Gingival Retraction Techniques Research Articles

Comparative Evaluation of Gingival Displacement and Patient Outcomes with Different Gingival Retraction Techniques: A Cross-over Clinical Trial

Comparative Evaluation of Gingival Displacement and Patient Outcomes with Different Gingival Retraction Techniques: A Cross-over Clinical Trial

Estimation of cytokine levels in gingival crevicular fluid following the use of different gingival retraction systems in patients requiring fixed partial dentures - An original research.

To comparatively evaluate the amount of inflammation, as assessed by TNF-α in GCF induced by three different gingival retraction techniques. Ten patients with a minimum of three teeth that required biomechanical preparation for fixed prostheses and acceptable oral hygiene with no periodontal pathology were included. The patients each received an oral prophylaxis. After a washout period of 10 days patients with gingival index scores of 0 or 1 were included. Measurements of TNF-α was done at baseline, after 30min, after 7 days and after 28 days using ELISA test kit specific to TNF-α. The sample population for whom Magic Foam cord was used showed a massive reduction in the amount of TNF -α, from 78% at 7 days to 18.6% at 28 days. There was a reduction in the percentage of TNF -α produced in the samples where normal knitted cord was used and for those where Expasyl was used from 95% to 64.2% and from 70% to 48.3% respectively. Maximum amount of inflammatory response was seen with plain knitted gingival retraction cord. This was followed by Expasyl gingival retraction system and the least amount of inflammatory cytokine was recorded with Magic Foam retraction cord.

ASSESSMENT OF TECHNIQUE SENSITIVITY AND GINGIVAL HEALTH IN MANAGEMENT OF CERVICAL LESIONS PERFORMED USING SUBGINGIVAL CLAMP VERSUS RETRACTION CORD: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Aim: the current study was conducted to compare technique sensitivity and gingival health of carious and non-carious cervical lesions performed using subgingival clamps and retraction cords. Methodology: 24 teeth with carious or non-carious cervical lesions were divided randomly into 2 groups receiving one of the two gingival retraction techniques, either subgingival clamp (KSK clamp #44) or retraction cord (Ultrapak E), technique sensitivity was evaluated at baseline (before application) and immediately after application while gingival health was evaluated before and immediately after application, 2 weeks, 1 and 4 months. Statistical analysis was done using t-test, Chi-square test, Kruskal-Wallis test and Mann-Whitney test where significance level was set at P ≤ 0.05. Results: There was a statistical significant difference between retraction cord and subgingival clamp regarding time of application and gingival laceration, where retraction cord took longer application time (p=0.01) and subgingival clamp showed higher laceration frequency (P=0.033). Regarding patient satisfaction, isolation from crevicular fluids, need for local anesthesia, pink esthetic score, gingival bleeding and sensitivity, there was no statistical significant difference between both groups. Conclusion: Technique sensitivity and long term gingival health were the same for both groups except that subgingival clamp provided minimal chairside time and care should be taken upon clamp application to avoid gingival laceration.

Evaluation of Clinical Accuracy of Implant Abutment-Level Impression Technique Using Digital Superimposition of Customized Abutment.

Taking a conventional implant abutment-level impression with the gingival retraction technique can cause side effects such as gingival recession and bleeding. In order to overcome these problems, an impression technique using digital superimposition of the customized abutment is newly introduced. In this technique, digital impression data and pre-scanned abutment data are superimposed to reproduce the abutment's location and shape on computer-aided design software. The present investigation was conducted to evaluate the clinical accuracy of the newly adapted digital superimposition impression technique by assessing the fit of fabricated prostheses. The results showed clinical efficacy of this technique, satisfying both convenience and clinically acceptable marginal and internal fit.

