This document discusses various methods for gingival retraction during the fabrication of fixed partial dentures. It defines gingival retraction as deflecting the marginal gingiva away from a tooth, which is important for accurate impressions. Methods discussed include mechanical retraction cords soaked in chemicals, rotary gingival curettage, and electrosurgery. The document provides details on techniques, effectiveness, and risks/considerations for each approach.

1. GINGIVAL RETRACTION
IN FIXED PARTIAL
DENTURES
Presented by- Dr. Nikita Chhabariya

2. Contents
 Introduction
 Definition
 Importance
 Criteria
 Classification and types:
• Mechanical
• Mechanico-chemical
• Rotary gingival curettage
• Electrosurgery
 other methods

3. Introduction
 Important factor in cast partial dentures-
Marginal integrity.
 Inadequate marginal fit leads to:-
-dissolution of luting agent.
-seepage and cervical caries.
-periodontal disease.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

4. Definition
 Gingival Retraction /Gingival Displacement:
The deflection of the marginal gingiva away
from a tooth. - (GPT9)

5. NEED AND IMPORTANCE OF
DISPLACEMENT
1. Adequate access to the prepared tooth.
2. Reproduction of the finish line.
3. For accurate duplicating the sub-gingival
margins.
4. Providing the best possible condition for the
impression material, fluid control.
5. Precision of the restoration for prevention of
periodontal disease.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

6. CRITERIA FOR SELECTION :
 Effectiveness in gingival displacement and
hemostasis
 Absence of irreversible damage to the
gingiva
 Paucity of untoward systemic effect
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

7. CLASSIFICATION
MECHANICAL
CHEMICO-
MECHANICAL SURGICAL
ROTARY GINGIVAL
CURETTAGE
‘GINGETTAGE’
ELECTROSURGER
Y
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition
GINGIVAL RETRACTION

8. Copper Band
 Means of carrying the impression material and
a mechanism for gingival retraction.
Reference : Hovestad JF. Fixed Dental Prosthesis. St. Louis : Mosby , 1924:

9. Technique:-
Reference : Hovestad JF. Fixed Dental Prosthesis. St. Louis : Mosby , 1924:

10. Reference : Hovestad JF. Fixed Dental Prosthesis. St. Louis : Mosby , 1924:
-Material used
Modelling compound
ELASTOMERIC MATERIALS

11. Can we evaluate the
Disadvantages by ourselves ?
 HINTS-
Ruel, J., Schuessler P.J., Malament, K. and Mori, D., 1980. Effect of retraction
procedures on the periodontium in humans. Journal of Prosthetic Dentistry,
44(5), pp.508-515.

12. 2. Rubber Dam
 Produced retraction by compression.
 Heavy and extra heavy rubber dams were
used.
 Retraction is done by rubber dam or clamps
(No. 212 cervical retainer).
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

13. Limitations-
 Should not be used with polyvinyl siloxane
impression material, because the rubber dam
will inhibit its polymerization.
 Cannot be used to record subgingival
preparation.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

14. 3. Plain cotton cord
 It physically pushes the gingiva away from the
finish line.
 Its effectiveness is limited because pressure
alone will not control sulcular haemorrhage
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

15. Chemico – Mechanical
 Retraction Cords
• Combining chemical action with pressure
packing of the retraction cord
• Enlargement of gingival sulcus as well as
control of fluids seeping from the walls of
the gingival sulcus
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

16. Caustic Chemicals tried earlier:
• Sulfuric acid
• Trichloroacetic acid
• Negatol (45% condensation product of meta
cresol sulfonic acid and formaldehyde)
• Zinc Chloride
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

17. CHEMICALS USED ALONG WITH
CORD
Hemostatic
agents
ferric
sulphate
Astringents
{ cause tissue
contraction }
aluminium
chloride
Aluminium
sulphate
Vasoconstrictor
Epinephrine
An evaluation of the drugs used for gingival retraction. Woycheshin FF. J of Prosthet Dent. 1964;14:

18. Epinephrine
Epinephrine has been documented as gingival retraction agent in 1980s
 Advantages of epinephrine :
 Effectiveness in gingival displacement
 Haemostasis
 Absence of irreversible damage to gingiva
 Disadvantages of epinephrine :
‘Epinephrine Syndrome’
Tachycardia
Rapid respiration
Elevated blood pressure
Anxiety
Postoperative depression
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

19. Contraindications of
Epinephrine
 CVS Disease
 Hypertension
 Hyperthyroidism
 Known Hypersensitivity to epinephrine
 Patients on, Ganglionic Blockers or
Epinephrine potentiating drugs
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

20. TECHNIQUE FOR PLACEMENT OF
CORD INTO THE GINGIVAL SULCUS
Single cord technique.
Double cord technique.
Infusion technique of gingival displacement.
Gelcord
Stat Gel
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

21. TECHNIQUE FOR PLACEMENT
OF CORD INTO THE GINGIVAL
SULCUS

22. SINGLE CORD TECHNIQUE
 Simplest & least traumatic technique
Indication- when gingival tissue are healthy & do not
bleed.
- For making impressions for 1 to 3 prepared teeth.
Procedure :
• Isolate the quadrant
• Suitable length / diameter of cord selected.
• Dip the cord in astringent solution and squeeze out the
excess with gauze square
Krammer et al;DCNA 2004

23. • Push cord between tooth & gingiva on mesial
aspect
• Continue packing on lingual, distal & buccal
aspects.
• Leave 2 mm of cord in excess
• Kept in place for 10 min

24. Double cord technique:
Indication:
When making impression of multiple prepared
teeth and when making impression when tissue
health is compromised.
Procedure: Small diameter cord is placed in
sulcus. This cord is left in the sulcus during
impression making.
Second cord is soaked hemostatic agent of choice
is placed in the sulcus above small diameter
cord.
After waiting 8-10 minutes, the larger cord
is removed.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

26. Infusion technique:
 It is indicated to control the haemorrhage.
 Dento infusor is used to apply 15% or 20%
ferric sulphate in the sulcular area.
 Infuser is used with a burnishing motion.
 Haemostasis is verified, a knitted retraction
cord is soaked in ferric sulphate and packed
into the sulcus.
 The cord is removed after 3 minutes.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

27. •1.0-cc dento- infuser with the
astringent chemical and place
tip on the syringe.
•Use fibrous syringe tip to rub
or burnish cut sulcular tissue
•Untill all bleeding stop.
•Keep till hemostasis
achieved .
Shillinburg HT. Fundamentals of Tooth
Preparation. 3rd Edition

28. Gelcord
 25% aluminium sulphate gel
 Aids in hemostasis & tissue retraction
J. Adv. Res. Dent. Oral Health 2016; 1(2)

29. Statgel
 15% ferric sulphate
 Aids in hemostasis & tissue retraction
J. Adv. Res. Dent. Oral Health 2016; 1(

30. NASAL AND OPHTHALMIC
DECONGESTANTS FOR GINGIVAL
RETRACTION
 Phenylephrine hydrochloride – 0.25%
 Oxymetazoline hydrochloride – 0.05%
 Tetrahydrozolin hydrochloride – 0.05%
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd
Edition

31. Surgical technique

32. Rotary Gingival Curretage
 “Gingitage” or “Denttage”
 Troughing technique.
 Amsterdam gave the concept,further
developed by Hansing and Ingraham.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

33. Criteria for rotary curettage
1.Must be done on healthy and inflammation
free tissue to prevent tissue shrinkage that
occurs when diseased tissue heals.
2.Absence of bleeding on probing.
3.Sulcus depth less than 3.0 mm.
4.Presence of adequate keratinized gingiva.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

34. Technique
 Shoulder finish line preparation at gingival crest using flat
end tapered diamond.
 Then with a torpedo diamond finish line is extended
apically,1/2 to 2/3 the depth of the sulcus.
 Place aluminium chloride impregnated retraction
cord to control hemorrhage.
 Remove the cord after 4-8 minutes and make impression
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

35. Electro Surgery/Electro Cautery
 Electrosurgery unit is a high frequency
oscillator or radio transmitter that uses either
vaccum tube or a transistor to deliver a high
frequency electrical current at least 1.0MHz.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

