overdenture to attach it to the prepared teeth.
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
This document discusses resin-bonded fixed partial dentures (FPDs). It introduces resin-bonded FPDs as a way to minimize destruction of sound tooth structure compared to conventional FPDs. Resin-bonded FPDs have a metal framework that is bonded to abutment teeth with resin cement after minimal tooth preparation. Several types of resin-bonded FPD designs are described, including Rochette, Maryland, cast mesh, and Virginia bridges. The techniques, advantages, disadvantages, indications, and contraindications of resin-bonded FPDs are outlined. Tooth preparation for resin-bonded FPDs involves minimal axial reduction and guide planes on proximal surfaces.
This document discusses overdentures, which are complete or partial dentures constructed over existing teeth, roots, or implants to provide additional support, stability, and retention. It describes different types of overdentures including tooth-supported and implant-supported overdentures. Various techniques for constructing tooth-supported overdentures are presented, including different ways of preparing and covering abutment teeth. Indications and contraindications for overdentures are also outlined.
Root canal obturation timing materials and techniquesSilas Toka
This document discusses root canal obturation including timing, materials, and techniques. It recommends obturating after thorough cleaning and shaping when the canal is dry, except if exudate is present. For necrotic teeth, calcium hydroxide is recommended as an antimicrobial dressing if treatment cannot be completed in one visit. Common obturation materials discussed include zinc oxide-eugenol, calcium hydroxide, resin, and bioceramic-based sealers. Proper obturation aims to prevent reinfection and microleakage and facilitate healing.
Dental implants are artificial tooth roots inserted into the jaw to hold replacement teeth. There are several types but all rely on a process called osseointegration where the implant fuses with the jaw bone. Implants can replace single teeth, multiple teeth, or a full arch. They have advantages over other options like preserving bone, improved function and aesthetics. However, they also have longer treatment times and costs compared to other options. Placement involves surgery to insert the implant which then fuses with the bone before an abutment and crown are added to restore bite and appearance.
The document discusses various techniques for gingival retraction including mechanical, chemomechanical, and surgical methods. Mechanical methods include using a rubber dam or copper band to displace gingiva. Plain cord techniques involve pushing gingiva with cotton cords. Chemomechanical techniques combine chemical agents like epinephrine, aluminum sulfate gel, or ferric sulfate with cord packing to aid retraction and control bleeding. Selection of retraction materials depends on effectiveness, lack of toxicity, and minimal tissue damage.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
This document discusses various methods for gingival retraction to expose the tooth structure beneath the gingiva. It describes mechanical, chemico-mechanical, and surgical retraction methods. Mechanical methods include use of retraction cords, while chemico-mechanical methods involve chemically-treated cords to shrink gingival tissue. Recent advances discussed include laser retraction and cordless techniques like Expasyl paste that cause less trauma than cords. Proper technique and material selection are important to effectively retract tissue without damaging the periodontium.
horizontal jaw relation in complete denturedipalmawani91
This document provides an overview of centric relation and how its definition has changed over time. It discusses the significance of centric relation as a reference position and reviews various theories about how it is achieved musculoskeletally. The document also examines the relationship between centric relation and centric occlusion, and describes different methods for recording centric relation, including static, functional, graphic, and physiological techniques. Factors that can influence the accuracy of centric relation records are also reviewed.
This document discusses guided bone regeneration (GBR), a surgical procedure that uses a membrane barrier to exclude soft tissues and promote bone growth in a defect site. It provides background on GBR and guided tissue regeneration, reviews pioneering animal and human studies demonstrating the efficacy of GBR using membranes like e-PTFE, and discusses principles, indications, clinical procedures, and membrane types used in GBR. Key GBR principles include cell exclusion, tenting, scaffolding, stabilization, and framework to support new bone formation.
Retention in complete dentures is influenced by physical, biologic, chemical, psychological, and mechanical factors. Physical factors include adhesion, cohesion, capillarity and atmospheric pressure. Biologic factors involve neuromuscular control, saliva, mucosal health, and ridge characteristics. Denture adhesives are a chemical method to enhance retention. Retentive features like magnets, implants, and ultra suction chambers are mechanical approaches. Proper consideration of all relevant factors leads to optimal complete denture retention.
This document discusses attachments used in prosthodontics. It begins with an introduction to attachments, defining them as mechanical devices used to retain and stabilize prostheses. The document then covers the history, classification, indications, disadvantages, and selection of attachments. It discusses both intracoronal and extracoronal attachments. In summary, the document provides an overview of attachments, their uses in prosthodontics, and factors to consider in selecting the appropriate attachment.
