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.

1. Presenter :
Dr. Charupriya Rajore

2. 1. Introduction

3. 7. Gingival tissue displacement around implant

4. INTRODUCTION
Supra-gingival margins

5. marginal fit
Excellent Marginal Fit

6. Gingival retraction

7. NeedAnd ImportanceOf Gingival Displacement
exposure of
finish line
impression
material and fluid control.
esthetics prevention
of periodontal disease

8. CRITERIA
minimum tissue damage
.
gingival displacement and
hemostasis.

9. TYPES OFDISPLACEMENT
• Displaces the tissue so that
adequate bulk of the
impression material can be
interfaced with theprepared
tooth.
LATERAL
• exposes the unprepared
portion of the tooth apical to
the finish line. May cause
trauma to the gingivaltissues
followed by recession.
APICAL/VERTICAL

10. COMBINATION
OF DIFFERENT
TECHNIQUES
Tissue displacement methods in Fixed Prosthodontics ,BW Benson et al. ,JPD 1986 ,Feb

11. MECHANICALTISSUE
DISPLACEMENT
first and earliest
4. Mechanical pack made from ZOE
5. Retraction cord
6. Strings of fibre.

12. Copper Band (Tube) Filled WithImpression
Material
COPPER BAND
•It is used to carry the impression as well as to displace the
gingiva to expose the finish line.
CopperTubes

13. TECHNIQUE OF COPPER BAND
DISPLACENENT or MATRIX METHOD

15. DISADVANTAGES:
ADVANTAGE:

16. According to this article gingival recession following use of copper band is
0.1mm to 0.3mm in healthy adolescent population.

17. RUBBER DAM
ADVANTAGES
DISADVANTAGES

18. TEMPORARY ACRYLICRESIN COPING
1 mm.
copings becomes
an integral part of the impression.
(Lawrence winland ,1964)

19. TEMPORARY METAL CROWN FILLEDWITH
THERMO-PLASTIC STOPPING MATERIAL

20. prolonged or lasting recession
sensitive
susceptible to caries
same appointment
GINGIVALTISSUE RETRACTION-AREVIEW:
Syed Shujaulla, SyedaTawkhiraTabasum, Sunil Kumar MVJIDENT ISSUE 1VOLUME 1 OCTOBER 2012

21. Chemicomechanical Displacement
Methods

22. SterileTwills Of Cotton ImpregnatedWith
Slow Setting Zinc-oxide EugenolCement
-

23. RETRACTION CORDDESIGNS
Twisted
Braided
Knitted

24. Size: 000
very sensitive and thin gingiva
Size: 00
Size: 0
Sizes of Retraction cords

25. Size: 1
Size: 2
Size: 3

26. CHEMICALLY IMPREGNATEDCORDS

27. VARIOUS DRUGS USED FOR GINGIVAL
DISPLACEMENT CHEMICALS ANDBRANDS

28. Vasoconstrictors
They act by:
1. Transient gingival shrinkage.
2. Transient ischemia
3. Controlling seepage of gingival fluid.
Ex: Epinephrine (used widely before 1980’s)
Epinephrine causes an evaluation in the blood pressure and increased heart rate.
Though its effect are minimal in healthy gingiva but it has profound effect on
lacerated or inflamed gingiva.

29. EPINEPHRINECONTRAINDICATIONS:

30. Baba NZ,GoodacreCJ , Jekki R,Won J.GingivalDisplacement for Impression Making in Fixed ProsthodonticsContemporary
Principles,Materials,andTechniques. DentClin NAm 58 (2014) 45–68
.
PhataleS,Marawar, P.P,Kalburge,JV.Effect of Retraction materials on Gingival Health : A Histopathological study.J Indian Soc
Periodontol 2010; Jan- Mar; 14(1): pp 35-39.