The Effect of Gingival Retraction Cord on Periodontal Health Compared to Other Gingival Retraction Procedures: A Systematic Review

Background: An accurate impression is obtained for the fabrication of fixed restorations only when the gingival tissue is managed properly. And this is especially true when the location of the finish line is at, or within, the gingival sulcus. Gingival retraction is an important aspect of currant impression techniques in fixed prosthetic procedures. Effective gingival retraction prior to taking an impression without damaging periodontal tissues is very important in long-term success of cast restorations. Purpose: To collect and evaluate, in a systematic manner, data available on the post-operative effect of retraction cords on gingival tissue in patients with healthy gingiva compared to cordless techniques in respect to effect on gingival recession, parameters of gingival inflammation and patient comfort. Methods: PubMed/Medline, Science Direct, ISI Web of Science, the Cochrane library, EMBASE, and Google Scholar databases were searched. The studies were chosen according to the inclusion criteria followed by data extraction, and quality check. Results: 85 potentially eligible articles were identified, of which only 5 fulfilled the objective of the study and were included. Five studies reported that the gingival retraction techniques affected the gingival health with a variable degree level and this effect was temporary in nature taking in consideration the health of the gingival tissues. One study compared three different techniques of retraction materials and reported that temporary gingival inflammation was observed with all techniques and Expasyl had the greatest effect with slower recovery. Bleeding was induced by the cordless techniques neither during nor after retraction. One study investigated non-aluminum chloride-containing injection-type retraction material (Korlex-GR) compare it with 2 other commercial retraction materials (Ultrapak 1, a medicated retraction cord, and Expasyl), there results indicated that the non-aluminum chloride-containing injection-type retraction material is as effective as the other 2 materials for gingival retraction but produces less pain and limits injury to the gingival tissue during the procedure. Conclusions: It may be suggested that all tested gingival retraction technique will affect the gingiva negatively temporarily, however, well-fitted fixed dental prosthesis and its procedures performed to periodontaly healthy subjects will have a reversible effect on the periodontal tissue health.

Efficiency of Cordless Versus Cord Techniques of Gingival Retraction: A Systematic Review.

Primarily to assess the efficacy of cordless versus cord techniques in achieving hemostasis control and gingival displacement and their influence on gingival/periodontal health. In addition, subjective factors reported by the patient (pain, sensitivity, unpleasant taste, discomfort) and operator's experience to both techniques were analyzed. An electronic database search was conducted using five main databases ranging from publication year 1998 to December 2014 to identify any in vivo studies comparing cord and cordless gingival retraction techniques. Seven potential studies were analyzed. Out of the four articles that reported achievement of hemostasis control, three compared patients treated by an epi-gingival finish line and concluded that paste techniques were more efficient in controlling bleeding. Five studies reported on the amount of sulcus dilatation, with contrasting evidence. Only one study reported an increased gingival displacement when paste systems were used. Two studies did not observe any significant difference, although two showed greater gingival displacement associated with cords, particularly in cases where the finish line was placed at a subgingival level. Of the four studies that assessed the influence of both techniques on the gingival/periodontal health, three noted less traumatic injury to soft tissues when gingival paste was used. A paste system, in general, was documented to be more comfortable to patients and user-friendly to the operator. Because of heterogeneity of measurement variables across studies, this study precluded a meta-analytic approach. Although both techniques (cord/cordless) are reliable in achieving gingival retraction, some situations were identified wherein each of the techniques proved to be more efficient.

Gingival displacement in prosthodontics: A critical review of existing methods

Tremendous progress has been made in procedures for making fixed prosthodontic impressions over the past few decades. A common objective for impressions and interim crowns or fixed dental prostheses is to register the prepared abutments and finish lines accurately. For all impression procedures, the gingival tissue must be displaced to allow the subgingival finish lines to be registered. Retraction is the temporary displacement of the gingival tissue away from the prepared teeth. This article discusses the current methods that are applied for displacement of gingival tissues so that adequate amount of unprepared tooth structure can be recorded with least distortion of impression material as well as minimal damage to attachment apparatus of the tooth. In addition to this, gingival displacement techniques around implants and for computer aided design/computer added manufacturing (CAD/CAM) based restorations have been discussed. PubMed and Google Scholar were used to search any studies involving gingival retraction techniques. The keywords used were gingival retraction, gingival displacement, gingival retraction in implants and retraction cord. Gingival retraction holds an indispensable place during soft tissue management before an impression is made. Swift increase in research work in the recent past leaves no option for a clinician, but to be updated and to possess optimum knowledge to rationalize the use of materials and techniques that are employed for gingival displacement in proximity to both teeth as well as implants.