36. Mechanism ofAction:
Controlled tissue destruction
Current flows through a small cutting electrode
Producing high current density and rapid temperature
rise
Cells directly adjacent to electrode are destroyed due
to temperature increase
The circuit is completed by contact between the patient
and a ground electrode
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

37. TYPES OF CURRENT
Fully Rectified current (modulated)
Fully Rectified current (filtered)
Partially rectified current (damped)
Unrectified current (damped)
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd

38. ELECTRO SURGERY
TECHNIQUE
STEPS:
 Anesthetize the area
 Apply peppermint oil, at the vermilion border
of lip
 Check the equipment setting
 Cutting electrode should be applied with very
light pressure and quick, deft strokes
 Electrode should move at a speed of no less
than 7mm/second
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

39. GINGIVAL SULCUS
ENLARGEMENT
 To enlarge gingival sulcus, a small, straight or J-shaped
electrode is selected. It is used with wire parallel to the
long axis of the tooth.
 If the electrode is maintained in this direction the loss of
gingival height will be about 0.1mm.
 Probe is run at a speed of 7mm per second to avoid
lateral heat dissipation
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

40. REMOVAL OF AN EDENTULOUS
CUFF
 The remnants of the interdental papilla
adjacent to an edentulous space
 A large loop electrode is used for planning
away the large roll of tissues.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

41. CROWN LENGTHENING
 There are circumstances in which it may be
desirable to have a longer clinical crown on a
tooth than is present.
 wide band of attached gingiva surrounding the
tooth.
 DIAMOND ELECTRODE.
 surgery leaves an extensive post-operative
wound as in this case, it is necessary to place a
periodontal dressing, which should be changed in
about 7 days.
Shillinburg HT. Fundamentals of Tooth Preparation. 3rd Edition

42. Recent Advances
 EXPASYL
 MAGIC FOAM
 MEROCEL
 ASTRINGENT RETRACTION PASTE
•J. Adv. Res. Dent. Oral Health 2016; 1(2)
•Phatale S.et al J Indian Soc Periodonto 010;14(1):35–39. doi:10.4103/0972-
124X.65436000

43. CHEMICALS WITH AN
INJECTIONABLE MATRIX :
EXPASYL TECHNIQUE
Expasyl a unique clinical technique;JADA2003
COMPOSITION
1) Kaolin 66.75%
2) Water 23.36%
3) AlCl3 6.54%
4) Colorant 1.02%
5) Essential oil of
lemon 0.33%

44. SULCUS OPENING WITH
EXPASYL

45. Magic Foam
first expanding vinyl polysiloxane material
Phatale S.et al J Indian Soc Periodonto 010;14(1):35–39. doi:10.4103/0972-124X.65436000

46. Merocel
Marco Ferrari et al in 1996
they found merocel a
synthetic material that is
specifically chemically
extracted by a biocompatible
polymer (hydroxylate
polyvinyl acetate)
Tissue management with a new gingival retraction material: A preliminary clinical repo
Marco Ferrari, PROSTHET DENT 1996;75:242-7.)

47. Astringent Retraction Paste
La ForgiaA:Cordless tissue retraction for fixed prostheses

48. Conclusion
 The accuracy of the impression taken in the
prosthetic area is extremely important both for
the health and the esthetics of the treated
patients. The offered techniques should be
patient-based and applied whenever the
individual treatment necessitates, or allows it.

49. References
 Shillinburg HT. Fundamentals of Tooth Preparation. 3rd
Edition
 Hovestad JF. Fixed Dental Prosthesis. St. Louis : Mosby
, 1924: 34-36
 Ruel, J., Schuessler P.J., Malament, K. and Mori, D.,
1980. Effect of retraction procedures on the
periodontium in humans. Journal of Prosthetic Dentistry,
44(5), pp.508-515
 An evaluation of the drugs used for gingival retraction.
Woycheshin FF. J of Prosthet Dent. 1964;14: 769-76
 Krammer et al;DCNA 2004
 Adv. Res. Dent. Oral Health 2016; 1(2)
 La ForgiaA:Cordless tissue retraction for fixed
prostheses J.P.D.1967,vol.17,pg.379