31. BIOLOGIC FLUID COAGULANTS
• Astringent agents such as alum, aluminum chloride and zinc chloride
are metal salts that inhibit plasma proteins’ inter-capillary immigration,
decrease cell permeability, control the moisture in the peripheral tissues
through protein precipitation on the superficial layer, and increase the
mechanical strength of the mucosa. Thus, protein precipitation has
hemostatic effects under physiological condition.
• Very safe agent as they induce minimal systemic effects.
• Eg. 100% Alum
• 15-25% AlSO4
• 15- 20% Fe2 SO4
• 25% AlSO4

32. ALUM (POTASSIUMALUMINUMSULFATE)
transientischemia

33. ALUMINIUM CHLORIDE 5%-25%
effect of other
•Most commonly used
• 25% solution approx. doubles the haemostatic
chemicals.
ADVANTAGES:
1.No known contraindications and minimal side effects.
2.Considered most effective chemical to control bleeding and displace
tissue with minimal damage.
DISADVANTAGE:
More than 10% may causes local tissue destruction.

34. 25% Aluminium sulphate
• Most popular astringent.
• Excellent retraction ,hemostatic control
and tissue rigidity.
• Recommended treatment time is 5-8
min.
• Its blue in color and comes in pleasant
raspberry flavor.
• No known contraindications and minimal
systemic effects.

35. FERRIC SUBSULFATE –MONSEL’SSOL.
more effective
corrosive
stain the enamel

36. FERRIC SULFATE13.3%
30 min.
tissue discoloration.

37. ZINC CHLORIDE 8% -40%(bitartarate)
severe necrosis
caustic
not recommended

38. TANNIC ACID 20%-100%

39. TIME OF PLACEMENT OFRETRACTION
CORDS
5-30
Min.
5 –10 min

40. •CORD PACKING INSTRUMENTS:
serrated
braided cords
non serrated
twisted cord a sliding motion.

41. PASCAL Cord PackingInstrument
Circlet®
Packing
Plain
Standard
Packing
Plain
Angled Circlet® PackingSerrated Standard PackingSerrated

43. Techniques For Gingival DisplacementUsing
RetractionCords

44. SINGLE CORDTECHNIQUE
mesial

45. towards the area
pushed slightly
already tucked
angled
towards the root

47. THE DOUBLE CORDTECHNIQUE

49. THE ‘EVERY OTHERTOOTH’
TECHNIQUE:
strangulation of the gingival papillae
alternate tooth

51. ROTARY GINGIVALCURETTAGE

53. ELECTROSURGERY

55. CONTRAINDICATIONS:

56. LASERS
• Lasers may also be employed as they cause tissue-coagulation
facilitating hemostasis tissue removal via vaporization, and sulcular
epithelium is removed.
• Commonly used soft-tissue lasers for gingival displacement include
CO2 lasers, diode lasers, Nd:YAG lasers, erbium lasers, etc.
• These minimally penetrate the soft tissues, so they are fairly safe to use.
• Some of the advantages with lasers include a dry bloodless field of
surgery, sterile working area, less mechanical trauma, minimal pain and
less postoperative swelling and scarring.
• However, cost factor is a drawback and it is technique-sensitive. Er:
YAG laser is not good in hemostasis as CO2 laser. However, CO2 laser
provides no tactile feedback, leading to risk of damage to junctional
epithelium.

57. Other Methods And New Materials

58. Expa-syl
•The system includes an
injectable material supplied in a
cartridge and delivered with a
specially designed gun.
•The Expasyl material is Kaolin
(natural clay) incorporated into
an organic binder with
aluminium chloride added for
haemostatic action.

60. STEPS

61. • Advantages
• Disadvantages

62. 3M Astringent Retraction Paste
15% aluminium chloride

63. COMPARSION OF THE SIZE OF TIPS

65. Steps for application

66. •Magic Foam Cord is a new non-
haemostatic gingival retraction
system.
•It is the first expanding vinyl
polysiloxane material
for retraction of
designed
the gingival
the potential
sulcus without
trauma to sulcus.
Magic FoamCord™

67. Magic FoamCord
“How Does ItWork”
Syringe
FoamCord
around the
preparation
Placepre-fitted
Comprecap
over tooth and
ask patient to
bite down
Wait 5 min. to
allow FoamCord
material to fully
set and sulcusto
expand
Preparation
ready for
final
impression

68. Magic FoamCordExpansion

69. NEW
“Comprecap Anatomic”
Old Comprecapshape New Comprecapshape
Advantage:
Uniform compression around the whole
Preparation.

