SOFT TISSUE MANAGEMENT IN FIXED PARTIAL DENTURE

SOFT TISSUE MANAGEMENT IN FPD
Presented by,
Dr.TESSA KURIACHAN
READER
DEPT OF PROSTHODONTICS
SREE ANJANEYA INSTITUE OF

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CONTENTS
• Introduction
• Definition
• Pre-retraction assessment of gingival tissues.
• Indications
• Classification
Mechanical
• Heavy weight rubber dam
• Copper band
• Acrylic resin temporary coping
• Anatomic compression cap
• Gingival protector
• Matrices and wedges
• Retraction cord
2

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• Chemomechanical
o Vasoconstrictors
o Biologic fluid coagulants
o Surface layer tissue
coagulants
• Techniques of retraction with
retraction cord
o Single cord
o Double cord
3
• Other recent techniques and materials
-Dento-infusor tips
-Expasyl
-Gingitrac
-Magic foam cord
-Traxodent Hemodent Paste Retraction
System
-Merocel retraction strips
• Rotary curettage
• Electrosurgery
• Lasers for gingival retraction
• Retraction in implants
• Conclusion

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INTRODUCTION
• A perfect impression should include finish lines which in turn results in good
marginal fit of the restoration. The gingiva must be displaced to make a complete
impression and some times even to permit completion of the preparation and
cementation of the restoration.
• The aesthetics and longevity of restorations is significantly dependent on
gingival and periodontal factors.
• The intimate interaction between the restorations and the surrounding
soft tissues means that all procedures performed should keep the health
of the gingiva and periodontium under consideration.

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DEFINITION
 Gingival tissue displacement is the deflection of the marginal
gingiva away from a tooth- GPT 9
 It is defined as the procedure of
 temporary eversion (widening of gingival sulcus)
 resection of gingiva away from the tooth surface or
 deepening of gingival sulcus to expose the cervical portion of
tooth in order to have proper marginal finish to the restoration
and recording the preparation accurately.
6

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PRE-RETRACTION ASSESSMENT OF
GINGIVAL TISSUES
• The gingival tissues intended to be retracted should be normal
in colour and firm.
• The contour, consistency and any pain originating from the
gingiva or supporting tissues should be evaluated
• There should be minimum or no bleeding on probing
• ideally to control the apical extent of the preparation so as not
to encroach on the epithelial and connective tissue attachment

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# 1
# 2
# 3
# 1 – Sulcular Depth
0.69mm
# 2 – Junctional Epithelial
Attachment = 0.97mm
# 3 – Connective Tissue Attachment
1.07mm
Gargiulo et al. reported in 1961

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Based on the sulcus depth, the following three rules can be used
to place intracrevicular margins:
1. If the sulcus probes are 1.5 mm or less, the restorative margin
could be placed 0.5 mm below the gingival tissue crest.
2. If the sulcus probes are more than 1.5 mm, the restorative
margin can be placed in half the depth of the sulcus.
3. If the sulcus is greater than 2 mm, gingivectomy could be
performed to lengthen the tooth and create a 1.5 mm sulcus.
The patient can then be treated as per rule1.

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The criteria which should be used in evaluating the retraction:
( 1) A trough or space must be created which makes the
subgingivally prepared margins both accessible and visible.
(2) Must be wide enough to accommodate elastic impression
material of sufficient thickness and strength so that it cannot be
torn during the removal of the finished impression.
(3) Must be free of blood and tissue fluids and must remain dry
for a time sufficient for placement and set (or gel) of the elastic
impression materials.

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(4) There must be minimum tissue damage resulting from the
gingival displacement procedure, as well as minimum tissue
damage resulting from the preparation of the subgingival
margins.
(5) The tissues must recover within a reasonable period of time.
(6) The resulting tissue contours must be predictable.
(7) The general systemic effect must be minimal and certainly
must be tolerable to the individual patient.