Platform switching involves using a smaller diameter abutment on a larger diameter implant. This shifts the implant-abutment junction inward and away from the crestal bone. According to the document, platform switching reduces crestal bone loss in the following ways: 1) It shifts the inflammatory cell infiltrate inward, decreasing its effect on the crestal bone. 2) It maintains the biological width between the implant and bone. 3) It decreases stress levels in the peri-implant bone by shifting the stress concentration area away from the bone-implant interface. The document discusses the concept, history, advantages, and limitations of platform switching.
This document discusses balanced occlusion for complete dentures. It begins with an introduction that defines occlusion and the goal of reducing trauma to supporting tissues. It then defines various occlusion terms like centric occlusion, eccentric occlusion, functional occlusion, and balanced occlusion. The document discusses theories of complete denture occlusion and various concepts like balanced, monoplane, and lingualized occlusion. It outlines the objectives, characteristics, types, advantages, and factors influencing balanced occlusion. The factors discussed are condylar guidance, incisal guidance, plane of occlusion, cuspal angulation, and compensating curve. The document provides details on each of these factors and their significance in achieving balanced occlusion.
The double cord technique involves placing a small diameter cord in the gingival sulcus first, leaving it in place, and then packing a larger diameter cord over the first cord to provide additional retraction and hemostasis for making impressions of multiple prepared teeth or when the gingival tissues are compromised. The small inner cord provides retraction while the outer cord provides additional hemostasis and tissue displacement needed for accurate impressions.
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Journal club presentation on tooth supported overdentures NAMITHA ANAND
This document presents a case report of a full mouth rehabilitation with an immediate maxillary denture and a mandibular tooth-supported magnet-retained overdenture. Specifically:
- A 43-year old female patient presented with missing teeth in the upper back region and multiple missing teeth in the lower arch.
- For rehabilitation, the maxillary teeth were extracted and an immediate denture placed. In the mandible, several teeth were prepared to receive magnetic attachments or copings.
- At the insertion appointment, the remaining maxillary teeth were extracted and the denture was relined. In the mandible, magnets were incorporated into the overdenture to attach it to the prepared teeth.
dental Monoblock obturation technique or concept in endodonticsAhmed Ali
dental Monoblock obturation technique or concept in endodontics which are classified into primary ,secondary & tertiary based upon resin , now the bioceramics
loading protocols in dental implants about indications and contraindications of conventional , immediate,progressive and delayed loading of dental implants
This document discusses resin-bonded fixed partial dentures (FPDs). It introduces resin-bonded FPDs as a way to minimize destruction of sound tooth structure compared to conventional FPDs. Resin-bonded FPDs have a metal framework that is bonded to abutment teeth with resin cement after minimal tooth preparation. Several types of resin-bonded FPD designs are described, including Rochette, Maryland, cast mesh, and Virginia bridges. The techniques, advantages, disadvantages, indications, and contraindications of resin-bonded FPDs are outlined. Tooth preparation for resin-bonded FPDs involves minimal axial reduction and guide planes on proximal surfaces.
This document discusses overdentures, which are complete or partial dentures constructed over existing teeth, roots, or implants to provide additional support, stability, and retention. It describes different types of overdentures including tooth-supported and implant-supported overdentures. Various techniques for constructing tooth-supported overdentures are presented, including different ways of preparing and covering abutment teeth. Indications and contraindications for overdentures are also outlined.
Root canal obturation timing materials and techniquesSilas Toka
This document discusses root canal obturation including timing, materials, and techniques. It recommends obturating after thorough cleaning and shaping when the canal is dry, except if exudate is present. For necrotic teeth, calcium hydroxide is recommended as an antimicrobial dressing if treatment cannot be completed in one visit. Common obturation materials discussed include zinc oxide-eugenol, calcium hydroxide, resin, and bioceramic-based sealers. Proper obturation aims to prevent reinfection and microleakage and facilitate healing.
Dental implants are artificial tooth roots inserted into the jaw to hold replacement teeth. There are several types but all rely on a process called osseointegration where the implant fuses with the jaw bone. Implants can replace single teeth, multiple teeth, or a full arch. They have advantages over other options like preserving bone, improved function and aesthetics. However, they also have longer treatment times and costs compared to other options. Placement involves surgery to insert the implant which then fuses with the bone before an abutment and crown are added to restore bite and appearance.
The document discusses various techniques for gingival retraction including mechanical, chemomechanical, and surgical methods. Mechanical methods include using a rubber dam or copper band to displace gingiva. Plain cord techniques involve pushing gingiva with cotton cords. Chemomechanical techniques combine chemical agents like epinephrine, aluminum sulfate gel, or ferric sulfate with cord packing to aid retraction and control bleeding. Selection of retraction materials depends on effectiveness, lack of toxicity, and minimal tissue damage.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
This document discusses various techniques for managing gingival tissues during restorative dental procedures. It covers fluid control, gingival assessment and treatment, and different retraction methods including mechanical, chemomechanical, and surgical approaches. Plain cotton cord, double cord, and chemomechanical techniques using epinephrine are described in detail. Selection criteria for retraction materials and the effects of various medicaments are also summarized.