Internalized discoloration of dentin under porcelain crowns: A clinical report

This clinical report describes the situation of a patient who was concerned about the appearance of porcelain crowns that were placed on the maxillary incisors 4 years prior. The mechanicochemical gingival retraction technique combining the use of ferric sulfate and knitted retraction cord is described as a possible etiology of internalized discoloration of the dentin in this situation. The hypothesis is explained by the high acidity of gingival retraction fluids (GRFs) and the high affinity of iron for hard tooth tissues, resulting in an interaction with bacterial byproducts and precipitation of insoluble ferric sulfide in the porous demineralized dentin. A prospective clinical trial is warranted to track the effects of GRFs on tooth structure. This article describes the treatment of internalized discoloration of dentin under porcelain crowns.

Gingival Retraction Techniques for Implants Versus Teeth: Current Status

The authors reviewed and compared gingival retraction techniques used for implants and teeth. The authors searched the literature using article databases Ovid MEDLINE up to May 2008, PubMED and Google Scholar (advanced search) and the following search terms: gingival retraction, implant abutment, impressions, cement-retained implant restoration, impression coping, peri-implant tissue, emergence profile and tissue conditioning. The authors found insufficient evidence relating to gingival displacement techniques for impression making for implant dentistry. Gingival retraction techniques and materials are designed primarily for peridental applications; the authors considered their relevance to peri-implant applications and determined that further research and new product development are needed. The use of injectable materials that form an expanding matrix to provide gingival retraction offers effective exposure of preparation finish lines and is suitable for conventional impression-making methods or computer-aided design/computer-aided manufacturing digital impressions in many situations. There are, however, limitations with any retraction technique, including injectable matrices, for situations in which clinicians place deep implants.

Alternative Gingival Retraction Techniques and Isolation of the Cervical Lesion

This paper introduces techniques that help manage gingival retraction during isolation of the working field in preparation for cervical restorations. This paper introduces techniques that help manage gingival retraction during isolation of the working field in preparation for cervical restorations.

Periodontal and Restorative Considerations in Rotary Gingival Curettage

A relatively new surgical gingival retraction technique has been discussed from a periodontal point of view. This technique provides a method of enlarging the gingival sulcus so preparation margins for cast restorations can be visualized and accurately recorded in impression material. The preoperative health of the periodontium is an important consideration when selecting this technique. The attachment apparatus must be free of inflammation and the marginal gingiva must have an acceptable width and a high degree of keratinization. If these criteria are met, a hemorrhage-free opened gingival trough will be easily and consistently obtained. The following restorative sequence was suggested and should be used and completed one step at a time: pulp therapy, buildup restoration, supragingival casting preparation, rotary gingival curettage, reversible hydrocolloid wet field impression technique, indirect provisionalization, placement of final cast restoration. These recommendations were based on the compatibility with the periodontal tissues. Such periodontal compatibility is evident in consistent postoperative tissue healing. There is minimal or no change in the position of the epithelial attachment and location of the crest of the free marginal gingiva. Histological and longitudinal clinical research studies are needed on the rotary gingival curettage technique. Clinical studies on the reversible hydrocolloid wet field technique would also be helpful. Until such evidence is available, my clinical experience indicates that rotary gingival curettage is an excellent technique producing predictable and gratifying results if the treatment planning and restorative sequence suggested in this paper are followed.

Gingival retraction techniques and their healing effect on the gingiva

C ervical clamps are generally employed in dentistry to retract the gingival tissurY from the operating field. Where the carious lesion extends below the free malgirr of the gingiva, retractions have been combined with flap procedures. ‘l’his method assures a successful cavity preparation and a functionally and cstheticallv acctptabk restoration. Several authors*-” have described the retraction techniques for the ging-ival tissue. and many publications ha\re reported the repair of the soft tissue followin,? surpical interventions.5-7 However, there is littlr information regarding the assessment of the recovery of the gingival tissue after the application of various retraction methods. This clinical study was designed to evaluate the healing process of the gingiv:J tissue, after placement of class V direct gold restorations, when four types of r+ traction techniques were used.