70. Advantages of Magic FoamCord
• Astringent is not required – no need to rinse
• More efficient – when doing multiple preparations
• Perfect retraction of the Sulcus, stops bleeding without
invasive materials or techniques
• Easier to use (same as impression making). Flows directly into
the Sulcus. No need for technique sensitive application
technique.
• No trauma (no packing or pressure, no bleeding caused by the
procedure)

71. NoCordVPS
Vinyl Polysiloxane
self-retracting
impression system

72. Orange
Green

73. Technique

74. Final impression

75. Advantages:
• Atraumatic to gingiva as no retraction cords are required
for displacement.
• One stage procedure saves chair side time.
• No use of application of additional haemostatic agent
before impression making which also saves time and
money .

76. Merocel Strips
• Merocel retraction strips are a synthetic material that is
specifically chemically extracted from a biocompatible polymer
(hydroxylate polyvinyl acetate) that creates a netlike strip
without debris or free fragments.
• It can be easily shaped and adapted around the tooth. It is highly
effective in absorption of oral fluids. It is not abrasive and hence
provides a gentle displacement.

77. • Tooth is initially prepared at the gingival level without retraction
of the gingival sulcus. A provisional crown is lined with acrylic
resin and then inserted.
• A gingival finish line is prepared within the intracervicular space
during the second appointment, and caution is exercised to avoid
injury to the gingival tissue.
• A 2 mm thick Merocel retraction strip is inserted around the
tooth and the provisional crown is reinserted.
METHOD

78. • The patient is asked to maintain pressure on the artificial
crown and concomitantly on position is sustained for 10 to 15
minutes.
• The Merocel retraction strips tend to expand with absorption
of selected oral fluids, exerting pressure on surrounding
tissues to provide gingival retraction. The material in the
intracrevicular space is removed and an impression is made.

79. STAY PUT
• Stay Put combines the advantages of an impregnated braided
retraction cord with the adaptability of a fine metal filament.
• Both impregnated and unimpregnated options are available
for clinical use. Hemostatic agent, aluminum Chloride is
employed for impregnated Stay Put.
• Non-impregnated stay put cord may be impregnated with a
suitable hemostatic agent as desired.
• Main advantages are quick hemostasis, can be pre-shaped,
adaptable and pliable, good contrast to gingiva, and no risk of
cardiovascular problem.

80. retraction cords
chemicals
• Lasers
• Electrosurgery
• Rotary curettage

81. G- Cuff
• There are challenging techniques to record subgingival contour of
the abutment. Comparison of the implants to the teeth showed that
there was not a special technique to retract the gingiva before
impression making.
• Chang et al. evaluated the effects of cordless retraction material
(Expasyl) on the implant surface and found that minimal changes
occurred. Wide healing caps or temporary abutments which are used
in some kinds of implant systems (e.g. Bicon) have not predictable
results due to various tissue rebound.
• G-Cuff™ is an impression device that is claimed taking an accurate
registration of a dental implant abutment.

82. • The main purpose of G-Cuff is to support the soft tissue that
surrounds the implant abutment. So it retracts the gingiva to allow
the impression material or digital intra-oral scanner recording the
implant abutment, so the final restoration can be accomplished
within two visits.
• The instructor claimed that the restoration using G cuff is more
accurate than open tray and close tray impression techniques.
• It is helpful for unidentified dental implants and eliminates the
need to transfer the copings and analogs. It is not traumatic for
the soft tissue unlike retraction cord .
• However, more studies are recommended to verify its efficiency.
Further research is recommended, especially on abutment level
impressions.

83. Conclusion
• Gingival retraction holds the merit of being an indispensable
clinical procedure for predictable soft tissue management and
impression making.
• The myriad clinical complications arising out of inadequate
marginal adaptation can be clearly avoided, provided apt
attention is paid to impression-making after due exposure of
finish margins with any of the mentioned methods of gingival
retraction.

84. • Soft tissues form is a integral part of a restoration/
prosthesis along with hard tissues.
• Proper balance between soft and hard tissue is a essential
pre-requisite for longevity of the restoration as well as for
its success.

86. Next seminar : Dr. Fauzia
Topic : Current trends in Prosthodontics
Date : 28th may at 12:00pm