Peri-implantitis is a pathological inflammatory condition affecting the tissues surrounding dental implants, characterized by inflammation of the peri-implant mucosa and progressive bone loss. It is caused by plaque accumulation on the implant surface. Risk factors include a history of periodontitis and smoking. Treatment involves non-surgical mechanical debridement using air abrasives or ultrasonic tips for mild cases. More severe cases may require surgical debridement and decontamination of the implant surface along with local or systemic antibiotics. Long-term maintenance therapy and adherence to the CIST protocol are important for managing peri-implantitis and ensuring the success of dental implants.
Gingival retraction is a necessary step for accurate impressions in fixed prosthodontics. There are various methods for gingival retraction including mechanical methods using retraction cords, chemicals applied to cords or directly to tissue, electrosurgery, lasers, and new cordless systems. Retraction cords come in different sizes and are placed for 5-30 minutes. Chemicals used include astringents like aluminum chloride that cause hemostasis and tissue displacement. New developments provide retraction without cords or chemicals but additional research is still needed on some techniques and materials. Proper gingival retraction allows for an accurate impression and fit of restorations for optimal function and health of surrounding tissues.
Complication & failure of dental implants / cosmetic dentistry trainingIndian dental academy
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This document discusses gingival retraction, which is the deflection of marginal gingiva away from a tooth to facilitate impression making of subgingival margins. It defines gingival retraction and describes the biologic width and clinical assessment of gingival biotypes. Various criteria for effective gingival retraction are provided. Methods of gingival retraction include mechanical retraction cords, chemicomechanical agents, and surgical techniques like rotary curettage and electrosurgery. Fluid control during the procedure involves tools like high-volume evacuation, saliva ejectors, and antisialagogues. Gingival retraction allows for visualization and impression of subgingival tooth margins and
This document discusses various surgical periodontal therapy techniques. It describes procedures like gingivectomy, modified Widman flap, and curettage. It outlines their indications, techniques, healing processes, and effectiveness based on studies. Surgical techniques aim to improve access, regenerate structures, and maintain periodontal health. While many techniques are effective, some like curettage provide no additional benefits over nonsurgical scaling and root planing alone. The best approach depends on the individual patient's periodontal case.
This study evaluated a surgical technique combining modified apically repositioned flap surgery with vestibular deepening using diode laser to increase attached gingiva in the lower anterior teeth. 16 patients underwent phase I therapy followed by flap surgery, bone grafting, and laser-assisted vestibular deepening. Post-operative increases were seen in attached gingiva, keratinized gingiva, and vestibular depth. The one-step procedure helped relieve tension on the gingiva while regenerating periodontal tissues, with minimal discomfort and complications. The technique aims to prolong the life of compromised lower front teeth in a cost-effective manner.
1) A 20-year-old female presented with a 6-month history of pus discharge and draining sinus tract through her chin region.
2) Clinical and radiographic examination revealed chronic periapical abscesses with teeth 31, 32, and 41 as the cause of the extraoral sinus tract.
3) The sinus tract was treated successfully with root canal therapy of the affected teeth, intracanal laser therapy using gallium-aluminum-arsenide diode laser, and placement of propolis as an intracanal medicament. Follow up 6 months later showed complete resolution of the sinus tract and periapical healing.
Peri implantitis treatment with regenerative approachajayashreep
This study evaluates the clinical results and compare reentry hard tissue measurements following regenerative surgery after strict implant decontamination peri-implantitis cases.
This presentation of mine is a brief overview of surgical management of root canal treatment failure . The non surgical approach is already explained in other presentation.
This document discusses gingival recession, including its causes, classification, symptoms, and treatment options. It begins with an introduction that defines gingival recession and reports on its prevalence. It then covers the main causes of recession, including anatomical factors, trauma, smoking, aging, and biotype. Treatment options are separated into non-surgical approaches like prevention and desensitizing agents, and surgical options like free gingival grafts, pedicle flaps, and guided tissue regeneration. Two case reports demonstrate surgical treatments using subepithelial connective tissue grafts and Emdogain. The document concludes with a discussion of factors affecting surgical outcomes and the need for long-term maintenance.