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INDICATIONS OF GINGIVAL RETRACTION:
 Esthetic consideration-Subgingival finish lines
 To control haemorrhage and gingival seepage
 Presence of Sub gingival Caries.
 Cervical abrasion or erosion
 Visualize margins and remove excess cement during final
cementation
 Protection of the gingiva during preparation of tooth for
direct or indirect restoration with subgingival margins.

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CLASSIFICATION
Acc to Marzouk: a) Physio-Mechanical
b) Chemical
c) Electro surgical
d) Surgical
Acc to TylMan : a) Mechanical
b) Mechanical – Chemical
c) Surgical- (Electro surgery )
18

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ACCORDING TO
GILMORE
a) Conventional methods
i. Rubberdam
ii. Chemomechanical
b) Radical methods
Surgery
I. Knife
II. Electric cautery
III. Electro coagulation
Chemical cautery
I. ZnCl2 (40%)
II. Na2S – Sodium sulfide
III. Potassium hydroxide(KOH)
19

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20
ACCORDING TO B.W.BENSON ET AL
1. Mechanical method
2. Mechanico-chemical method
3. Rotary gingival curettage
4. Electrosurgical methods.

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MECHANICAL METHODS
• Physically displacing the gingiva to ensure adequate
reproduction of the preparaed finish line.
• Methods used:
- Heavy weight rubber dam
- Copper band
- Acrylic resin temporary coping
- Anatomic compression cap
- Gingival protector
- Matrices and wedges.
- Retraction cord
21

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• Use of heavy weight rubber dam with proper interceptal
dimensions, has an effect which is immediate.
• According to Gilmore it can be called as
gum compression rather than displacement.
1. HEAVY WEIGHT RUBBER DAM
22

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Indication:
• When a limited number of teeth in one quadrant
are being restored.
• When preparations do not have to be extended too
far sub-gingivally
Limitations:
• Full arch impressions are difficult
• Should not be used with PVS because the rubber
inhibits their polymerization
26

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2. COPPER BAND
28
• A copper band or tube can serve as a means of
carrying the impression material as well as a
mechanism for displacing the gingiva to ensure that
the gingival finish line is captured in the impression.
• Impression compound or elastomeric impression
materials can be used along with this band.

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Gingival margin are crimped to adapt to
gingival contour

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Advantage
• The gingival tissue retraction is maximal.
• the margins may be established at the maximum subgingival
depth
• the band impression made under pressure with no air bubbles
or voids
• the technique can be used for either sectional or complete-
arch impression, inlays, three-quarter crowns, or full-coverage
crowns;
• it is not necessary to pour the cast as soon as the impressionis
made
32

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Disadvantage
• Can cause incisional injuries of gingival tissues.
• More time necessary to fit and adapt the band
• Difficulty in removing the modelling compound filled
band from undercuts.

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3. ACRYLIC RESIN TEMPORARY COPING
33
Temporary acrylic resin coping
constructed
Tray adhesive applied
Filled with elastomeric impression
material and reseated
Tissue displacement occurs
Full arch impression made

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4. ANATOMIC COMPRESSION CAP
Anatomic
compression caps
placed on
patient’s teeth
Instruct the
patient to bite on
it

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Advantages:
• Stops bleeding due to compression
• Opens the sulcus wide
• Ensures clean , dry area with well defined gingival margin

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5.GINGIVAL PROTECTOR
• It has a crescent shaped tip on an adjustable
ball joint attached to a metal handle.
Uses
• Gingival retraction and protection or Veneer
preparation
• Finishing porcelain/resin veneer margins.
• Sub gingival caries
• Check marginal fit of crown

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6.MATRICES AND WEDGES
• Placed inter proximally
Uses
• Depresses gingiva
• Matrices with gingival extension provides displace gingival
tissue

