1) The study compared the effects of gingival displacement cords and cordless systems on gingival crevice closure, displacement, and inflammation. 2) It found that while cords provided better gingival displacement than cordless systems, cordless systems like Expasyl caused less inflammation of the gingiva. 3) All materials tested maintained an adequate sulcal width for up to 60 seconds after removal, but the cordless material Expasyl achieved the narrowest sulcal width, risking defects in the dental impression.

1. GOOD MORNING
JOURNAL CLUB

2. Effect of gingival displacement cord and cordless systems
on the closure, displacement, and inflammation of the
gingival crevice
Sumi Chandra, MDS, Ajay Singh, MDS, K. K. Gupta, MDS, Chetan
Chandra, MDS, and Varun Arora, MBA, MEARMA
J Prosthet Dent. 2016 Feb;115(2):177-82

3. CONTENTS
• Introduction
• Purpose
• Material and methods
• Results
• Discussion
• Conclusion

4. Introduction
• It allows a gingival or subgingival finishing line of the tooth to be
recorded in the impression.
• provides sufficient space for an adequate bulk of material between
the tooth and the sulcal wall.
• Sulcus width at finish line- 0.2-0.4mm
• Lack of critical sulcular width- a) voids
b) tearing of material
c) reduction in marginal accuracy

5. Analysis of introduction-
• Definition-gingival displacement jĭn΄ja-val dĭs-plas΄ment: the
deflection of the marginal gingiva away from a tooth (GPT 9)
• Need for the accuracy of the impression is not mentioned.
• Hypothesis is not given- the expected result of the study is not
mentioned on the basis of which null and alternative hypothesis is to
be concluded.

6. Need for the study
• to study the closure and inflammation of the gingival crevice after
removal of the medicated displacement cord and cordless systems.
• to investigate the gingival displacement of cordless materials in
comparison with conventional displacement cords.

7. Analysis
• Objective of the study is not mentioned- (what results he actually
want to achieve.)
• Need for the study is well explained that this study is done to know
the effect of cord and cordless method of gingival displacement on
the health of gingiva and also to know the difference between two
methods.

8. Material
Price Rs.10,580/20 capsules Rs 16,730/25 per pkt
Rs. 900/pktRs. 783/pkt

9. Analysis
• The gingival retraction cord
comes in various sizes which
the author did mentioned,
that is been used in the study.
• Ultrapak comes in size of 000,
00, 0, 1, 2 and 3 of various
thickness with a color coding
(no. 1 impregnated with
1:1000 epinephrine dilution is
used in the study)
• Siltrax gingival displacement
cord no. 1 is used in the study
impregnated with aluminium
sulphate)

10. • Expasyl-
Aluminium chloride(=15%),Kaolin, Excipients
• Traxodent -
Aluminium chloride 15%

11. Other methods of gingival displacement-
• Magic foam cord (vinyl
polysiloxane)
• Merocel (hydroxylate
polyvinyl acetate)
• Lasers
• Stay put ( braided cord
with copper filament)
• Gingitrac (silicone based
material)
• Access flow (aluminium
chloride and kaolin clay)
Rs. 848
Rs. 6500
Rs 720
Rs 1260
Rs 6230

12. Material
Inclusion criterion-
• 40 study participants
• 20-40 years of age
• Both sexes
• Varying socioeconomic statuses
• Clinically free of gingival inflammation or systemic disease

13. Exclusion criterion-
• relevant medical history,
• signs of periodontal disease and attachment loss
• history of systemic disease,
• and smokers

14. Analysis
• The sampling is not clearly explained- what type of randomized
sampling is done- whether it is simple, stratified, cluster or
multiphase.
• Sample size chosen is not specied on what basis it is done. Size is
selected on the basis of previous studies or pilot studies, probability
level of precision or availability of available source.

15. Method
• 4 experimental groups-
1) Group U (Ultrapack)
2) Group S (SilTrax AS)
3) Group E (Expasyl)
4) Group T (Traxodent Hemodent paste)

16. Site-
• labial surface of the maxillary right and left central incisors.

17. • Why the author must have choosen this particular site??
• The author clearly mentioned the methodology of the displacement.

18. • Sulcal depth was measured by inserting a
periodontal probe (UNC-15; Hu-Friedy Mfg
Co, LLC) into the gingival sulcus opposite the
transitional line angles (TLA) and mid-buccal
areas of the tooth until slight resistance was
felt.
• Measurements were made at the TLA and
mid-buccal areas to rule out the presence of
periodontal pockets.
• On a diagnostic cast, an acrylic resin jig was
fabricated to fit over the mandibular teeth
to prop the mouth open and to stabilize the
mandible during assessment.