Treatment of gingival recession using coronally advanced flapShruti Maroo
This document describes a case study evaluating the efficacy of the coronally advanced flap technique for treating gingival recession. A 27-year old male patient presented with Miller's Class I gingival recession on teeth 22 and 23, along with sensitivity. The coronally advanced flap procedure was performed, involving incisions and elevation of a partial-thickness flap. One month and three months post-operatively, the patient showed uneventful healing and 100% root coverage, with reduction in sensitivity and no probing defects. The coronally advanced flap technique alone can successfully treat gingival recession when residual gingiva is thick and wide, resulting in good esthetic and functional outcomes.
Implant surgeries to overcome anatomic difficulties ii / dental implant cour...Indian dental academy
This document discusses various surgical techniques used to overcome anatomical difficulties for dental implants. It covers guided tissue regeneration, ridge augmentation, maxillary sinus lift, inferior alveolar canal lateralization, and mental nerve distalization. The maxillary sinus lift technique is described in detail, including indications, contraindications, the original method, benefits and potential complications like membrane perforation. Lateralization of the inferior alveolar nerve and distalization of the mental nerve are also summarized. The document provides an overview of these procedures to help restore function and aesthetics for patients with atrophy or injury.
This case report describes the rehabilitation of an edentulous 63-year old female patient with an implant supported overdenture. The patient presented with a loose lower denture and difficulty with mastication and speech. Clinical examination and radiographs showed resorbed alveolar ridges. The treatment plan involved placing two implants in the mandible and four implants in the maxilla. After osseointegration, ball attachments were connected to the implants and incorporated into the overdenture. The patient was followed up for 6 months and showed improved function, retention, stability and satisfaction with the new overdenture. Implant supported overdentures can successfully rehabilitate edentulous ridges and provide superior outcomes compared to
This case report describes the rehabilitation of an edentulous 63-year old female patient with an implant supported overdenture. The patient presented with a loose lower denture and difficulty with mastication and speech. Clinical examination and radiographs revealed resorbed alveolar ridges. The treatment plan involved placing two implants in the mandible and four implants in the maxilla. Ball attachments were used to connect the overdentures to the implants. The surgical placement of the implants was described. After osseointegration, the ball attachments were connected to create an implant supported overdenture. The patient was satisfied with improved function and esthetics. The case report concluded implant supported overdentures are an effective treatment for
This document provides information on surgical endodontics procedures performed by Dr. Osama Mushtaq. It discusses the reasons for endodontic treatment failure and describes objectives and indications for endodontic surgery, including managing periapical disease and lesions that cannot be treated via nonsurgical root canal treatment. The document outlines the surgical procedure, covering topics like flap design, root resection, root-end filling materials, and postoperative care. It also discusses factors associated with success and failure of periapical surgery, and indications and contraindications for corrective endodontic surgery to repair procedural errors or resorptive defects.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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• Pitfalls and pivots needed to use AI effectively in public health
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2. contents
INTRODUCTION
COMPARISON OF PERIDENTAL AND PERI
IMPLANT TISSUES
REQIREMENT OF IMPRESSION
GINGIVAL RETRACTION TECHNIQUES
ADVANCEMENT IN GINGIVAL RETRACTION
TECHNIQUES
DISCUSSION
CONCLUSION
REFERENCES
2
3. INTRODUCTION
▸ Implant dentistry has seen rapid progress in recent years. Its
increased use in the treatment of partially edentulous patients
has led to two restorative techniques: screw retained implant
restorations and cement-retained restorations.
3
4. introduction
Cement-retained prostheses are the restoration of
choice for many patients who receive implants for
several reasons, including
esthetics,
occlusal stability,
overcoming angulation problems and
fabrication of a passively fitting restoration.
4
6. Baharav H, Laufer BZ, Langer Y, Cardash HS. The effect of displacement
time on gingival crevice width. Int J Prosthodont 1997;10(3):
248-253.
To ensure accuracy with polyvinyl siloxane impression materials,
clinicians must maintain a minimum bulk of 0.2-millimeter
thickness in the sulcus area, which they can achieve by
retracting the gingiva for at least four minutes before making the
impression.
6
7. Donovan and Chee described a variety of gingival
displacement techniques, but there is no
articles that specifically reviewed gingival retraction
techniques in implant dentistry.
Since the architecture of the gingival crevice surrounding
natural teeth is different biologically from that around
implants, we wanted to know if conventional retraction
techniques could be applied safely to peri-implant tissue.