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7. RETRACTION CORDS
• These are ready made cotton or synthetic woven cords,
frequently with metallic or resin wire wrapped around
them to assure their compactness, immobility, and non
shredding.
• They come in different sizes, arbitrarily numbered by
their manufacturers.
• They may be supplied already impregnated with the
chemical, or the chemical may be added before
insertion of the cord or after insertion while the cord is
within the sulcus.
40

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MECHANISM OF RETRACTION
• Deformation of gingival
tissues during retraction
and impression
procedures involves four
forces:
• Retraction,
• Relapse
• Displacement
• Collapse.
42

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CLASSIFICATION OF RETRACTION CORDS
Depending on
the
configuration
• Twisted
• Knitted
• Braided
Depending on
surface finish
• Wax
• Unwaxed

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Depending on
the chemical
treatment
• Plain
• Impregnated
Depending on
number strands
• Single
• Double-string

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Depending
on thickness-
color coded
• Black- 000 ( extra small)
• Yellow – 00 ( small)
• Purple- 0
• Blue- 1
• Green – 2
• Red- 3 ( extra large)
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DESIRABLE QUALITIES OF CORD
• Dark color ---contrast with tissues, tooth and cord
• Absorbent ---wet medicament
• Spontaneously reversible
• Safe locally & systemically
• Haemostasis
• Should not cause chemical injury
45

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TWISTED GINGIVAL CORDS
• Allow the dentist to customize the cord as individual
strands can be removed

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• Knitted cord afford greater inter-thread space than braided
cord
• Knitted to form an interlocking chain of thousands of tiny
loops, making it easy to pack below the gingival margin and
stays when packed into place.
braided
knitted
48
KNITTED GINGIVAL RETRACTION CORD

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• knitted cords compresses upon packing, then expands
for tissue displacement.
• Twisted and braided cords can’t offer ease of packability and
tissue displacement like knitted ones.
49

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RECOMMENDED SELECTION OF RETRACTION CORD SIZE
• The size of cord is clinically determined by evaluating the
depth of the sulcus with a periodontal probe and observing
the friability of the particular tissue.

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• The #000 and #00 is recommended for anterior teeth with
minimal crevicular space.
• Also can be used as a primary cord for the double cord
technique.
• Preparing and cementing veneers
• Restorative procedures dealing with thin, friable tissues

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• The #0 is recommended for bicuspids as the primary
cord for the double cord technique.
• The #1 cord is recommended for the secondary cord
• Tissue control and/or displacement when soaked in
coagulative hemostatic solution prior to and/or after crown
preparations

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• The #2 ,3 is used for molars where tissue friability
permits.
• Upper cord for "two-cord" technique

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LENGTH OF CORD
max ant -
30mm
pre molar- 25mm
Molar - 40mm
mand ant-17mm
premolar-25mm
molar- 40mm
(slightly more than tooth circumference)

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2.CHEMO-MECHANICAL METHOD
• Gingival retraction using chemically impregnated
retraction cord is a chemo-mechanical method of
displacement
Mechanical aspect
Chemical aspect

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• Combination of a chemical with pressure packing
(mechanical action) –
▫ Leads to enlargement of the gingival sulcus
▫ Control of fluids seeping from the sulcus.
• Either
 Previously impregnated
 Or saturated with solution prior to insertion
 Or placed dry and solution applied.

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3 categories
• Vasoconstrictors
• Biologic fluid coagulants
• Surface layer tissue coagulants

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Vasoconstrictors
• Physiologically restrict the blood supply to the area
by decreasing the size of the blood capillaries,
tissue fluid seepage and consequently size of the
free gingiva.
- Epinephrine
- Nor–epinephrine

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EPINEPHRINE
• most commonly used is 8% epinephrine.
• Other strengths are 2%, 4%, 16% and 32%.
• Because of the high vascularity of the gingival tissue, the systemic
effects exerted by epinephrine have been a cause for concern,
especially if the gingival tissues have been lacerated.
• The systemic effect of epinephrine has been described as
‘epinephrine reaction’ or ‘epinephrine syndrome’ and is associated
with the use of epinephrine-soaked retraction cords

