GINGIVAL RETRACTION

GIVGIVAL RETRACTION
Done after a tooth is prepared for a crown to ensure that an

impression with clear margins can be obtained No hemmorage present All hard & soft tissue to be reproduced must be clean & dry Ideal margins are supragingival Many may be subgingival Tissue displaced vertically- to expose margin Tissue retracted horizontally- allow room for impression material

GINGIVAL RETRACTION
Retraction- can be done chemically, mechanically,

surgically, or combination Retraction cord- available in variety of sizes, configurations, and chemical treatments Comes in dispensing package for easy use May be twisted, braided, or woven to hold its shape

TYPES OF RETRACTION
Two types of retraction
1.

Mechanical
Non-impregnated to displace tissue to allow access to margin

2.

Chemical
Impregnated with chemical agent added

MECHANICAL RETRACTION
MECHANICAL

Retraction cord placed in sulcus of healthy, inflamed-free gingiva Cotton left in place 10-15 minutes Too deep- crevice open at bottom, narrow at top (material will fracture at edge of prep) Too shallow- space inadequate to allow accurate reproduction of the margin of the prep

Proper position- 1-3 mm into the vshaped crevice

MECHANICAL RETRACTION
Another way to lengthen a

temporary crown form to cause tissue displacement and take the impression at a later date Dental dam clamp and rubber dam to displace tissue Clamp & dam placed and removed prior to taking final impression Both these techniques may cause tissue to bleed and impression distortion

CHEMICAL RETRACTION
May be done prior to

placement of the cord By impregnating cord, then placing it, or both Newer way- use a topical hemostatic solution astringent with dento-infusion tubes and plastic lure lock syringe

NEWER CHEMICAL RETRACTION PROCEDURE

1. Place solution using a disposable metal tip bent to the

desired area
2. Blood & solution merge together and are washed

away with air/water syringe

3. Temporary seal left that does not allow any seepage

4. Retraction cord of interwoven cotton with or without

solution placed vertically to expose prepared margin

5. This packing allows for horizontal retraction

NEWER CHEMICAL RETRACTION PROCEDURE

6. Cord could also have aluminum chloride or

astringent of aluminum salts for chemical retraction (this technique causes ischemia)
Epinephrine An astringent and vasoconstrictor Provides hemostasis and shrinks tissues constricting the blood vessels Causes tachycardia Contraindicated for patient with heart disease, diabetes, hyperthyroidism

NEWER CHEMICAL RETRACTION PROCEDURE

7. Dual astringent and hemostatic action of aluminum

chloride plus kaolin clay Controls bleeding Absorbs fluids to ensure a clean, dry sulcus

SURGICAL RETRACTION
Use surgical knife or electrosurgery to remove tissue

and preparation Area may bleed and cause additional treatment Electrosurgery unit- cauterizes tissues as it removes them (no bleeding) Must have soft tissue anesthesia Not used with patients receiving radiation therapy, have cardiac pacemakers, or slow healing diseases Non-metal HVE tip during surgery reduces odor if placed near surgical site Rinse sulcus with hydrogen rinse

ELECTROSURGERY

PLACING AND REMOVING RETRACTION CORD

EQUIPMENT NEEDED

HVE tip and air/water syringe tip Scissors Hemostat Retraction cord Retraction cord placement instrument or plastic instrument Cotton rolls 2x2 gauze sponges

STEPS FOR PLACING AND REMOVING RETRACTION CORD

1. 2. 3. 4. 5.

Tooth prepared for crown Rinse and dry area Place cotton rolls, dry area Dentist selects retraction cord Length determined by circumference of tooth anterior tooth

Wrap around small finger Posterior tooth: larger finger

6. Cut cord to appropriate length

STEPS FOR PLACING AND REMOVING RETRACTION CORD

7. Twist cord ends to compress fibers together 8. Cord is looped and placed in a hemostat or cotton pliers 9. Cord looped around margin of prepared tooth

and tightened slightly 10. Release ends of hemostat or cotton pliers leaving cord in sulcus

STEPS FOR PLACING AND REMOVING RETRACTION CORD CONTD

11. Pack retraction cord into position with packing instrument or 12. 13. 14. 15.

plastic instrument Pack cord around cervical area, apical to preparation Pack cord around tooth and overlap on facial surface Leave tip of cord showing out of sulcus in order to remove just prior to taking impression Placement time
5 minutes left in place-for chemical retraction

10-15 minutes- for mechanical retraction

16. Remove end of cord in a circular motion prior to impression

being placed