Gingival retraction techniques for implants versus teeth :Current status
Vincent Bennani, Donald Schwass, Nicholas Chandler
7
8. PERIDENTAL TISSUE
▸ Free gingival margin with buccal keratinized
epithelium
▸ Gingival sulcus apically limited by the
junctional epithelium
▸ Keratinized epithelium at the base of gingival
sulcus
▸ Junctional epithelium adherent, less
permeable, high regenerative capacity
▸ Cementum
▸ Gingival fibers inserting perpendicularly in the
cementum
▸ Biological width of at least 2.04 millimetres
▸ Periodontal ligament
▸ No direct contact between tooth and bone
Comparison of peridental and
peri-implant tissues.(ERICSSON & LINDHE)
PERI-IMPLANT TISSUE
▸ Free gingival margin with buccal keratinized
epithelium
▸ Gingival sulcus apically limited by the
junctional epithelium
▸ No keratinized epithelium at the base of
gingival sulcus
▸ Junctional epithelium poorly adherent, more
permeable, low regenerative capacity
▸ No cementum
▸ Gingival fibers running parallel to the implant
collar
▸ Biological width of 2.5 mm ± 0.5 mm*
▸ No periodontal ligament
▸ Direct contact of implant to bone
8
11. “
Gingival retraction or displacement is the deflection
of the marginal gingiva away from the tooth. ‘tissue
dilation’-GPT 9
11
12. GINGIVAL RETRACTION TECHNIQUES
▸ Deformation of gingival
tissues during retraction and
impression procedures
involves four forces:
▸ retraction
▸ relapse
▸ displacement
▸ collapse
12
13. Relapse is the
tendency of the
gingival cuff to
go back to its
original
position.
Retraction is the
downward and
outward
movement
of the free
gingival margin
that is caused by
the retraction
material and the
technique used.
Displacement is a
downward
movement of the
gingival cuff that is
caused by heavy-
consistency
Impression
material bearing
down on
unsupported
retracted gingival
tissues.
13
Collapse is the
tendency of the
gingival cuff to
flatten under
forces associated
with the use of
closely adapted
customized
impression trays.
14. GINGIVAL RETRACTION TECHNIQUES
▸ Peri-implant fiber structure does not provide the
same level of support for gingival tissues when the
retraction agents are removed .
▸ Thus, more collapsing forces occur on retracted
tissues of implants as compared to peridental
retracted tissues.
▸ Particularly true in situations in which depth of
sulcus is greater than average, such as when implant
is placed deeply.
14
15. The aim of gingival
retraction is to atraumatically allow access for the
impression material beyond the abutment margins
and to create space so that the impression
material is sufficiently thick so as to be tear-resistant
15
17. MECHANICAL RETRACTION
17
CORD
(may be twisted, knitted or braided)
Single-cord technique VS Dual-cord technique
Retraction cords were developed for use with natural teeth. They provide
more effective control of gingival hemorrhage and exudate when used in
conjunction with medicaments than when used with no medicaments.
The dual-cord technique in which the first cord remains in the sulcus
reduces the tendency for the gingival cuff to recoil and partially displace
the setting impression material.
18. Maps
Placement of retraction cords can cause injury to the sulcular
epithelium and underlying connective tissues, as shown by the results
of experiments involving dogs’ teeth. The filaments or fibers of
conventional cords also may cause residual contamination of sulcus
wounds, creating foreign body reactions and exacerbating
inflammation.
18
19. Healing of the sulcus can take seven to 10 days. Use of
minimal force is necessary when packing cords to protect
Sharpey fibers and application of excessive force is
inappropriate because it may cause crevicular bleeding,
gingival inflammation and shrinkage of marginal tissues.
▸ use of cords around implants is questionable since the junctional
epithelium is not as adherent, is more permeable and has a lower
regenerative capacity than the junctional epithelium around teeth.
19
20. 20
ADVANTAGES
1. Inexpensive
2. Achieves varying
degrees of
retraction
3. Can be used with
chemical adjuncts
DISADVANTAGES
1. Painful
2. Rapid collapse of sulcus
after removal
3. Risk of traumatizing
epithelial attachment
4. No hemostasis without
chemical agent
5. Placement is time-
consuming
6. Risk of sulcus contamination
22. Chemomechanical retraction
22
CHEMICALS WITH CORD
1. EPINEPHRINE (0.1%)
ADVANTAGES
Hemostatic
Vasoconstrictive
DISADVANTAGES
Systemic effects “epinephrine syndrome”
Risk of inflammation of gingival cuff
Rebound hyperemia
Risk of tissue necrosis
NOT INDICATED IN IMPLANT DENTISTRY
includes tachycardia,
rapid respiration,
increased blood
pressure, anxiety and
postoperative
depression.
23. Dose-related effects of epinephrine on human gingival blood flow and crevicular fluid production used as
a soaking solution for chemo-mechanical tissue retraction
Maria Csillag 1, Gabriella Nyiri, Janos Vag, Arpad Fazekas
23
Purpose: The aim of this study was to identify the effective concentration of epinephrine
that may prevent the hyperemic response and consequently keep the crevicular fluid
production low after cord removal without local or systemic side effects.