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CONTRAINDICATIONS FOR EPINEPHRINE USE
1. Cardiovascular disease
2. Hypertension
3. Hyperthyroidism
4. Hypersensitivity to epinephrine
5. Patients on tricyclic anti-depressants
6. Diabetic patients

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BIOLOGIC FLUID COAGULANTS
• Coagulate blood and tissue fluids locally, creating surface
layer that is efficient sealant against blood and crevicular
fluid seepage.
• Safe, with no systemic effects.
• Examples
- 100% alum
- 15-25% aluminium chloride
- 10% aluminium potassium sulphate
- 15% tannic acid
- Ferric subsulfate

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ViscoStat Clear
• 25% aluminum chloride gel in a
viscous, aqueous vehicle causes the
collagen in the capillary ends to swell,
thereby closing off the capillaries.
• No coagulum is formed, nor does
hemostatic residue adhere to the
preparation
• Does not stain the hard and/or soft
tissues.

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C) SURFACE LAYER TISSUE COAGULANTS
• coagulates surface layer and free gingival epithelium as well
as seeped fluids, this creating temporarily impermeable film
for underlying fluids.
• Examples
-8% zinc chloride
-Silver nitrate

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• Local hazards
- Ulceration
- Local necrosis
- changes in location and dimension of free gingiva
• These can happen as a result of an excessive amount or
concentration or excessive time in application of agents

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PRODUCTS
BRAIDED
• Hemodent Retraction Cord (Premier Products
Company)
 Nor epinephrine
• Gingibraid+ Van R
 Epinephrine/Alum 87
 or Aluminum Potassium Sulfate
 or Non-Impregnated
• Gingi-Pak Z-Twist
 epinephrine HCI
 aluminum sulfate
 Non- Impregnated

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• Unibraid Van R
 Epinephrine/Alum or
 Aluminum Potassium Sulfate
• Sil-Trax® Plus (Pascal Company)
 with reduced Racemic Epinephrine HCl
and Zinc Phenosulfonate

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KNITTED
• GingiKnit Knitted Retraction Yarn
• Ultrapak

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NON-IMPREGNATED
• Ultrapak Ultradent Products, Inc.
• Gingiplain Original GingiPak
• Gingiplain Soft GingiPak
• Gingiplain Z-Twist GingiPak
• Knit Trax Pascal Company, Inc
• Retrax Pascal Company, Inc.
• Sil-Trax® Plain Pascal Company, Inc.

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IMPREGNATED- EPINEPHRINE HCI
• UltraPak E (Ultradent Products, Inc.)
• Crownpak (GingiPak )
• Racord (Pascal Company)
• Racord II (Pascal Company) Reduced Racemic
Epinephrine HCl and Zinc Phenosulfonate
• Sil-Trax® Epi (Pascal Company)
• Sil-Trax® Plus (Pascal Company)

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TECHNIQUES FOR CORD PLACEMENT
• Single cord technique
• Double cord technique

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ARMAMENTARIUM
1. Saliva ejector
2. Scissors
3. Cotton pliers
4. Mouth mirror
5. Explorer
6. Cord packer
7. Cotton rolls
8. Retraction cord
9. Medicament to be
used
10. Dappen dish
11. Cotton pellets
12. 2×2 gauze sponges

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SINGLE CORD TECHNIQUE
• The desired length of retraction cord is drawn from the
dispenser bottle with sterile cotton pliers .

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• The cord is twisted to make it tight and small.

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• The retraction cord should be dipped in the medicament
solution in a dappen dish.
• Hemorrhage can be controlled by using Homeostatic
agents like Hemodent liquid (aluminium chloride)

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• Pack all but the last 2.0 or 3.0 mm of cord
• This tag is left protruding so that it can be grasped for
easy removal

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• After 10 minutes, remove the cord slowly
toavoid bleeding.
• Inject impression material only if the sulcus
remains clean and dry.
• It may be necessary to gently rinse away any coagulum,
then lightly blow air on it.