19. • Gutta percha points (no. 40) were attached to the labial
surface of the tooth in the mid-buccal area, and at the
distal transitional line angle with a light-polymerized
flowable composite resin material.
• Gingival displacement was done using a double cord
displacement techniquewith black braided silk, size 3-0
(Ethicon; Johnson & Johnson Ltd), which remained in
the sulcus during the entire investigation of closure of
the sulcus, regardless of the displacement material.
• Both displacement cords were placed in the sulcus with
a cord packer (Dispodent) and remained in the sulcus
for 5 minutes. After cords were removed, the sulcus
was photographed at an interval of 20 seconds from 0
to 180 seconds.

20. • Both of the cordless materials were injected into the sulcus without
exerting pressure on the gingiva .
• The material remained in the sulcus for 2 minutes, after which it was
removed with a 3-way syringe and photographs were made.

21. Positioning of the participant.
Application of black braided silk along with gutta percha
markers placed at mid-buccal area and transitional line angle.
Nikon D-300S, 60 mm lens and ring flash

22. A, Application of Ultrapak cord dipped in epinephrine no. 1 (group U). B, Application of SilTrax AS cord no.
1 (group S). C, Application of Expasyl cordless paste (group E). D, Application of Traxodent Hemodent
paste (group T).

23. Clinical parameters-
• gingival sulcus closure
• gingival displacement
• BI
• GI.

24. Measurements -
• The BI and GI were measured at day 0, day 1, and day7.
• The width of the sulcal orifice was measured on the digital photograph.
• Closure of the sulcus was assessed with computer software (Photoshop version
7.0; Adobe).
• Measurements were made from the inner gingival wall across to the tooth
surface at a 90-degree angle.
• The sulcus was photographed with markers of known width (gutta percha no. 40)
placed across the mid-buccal and TLA sulci to calculate magnification

27. Statistical analysis test used-
• ANOVA, the
• Tukey HSD test,
• the Kruskal-Wallis test,
• Mann-Whitney U tests (a=.05)

28. Results

31. DISCUSSION
• The accurate transfer from the patient to the definitive cast with an
impression is crucial to obtain restorations with precise marginal fit.
• This study was performed using unprepared teeth, which avoided the
adverse effects of preparation and interim restoration fabrication
steps on the gingival tissue.
• The recovery of an impression without marginal tears depends on the
thickness of the impression margin, the tear strength of the
impression material, and its ability to undergo elastic deformation
when being removed from undercut areas.

32. • In the this study, all groups showed a sulcal width greater than 0.22 mm up
to 60 seconds after removing the gingival displacement materials at the
midbuccal area and up to 40 seconds at the transitional line angle.
• The cordless groups showed inadequate sulcal width after 60 seconds at
the mid-buccal and after 40 seconds at the TLA area, which may result in
defects in the impression.
• Among all groups at all time intervals, Expasyl showed the minimum sulcal
width.
• The widening of the sulcus at the mid-buccal area for the cord groups (U
and S) was 1.08 mm and 1.05 mm, respectively, and 0.44 mm and 0.71 mm
for the cordless groups (E and T), respectively, 3 minutes after the removal
of the gingival displacement material.

33. • no statistically significant differences were found between the closure
of the sulcus with the knitted (group U) and that of the braided
(group S) cords.
• Jokstad and Raja et al found that knitted cords were better than
braided cords, with greater gingival displacement.
• all groups showed a faster closure rate at the transitional line angle
than at the mid-buccal area.

34. Effect on gingiva-
• the GI was maximum for Ultrapack knitted cord (group U) and
minimum for the cordless group (group E/T) at days 0 and 1.
• De Gennaro et al also reported fewer inflammatory changes in cord
impregnated with aluminum sulfate than with other agents.
• Al Hamad et al reported that Expasyl had the highest GI compared
with cord after the first day and showed slower healing.
• No bleeding was noticed in group E at any time interval.
• At day 0, Ultrapack (group U) had the maximum score, whereas
groups E and T had the minimum, indicating the advantage of gentle
tissue management with cordless materials over cords

35. Conclusion
• All materials showed adequate sulcal width up to 60 seconds.
• Expasyl showed minimum sulcal width at all intervals.
• Cords showed better gingival displacement than cordless.
• The GI and BI were maximum for Ultrapack and minimum for Expasyl.