Material and methods: Seventeen healthy human subjects had their crevicular fluid
volume and gingival blood flow measured by Periotron and laser Doppler flowmetry,
respectively, before and after cord removal at the left maxillary central incisor. The right
maxillary incisor served as the control. Retraction cords were presoaked in physiological
saline or various concentrations (0.001%, 0.01%, and 0.1% w/v) of epinephrine solution.
Double repeated-measures analysis of variance with the Fisher Least Significant
Difference post hoc test was used to statistically evaluate the blood flow values (mean +/-
SE, alpha=.05), and the Wilcoxon matched pair test was used for crevicular fluid values,
given as median (25-75 percentile, alpha=.01).
24. 24
Results: In the saline group, cord removal resulted in elevated blood flow (140% +/- 11%,
P<.001) and crevicular fluid production (300% (130%-470%), P<.05). After cord removal
in the 0.01% and 0.1% epinephrine groups, blood flow remained low for the measured
period (43%-70%, P<.05). The crevicular fluid production transiently increased in the
0.01% epinephrine group (170% (140%-380%), P<.001), but then returned to baseline
level and remained low as for the 0.1% group. No systemic vascular effect was detected
in any groups.
Conclusion: The prolonged increase in crevicular fluid production and hyperemic
response after cord removal can be prevented by application of 0.01% epinephrine
solution without systematic changes.
25. Chemomechanical retraction
25
2.Synthetic sympathomimetic agents
ADVANTAGES
Hemostatic
Vasoconstrictive
More effective than epinephrine with
the absence of systemic effects
DISADVANTAGES
Rebound hyperemia
Risk of inflammation of gingival cuff
Risk of tissue necrosis
NOT INDICATED IN IMPLANT DENTISTRY
26. Chemomechanical retraction
26
3. Aluminum sulphate and aluminium potassium sulphate
ADVANTAGES
Hemostasis
Least inflammation of all agents used
with cords
Little sulcus collapse after cord removal
DISADVANTAGES
Offensive taste
Risk of sulcus contamination
Risk of necrosis if in high concentration
METHOD COULD BE USED BUT NOT RECOMMENDED IN IMPLANT DENTISTRY
27. Chemomechanical retraction
27
4. Aluminum chloride
ADVANTAGES
No systemic effects
Least irritating of all chemicals
Hemostasis
Little sulcus collapse after cord removal
DISADVANTAGES
Less vasoconstriction than epinephrine
Risk of sulcus contamination
Modifies surface detail reproduction
Inhibits set of polyvinyl siloxane and
polyether impressions
METHOD COULD BE USED BUT NOT RECOMMENDED IN IMPLANT DENTISTRY
28. Chemomechanical retraction
28
5. Ferric sulphate
ADVANTAGES
Hemostasis
DISADVANTAGES
Tissue discoloration
Acidic taste
Risk of sulcus contamination
Inhibits set of polyvinyl siloxane and
polyether impressions
METHOD COULD BE USED BUT NOT RECOMMENDED IN IMPLANT DENTISTRY
29. DRAWBACK
▸ The two main drawbacks of using chemicals with retraction
cords are:
▸ occurrence of rebound hyperemia that often occurs after cord
removal, which affects how effectively clinicians can make
impressions .
▸ inflammatory reactions induced by these chemicals, which can
affect the subepithelial connective tissue.
29
30. Chemomechanical retraction
30
Chemicals in an injectable matrix
1. Aluminum chloride with kaolin
ADVANTAGES
Reduced risk of inflammation (injectable form)
Nontraumatizing to junctional epithelium
Hydrophilic
Ease of placement
Painless
No adverse effects
DISADVANTAGES
Inhibits set of polyvinyl siloxane and polyether
impressions
More expensive
Less effective with very subgingival margins
METHOD RECOMMENDED IN IMPLANT DENTISTRY
31. Chemomechanical retraction
31
Inert matrix
Polyvinyl siloxane
ADVANTAGES
No risk of inflammation or irritation
Nontraumatizing
Ease of placement
Painless
No adverse effects
DISADVANTAGES
Limited capacity for hemostasis (no active
chemistry)
Less effective with subgingival margins
METHOD RECOMMENDED IN IMPLANT DENTISTRY
32. SURGICAL RETRACTION
32
Laser
ADVANTAGES
Excellent hemostasis–carbon dioxide (CO2) laser safe
for implants as reflected by metal
Reduced tissue shrinkage
Relatively painless
Sterilizes sulcus
DISAVANTAGES
Neodymium:yttrium-aluminum-garnet
laser contraindicated with implants
Erbium:yttrium-aluminum-garnet laser
reflected by metal but not as good at
hemostasis as CO2 laser
CO2 laser provides no tactile feedback,
leading to risk of damage to junctional
epithelium
METHOD COULD BE USED BUT NOT RECOMMENDED IN IMPLANT DENTISTRY
34. Rotary curettage
34
ADVANTAGES
Fast
Ability to reduce excessive tissue
Ability to recontour gingival outline
DISADVANTAGES
Causes considerable haemorrhage
Contraindicated with implants
High risk of the bur damaging the implant surface
Risk of tissue retraction exposing implant threads
High risk of traumatizing the epithelial attachment
NOT INDICATED IN IMPLANT DENTISTRY
35. Advancements in Gingival Retraction Techniques
35
1. Expasyl (SDS/KERR)
Expasyl is considered a viable alternative to a conventional retraction cord. It is
a viscous paste used for all techniques which necessitates gingival retraction .