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DOUBLE CORD TECHNIQUE
• This technique is routinely used while making
impressions when gingival health is compromised and
it is impossible to delay treatment procedures.
• When preparation involves multiple teeth.

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• With a deeper subgingival preparation, after removing
the cord, the sulcus ‘closes’ not allowing the ingress of
the impression material in the subgingival area.

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ADVANTAGE
• The first cord remains in place within the sulcus thus
reducing the tendency of the gingival cuff to recoil and
displace partially set impression material.
• Helps to control gingival haemorrhage and exudate
• Overcomes the problem of the sulcus impression tearing
because of inadequate bulk.

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DISADVANTAGE
• The main disadvantage of the two-cord technique
is difficulty to remove the first cord thereby
inflicting a painful, gingival reaction.

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• A specifically designed 1.0cc syringe known as dento-
infusor is used to deposit the hemostatic agent i.e. 20%
ferric sulfate.
• infuse hemostatic agents into bleeding capillaries.
DENTO-INFUSOR TIPS

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• The infusor is used with a burnishing motion in the sulcus & is
carried circumferentially around the sulcus.
• The medicament is extruded from the syringe/infusor as the
instrument is manipulated around the gingival sulcus.
• The tip infuses the hemostatic agent into capillaries, forming
a cork-like “plug,” then wipes coagulum away.

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• When hemostasis is achieved, a retraction cord soaked in
ferric sulfate solution is packed into the sulcus and left in
place for 1 to 3 minutes.
• This is an effective additional technique for control of
bleeding when using the single cord technique.

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• chemo-mechanical technique for sulcus opening and
hemotasis.
• Contains
▫ white clay to ensure the consistency of the paste and its
mechanical action,
▫ aluminium chloride enhances the haemostatic action.
EXPASYL

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EQUIPMENT CONSISTS OF:
• capsules;
• injection canulas; and
• applicator
• The Expasyl paste is injected into the sulcus, exerting a
stable, non-damaging pressure of 0.1 N/mm.

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The canula is pressed against the tooth and angled until it comes into
contact with the sulcus lining of the gingival edge.

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The product enters the sulcus.

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The marginal gingiva blanches.

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The angle of the canula tip is increased and maintains contact on
the sulcus lining of the gingival edge.

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The product is injected into the
interproximal space.
Support points: the thumb guides the
tip of the applicator.

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Removal of product by an air and water spray.

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Sulcus opening and the absence of oozing provide good access.

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Advantages
• Reduced chair time- patient comfort
• Hemostasis
• Safe, no danger of rupturing the epithelial attachments
and causing recession as little or no pressure as
compared to cord.
• Easy access and placement
• Easily removed
• No contamination

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GINGITRAC
• GingiTrac delivers the perfect combination of built-in
astringency with fast and gentle retraction assuring the
accurate impressions

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ADVANTAGES
• Single crown or multiple crown retraction, all without
packing cord
• Works in less than 5 minutes, regardless of number of
preps
• Get more accurate impressions
• Works gently, no tissue trauma or ligament damage
• Contains aluminum sulfate astringent to control
bleeding and oozing
• Easy-to-use 1:150ml automix gun system mixes and
delivers GingiTrac
• Removes in a clean manner, in one piece, without
rinsing

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MAGIC FOAM CORD
162

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• Magic FoamCord is the first expanding PVS material
designed for easy and fast retraction of the sulcus
without the time consuming packing of retraction
cord

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Comprecap anatomic technique
164

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0% expansion
immediately
after
application
60%
expansion
after 3 min.
after
application
165
MECHANISM OF ACTION

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Advantages
• Non-traumatic method of temporary gingival retraction
• Easy and fast application directly to the sulcus without
pressure or packing
• Comfortable to the patient
• No haemostatic chemicals to contaminate the impression
site – no need for extensive rinsing
• Outstanding retraction for perfect impressions
167

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MEROCEL RETRACTION STRIPS
• It is a synthetic material obtained from
biocompatible
polymer, i.e. hydroxylate polyvinyl acetate
• This material is placed in the sulcus, the material absorbs any
secretions present in the sulcus and expands to bring about
gingival displacement.

