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  1. 1. GINGIVAL TISSUE RETRACTION DR SATYANARAYANA NAIK MDS Dept Of Prosthodontics Navodaya Dental College
  2. 2. WHAT IS GINGIVAL RETRACTION?  Gingival retraction or displacement is the deflection of the marginal gingiva away from the tooth.  ‘tissue dilation’
  3. 3. CRITERIA FOR SELECTION • Effectiveness in gingival displacement and hemostasis • Absence of irreversible damage to the gingiva • Paucity of untoward systemic effect.
  4. 4. 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.
  5. 5. TYPES OF TISSUE DISPLACEMENT LATERAL: • Displaces the tissue so that adequate bulk of the impression material can be interfaced with the prepared tooth. APICAL/VERTICAL: • Exposes the uncut portion of the tooth apical to the finish line. May cause trauma of the gingival tissues followed by recession.
  6. 6. CLASSIFICATION  Mechanical  Chemico-mechanical  Electrosurgery  Rotary gingival curretage  Other methods
  7. 7. MECHANICAL TISSUE DILATION One of the earliest used methods which includes : • Impression material filled copper band/tube • Rubber dam • Temporary acrylic resin coping • Temporary metal crown filled with thermoplastic stopping material • Strings or fibers
  9. 9. IMPRESSION MATERIAL FILLED WITH COPPER TUBE VARIOUS IMPRESSION MATERIALS USED: Impression compound,elastomeric material, Gutta- percha or auto polymerizing resin. DISADVANTAGES: Incisional injuries to the gingival tissues Excess pressure tends to stripple the tissue from the tooth ADVANTAGE: Good method to confirm gingival margins e.g. in multiple abutments
  10. 10. RUBBER DAM ADVANTAGES : • Asset during tooth preparation as it exposes the finish line. • Excellent impressions are obtained due to fluid control DISADVANTAGES : • Useful only when limited number of teeth in one quadrant are being restored. • Used in simple preparations with minimal Sub- gingival preparations.
  11. 11. TEMPORARY ACRYLIC RESIN COPING 1. A Temporary acrylic resin coping is constructed and the inside is relieved by 1 mm. 2. Adhesive is applied and elastomeric impression material is placed and reseated. 3. The tissue is displaced when the material mechanically fills into the sulcus. 4. A complete arch impression is subsequently made over the coping and it becomes an integral part of the impression.
  12. 12. TEMPORARY METALCROWN FILLED WITH THERMO-PLASTIC STOPPING MATERIAL 1. Correct size is selected, trimmed to confirm to the gingival contour and the margins are smoothened. 2. Fill it with compound or gutta percha. Under occlusal pressure it is forced into the predetermined position. 3. The excess material from gingival end will displace the free gingiva. 4. The excess material is trimmed without excessive pressure (blanching). 5. Cement it with temporary cement for 24 hours 6. Final impression made in the next appointment
  13. 13. STRINGS OR FIBERS INCLUDES :  Plain cotton threads  Unwaxed floss  Cotton cord  2-0 Untreated surgical silk  Elastic retraction rings Types : plain, braided, knitted or other type.  Can be used wet or dry
  14. 14. MECHANICO-CHEMICAL METHODS • The Mechanical aspect involves placement of a string into the gingival sulcus to displace the tissues. • The Chemical aspect involves treatment of the string with one or more number of chemical compounds that will induce i) Temporary shrinkage of the tissues & ii) Control the hemorrhage & fluid seepage
  15. 15. RETRACTION CORD DESIGNS • Twisted, • Knitted & • Braided : • does not separate when inserted into the sulcus and much easy to use. • larger sizes should be avoided as they tend to double up and leads to traumatic placement
  16. 16. RETRACTION CORD DIAMETER  The cord that can be atraumatically placed into the sulcus should be used. • SMALL- to be used in anterior teeth, where thin firmly tissue is present • MEDIUM- indicated where greater bulk is encountered e.g. posterior teeth • LARGE- should be used with caution as can produce soft tissue trauma
  17. 17. CHEMICALLY IMPREGNATED CORDS 1. The cords are used to keep the chemicals in contact with the tissue and confine them to the application site. 2. By combining chemical action with pressure packing, enlargement of the gingival sulcus as well as fluid control is more readily accomplished.
  18. 18.  Astringdent  Gingi aid  Styptin  Hemodent  Hemogin  Orostat  Visco stat  Aluminiumchloride VARIOUS DRUGS USED FOR GINGIVAL DISPLACEMENT
  19. 19. TECHNIQUES FOR GINGIVAL DISPLACEMENT USING RETRACTION CORDS 1. Single cord technique 2. Double cord technique 3. Infusion technique of gingival displacement 4. The‘everyother tooth’technique
  20. 20. SINGLE CORD TECHNIQUE 1. Loop of retraction cord is Formed around the tooth and held with the thumb and forefinger 2. Placement of cord is began by pushing it to the sulcus of mesial surface and also it should be tacked into distal surface to hold thecord
  21. 21. SINGLE CORD TECHNIQUE 3. As the cord is placed subgingivally the instrument must be pushed slightly towards the area already tucked into place. 4. It may be needed to hold the cord with another instrument.
  22. 22. SINGLE CORD TECHNIQUE 5. Excess cord is cut at the mesial proximal area. 6. Placement of distal end of the cord is continues till it overlaos the mesial.
  23. 23. • CORD PACKING INSTRUMENTS: Fischer’s ULTRAPAK Packers PASCAL Cord Packing Instrument Circlet® Standard Packing Packing Plain Plain Angled Circlet® Packing f Sa c ee b ro ro k a. c to em / dn o t e s d e n t a l Standard Packing Serrated
  24. 24. DOUBLE CORD TECHNIQUE Indications :  impression of multiple prepared Teeth.  when tissue health is compromised.  excess gingival fluid exudates.  can be used routinely.
  25. 25. DOUBLE CORD TECHNIQUE  A smaller diameter cord is placed in sulcus.  A second cord (largest diameter that can be placed) is placed above the first.  After waiting for 8-10 min it is soaked in water and removed, dried and impression is made with the first cord in place
  26. 26. THE INFUSION TECHNIQUE Steps: 1.After preparation of the margins, hemorrhage is controlled Using a special dental Infusor with Ferric sulfate medicament 15% 0r 20%. 2.The infusor is used with a burnishing Action, 360 deg around the sulcus. 3.Recommended time 1-3 mins. 4.Cord is removed and impression made.
  28. 28. GINGIFOAM
  29. 29. Crown preparation prior to retraction Pre-fit one Comprecap per crown preparation Apply Magic FoamCord have the patient bite and maintain pressure Remove after 5 minutes multiple preparations
  30. 30. Gel Cord® or Stat Gel® Apply gel to sulcus Hemostasis occurs in as little as 2 minutes Pack cord through gel Gel works into cord After removing cord, rinse & dry Clean, dry site Final impression
  31. 31. LASERS • DIODE AND ND:YAG LASER channels laser through a fiber optic light bundle which incises and cauterizes tissue simultaneously creating haemostasisas well as a retracted field. • PULSED ND = YAG LASER IRRADIATION: The present histological findings revealed that with the application of PULSED ND: YAG LASER the gingival tissues showed faster healing with less hemorrhage and less inflammatory reaction in comparison with the Ferric sulphate (13.3%).
  32. 32. THANK YOU