Expasyl is a biocompatible material which presents with advantages of having
excellent retraction with longer shelf life.
Minimal pressure required to displace the tissues.
It produces hemostasis and controls crevicular seepage
36. Advancements in Gingival Retraction Techniques
36
Expasyl (Kerr) is an aluminum chloride (AlCl3) based paste-like
material syringed into the sulcus with autoclavable stainless steel
dispenser, acting both as a chemical hemostatic agent and mechanical
retraction material (chemomechanical method).
37. Advancements in Gingival Retraction Techniques
37
2. Magic Foamcord (Coltene/Whale dent)
Magic Foamcord presents with efficient hemostasis and minimal damage to
tissues while retraction
Magic foam cord is a polymeric material which is introduced into the gingival
sulcus and allowed to set.
Circular foams are supplied along with the material which is contoured to the
shape of gingival sulcus which is available in three sizes to accommodate
different teeth.
38. Advancements in Gingival Retraction Techniques
38
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
39. Advancements in Gingival Retraction Techniques
▸ ADVANTAGES
▸ Magic foam cord is less
traumatic to tissues than
conventional retraction cord.
▸ The Color of foam aids in
visualization. The material is
easy to separate from the
sulcus. It has adequate working
time
▸ DISADVANTAGES
▸ no hemostasis provided, expensive
No improvement is observed in
working time or quality of retraction
compared with conventional cord.
▸ It is considered to less effective on
subgingival margins. Intraoral tips
provided may be too bulky to
adequately inject material into
gingival sulcus.
39
40. Advancements in Gingival Retraction Techniques
40
3. Gingitrac (Centrix)
It is an effective gingival retraction system based on vinyl polysiloxane material
with aluminium sulfate astringent.
It truly harnesses the power of pressure, astringency and time unlike traumatic
cord techniques or messy paste alternatives.
Unlike with retraction cord, the coagulum will not stick to the silicone GingiTrac,
so there is no bleeding when it is removed.
A GingiCap is used for single preparation retraction which works in less than 5
minutes, without hands in mouth and blanches the gingiva till the vestibule.
42. Advancements in Gingival Retraction Techniques
42
4. Gel-Cord
Gelcord comprises of- 25% Aluminum Sulfate Gel. Unlike liquid astringents it
stays put when placed for maximum hemostasis.
No reports of tissue necrosis have been reported.
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.
44. Advancements in Gingival Retraction Techniques
44
5. Tissue Goo
Tissue Goo is a gel that contains active ingredient is 25% aluminum sulfate.
Aluminum sulfate does not cauterize, but rather acts similar to a coagulant to
arrest the bleeding.
It also acts as a lubricant while placement of the cord.
Tissue Goo will not impede with the set impression material.
45. Advancements in Gingival Retraction Techniques
45
6. 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.
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.
G-Cuffs major intention is to maintain soft tissue surrounding the implant abutment
permitting the impression (conventional or digital) to have an access to the surface of the
abutment required for the optimal restoration.
47. Advancements in Gingival Retraction Techniques
47
7. 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 with this
material can be up to 50% faster.
The significantly fine tip of the capsule offersimproved access into the sulcus
and interproximal areas.
49. Clinical evaluation of the effect of two gingival retraction systems, gingival cuff and gingival retraction
paste, on peri-implant soft tissue
Sugandha Gupta, Pankaj Dhawan, Pankaj Madhukar, Piyush Tandan, Aman Sachdeva
49
Aims: The aim of this study was to clinically evaluate the host tissue response around
oral implants using two gingival retraction systems, namely, G-Cuff™ and Traxodent®
Materials and Methods: Twenty cases were selected and divided into two groups:
Group A – ten patients in whom gingival retraction was done using G-Cuff™ and Group B
– ten patients in whom gingival retraction was done using Traxodent®. Patients with
immobile, stable, and planned cement-retained implant prosthesis were enrolled in the
study. Both Group A and B patients, peri-implant soft tissues were analyzed three times:
preretraction, postretraction, and after 7 days for the various parameters.