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Advantages
• Chemically pure
• Easily shaped
• Remarkably effective for absorption of intraoral fluids
such as blood, saliva, and crevicular fluid
• Soft and adaptable to the surrounding tissues
• Free of fragments, without debris

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SURGICAL METHODS
• Some methods utilized to improve the visualization of the
preparation margins of the tooth are not true retraction
techniques.
• This is because they actually remove some part or all of the
overlying gingival tissue in order to expose the finish line of the
preparation and/or control haemorrhage.
• These techniques are more invasive and should only be used in
cases where there is adequate amounts of attached gingiva.

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ROTARY CURETTAGE
• Also known as gingetage, Concept described by Amsterdam in
1954.
• Technique described by Hansing and subsequently enlarged
upon by Ingraham in 1975
• Troughing technique, wherein a portion of the epithelium
within the sulcus is removed to expose the finish line.
• It should be done only on healthy gingival tissue.

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THE FOLLOWING CRITERIA SHOULD BE FULFILLED FOR
GINGETTAGE.
• Absence of bleeding upon probing from the gingiva.
• The depth of the sulcus is less than 3mm.
• Presence of adequate keratinized gingiva.

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TECHNIQUE
• It is usually done simultaneously along with finish line
preparation.
• Torpedo-tipped diamond is used to remove the epithelial
lining of the sulcus.

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• Abundant water should be sprayed during the
procedure.
• A retraction cord impregnated with AlCl3, can be
used to control bleeding.

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DISADVANTAGES
• Poor tactile sensation when using diamonds on sulcular
walls can produce deepening of sulcus.
• It can potentially damage the periodontium if used
incorrectly.

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ELECTROSURGERY
Definition:
It is defined as the use of specially designed
electronic equipment that produces a limited variety of
high frequency wave forms for the purposes of cutting or
removing soft tissue.

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• Electrocautery refers to direct current
• whereas electrosurgery uses alternating current.

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• Electrosurgery denotes surgical reduction of sulcular
epithelium using an electrode to produce gingival
retraction

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Cutting edge designs :
a) Coagulating probe
b) Diamond loop
c) Round loop
d) Small straight probe
e) Small loop

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• Controlled tissue destruction.
• Current flows through a small cutting electrode a vacuum
tube or a transistor to deliver a high frequency electrical
current of at least 1.0 MHz
• The procedure is also called as “Surgical Diathermy”
• It uses radio currents in the range of 1.5 to 7.5 million
cycles/sec.
MECHANISM OF ACTION

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• Electrosurgical current flows from the unit to the active
(cutting) electrode to the ground and back to the unit.

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• Using the Straight Knife electrode to stop bleeding in
gingival sulcus

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• Using the Straight Knife electrode to restore gingival
symmetry

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• Using the Straight Knife electrode – best for sulcular
enlargement

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• Using the Long Loop electrode to remove occluding
gingiva

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• Clinical applications:
▫ Widening gingival sulcus
▫ Crown lengthening
▫ Exposing impacted teeth
▫ Incising abcesses
▫ Removing hyperplastic gingiva
▫ Frenectomy

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ADVANTAGES
• Excellent vision of the margins
• Removes unwanted tissue with ease
• Reduces chair time by simplifying operative procedures and
maintaining hemostasis
• Provides outstanding cutting precision for superior
clinical and aesthetic results
• Allows uneventful healing