50. 50
Statistical Analysis Used: The data obtained were statistically analyzed using Kruskal–
Wallis test, Pearson's Chi-square test and Mann–Whitney test.
Results: The use of G-Cuff™ resulted in decrease in the mean of the probing depth
values after 7 days from 1.30 to 1.13 mm. The values of the probing depth for the
Traxodent® group showed a slight increase from 1.30 mm to 1.60 and 1.57 mm at
immediately and 7 days after retraction. The mucosal index increased for G-Cuff™ and
Traxodent® group. Bleeding on probing significantly decreased in Traxodent® group.
Conclusion: There was difference in the host tissue response by the two types of
retraction agents in relation to some parameters, and also, the level of pain and
discomfort by the use of G-Cuff™ was found in few cases. Based on the results of short-
term evaluations, chemical cordless retraction system functioned statistically well in terms
of hemostasis.
51. Comparison of Gingival Retraction Materials Using a New Gingival Sulcus Model
Marco Dederichs, Mina D. Fahmy, Harald Kuepper,& Arndt Guentsch,
51
Purpose: To investigate the pressure generated by different retraction materials using
a novel gingival sulcus model.
Materials and Methods: A gingival sulcus model was made using a polymer frame
filledwith silicon.Apressure sensor and a sulcus-fluid simulationwere embedded into
the silicon chamber to evaluate the pressure generated by different retractionmaterials.
Six sizes of Ultrapak retraction cords (Ultradent, sizes #000 - 3), 4 retraction pastes
(Expazen, Expasyl, Acteon, Access Edge, Traxodent) and 2 retraction gels (Sulcus
Blue, Racegel) were analyzed. The mean andmedian pressure, interquartile range, and
standard deviation (SD) of n = 10 repeated measurements were calculated. Statistical
analysis was conducted by Kruskal-Wallis test for differences between the main
groups of retraction materials, and Mann-Whitney U-test was performed to analyze
differences between the single retraction materials.
52. 52
Results: Pressure (mean ± SD) generated by retraction cords increased with increasing
size (48.26 ± 11.29 kPa, size #000 to 149.27 ± 28.75 kPa for #3). There
was a significant difference between sizes (p < 0.01), except in #0 versus #1, and #2
versus #3. Retraction pastes generated pressures that ranged from 82.74 ± 29.29 kPa
(Traxodent) to 524.35 ± 113.88 kPa (Expasyl). Retraction gels generated pressures
from 38.96 ± 14.68 kPa (Racegel) to 95.15 ± 24.18 kPa (Sulcus Blue). Pressure
generated by Expasyl was significantly higher than pressure generated by all other
tested materials (p < 0.001).
Conclusion: Pressure generated by retraction pastes and gels depends on the consistency
of the retractionmaterial, while pressure generated by retraction cords increased
with increasing size of cords. Expasyl was found to generate the highest pressure
compared to all other retraction materials
53. 53
DISCUSSION
The mechanical retraction of gingival tissues by using cords around implant
restorations can lead to ulceration of the junctional epithelium.
The forces used in cord placement are likely to exceed peri-implant tissues’
capacity to resist them.
Once patients’ gingival epithelial structure is damaged, there is significant risk of
permanent recession and loss of attachment developing.
Thus, the use of mechanical retraction with cords may be contraindicated around
implants, except in situations in which patients’ sulcus depths are shallow, their
mucosal health is impeccable and a robust, thick periodontal biotype is present.
54. 54
The addition of chemical adjuncts to retraction cords further complicates the
situation and may lead to increased inflammation of the subsulcular tissues.
The lacerated sulcus provides reduced protection against the penetration of
chemicals into deeper subepithelial cell layers and against systemic
dissemination when the vascular bed is exposed.
Surgical retraction procedures, however, are destructive and involve excision
of tissue.
Peri-implant mucosa does not have the same capacity for regeneration as
peridental mucosa.
55. 55
The correct use of lasers with appropriate wavelengths may be applicable in
some, but not all, implant situations during retraction and when making
impressions.
the aluminum chloride in the injectable matrix offers the best outcome of the
chemical choices to date.
Although injectable matrices are promising as a gingival rétraction technique
for implant situations, further development is needed. Compared with research
on implant fixtures, there is relatively little research to guide clinicians
regarding how to restore implants and about which gingival retraction
techniques to use around implant abutments.
56. 56
CONCLUSION
The literature concerning gingival retraction for impressions in fixed prosthodontics is
extensive.
By contrast, little has been published about the challenges presented by the unique anatomy
surrounding
implants.
As implants become mainstream treatments for tooth loss, this topic will warrant further
research.
57. 57
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