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DISADVANTAGES
• Very technique sensitive
• Application of excessive pressure may produce severe
tissue damage
• Difficult to control lateral dissipation of heat
• It cannot be done in a dry field. The operatory area should
be very moist during the procedure. This leads to
compromised access and visibility

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CONTRAINDICATIONS
• Patients with cardiac pacemakers because the frequency of
the electrical current in the electrode can interfere with the
functioning of the pacemaker.
•Not suitable where thin attached gingiva is present.
(labial of maxillary canines)

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LASERS
• Lasers helps in exposure of subgingival finish lines,
controls the hemorrhage, and removes just enough
epithelial attachment to facilitate the placement of
retraction cord.
• Minimum gingival recession.
• Laser tips 400-600 micron in diameter.

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• Useful for cutting, vaporizing, coagulating, haemostasis on
gingiva and mucosa
• Some clinicians use laser only for haemostasis and follow it
with cord which needs to stay in place only 3-4 mins before
impressions.

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• The most commonly used lasers for gingival
displacement are the
▫ 980-nm Diode lasers,
▫ 1064-nm Nd-YAG laser
▫ Erbium class of dental lasers.(2940nm)

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ADVANTAGES
• Minimum pain, inconvenience
discomfort
• Less fear anxiety, stress
• Minimum or no anaesthesia
• No drill sounds
• Less chair time
• Reduced post operative complications
• Minimum or no bleeding

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DISADVANTAGES
• Cost factor is a drawback and technique sensitive

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GINGIVAL RETRACTION AROUND
IMPLANTS
• Indicated only in rare situations
• Fabrication of custom abutment
• The use of chemicals, such as 15% aluminum chloride in an
injectable kaolin matrix, is a better option

08/20/2024 133
BennaniV, Schwass D, Chandler N. Gingival retraction techniques for implants
versus teeth: current status. J Am Dent Assoc 2008; 139: 1354 1363.
−

08/20/2024 134
CONCLUSION
• Perfect tooth preparation are worth less without perfect impressions,
and perfect impressions can easily be achieved by using various gingival
retraction techniques as mentioned above
• Since gingival retraction is an integral part of clinical practice, the clinician
should make an effort to utilize different methods and products available
for retraction of gingival tissues in various clinical scenarios.
• Sometimes a combination of methods may be needed, and some things
may work for one clinician and not for another.
• The effort put into the appropriate retraction of gingival tissues pays off
in terms of longevity of restorations, better margins and aesthetics.

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REFERENCES
• Shillingburg HT; Fundamentals of Fixed Prosthodontics; 2012; 4th
edition ; Quintessence publications; USA; pp: 257-279
• Rosenstiel SF; Contemporary Fixed Prosthodontics; 2014; 4th edition;
India; pp: 431- 465
• Livaditis et al, Comparison of the new matrix system with traditional
fixed prosthodontic impression procedures, J Prosthet Dent
1998;79:200-7
• Shah M J et al; Gingival retraction methods in fixed prosthodontics –A
systematic review, Journal of dental sciences;2008, Vol 3(1):4-10
• Thomas MS et al, Nonsurgical gingival displacement in restorative
dentistry, June 2011, Vol32(5),27-39

08/20/2024 136
• Bennani V, Schwass D, Chandler N. Gingival retraction
techniques for implants versus teeth: current status. J Am Dent
Assoc 2008; 139: 1354−1363.
• Evaluation of Gingival Displacement Using Foam Cord and
Retraction Cord: An In Vivo Study
• Shivashakthy M, Comparative study on the efficacy of gingival
retraction using polyvinyl acetate strips and conventional
retraction cord - An in vivo study , Journal of clinical and
diagnostic research, 2013 Oct Vol- 7(10):8-11
• Reiman et al.Exposure of subgingival margins by nonsurgical
gingival displacement. J Prosthet. Dent. Dec 1976

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