UNDER THE GUIDANCE OF:PRESENTED BY:

Gingival tissue management

“GINGIVAL DISPLACEMENT /RETRACTION IS

THE DEFLECTION OF THE MARGINAL GINGIVA

AWAY FROM A TOOTH.”

Advantages of gingival tissue retraction

Provides maximal exposure of the operating site

Permits completion of the preparation and cementation of the restoration

Helps the operator to make a complete impression of the preparation

Finish line must be completely exposed to be reproduced in the impresion, to obtain marginal integrity.

Drawbacks

Time consumingPainful in absence of anaesthesiaRisk of epithelial detachmentRisk of irreversible gingival retraction and

excessive bleeding

Recent advances: expasyl

Comprises of:Kaolin : consistency of paste and mechanical actionAluminium chloride : hemostaticAir water spray application removes the material

from the sulcusExpayl paste is injected in the sulcus exerting a

pressure of 0.1N/nmThe product is left for 1 min there is sulcus

widening of 0.5mm for 2 minIt is available in reusable capsulesEquipment: capsules, injection canulas,applicator

Techniques for gingival retraction

Chemico-mechanical

methodsSurgical methods Mechanical

methods

Copper bandsRetraction

cordsRubber dams

Gingival retraction cords Rotary curettage

Electrosurgery

Copper bands

Used to carry the impression material and to expose the finish line.

Impression compound or elastomeric impression materials can be used along with it

Technique :copper bands

Copper and is welded to form a tube corresponding to the size of the prepared tooth.

One end is trimmed to follow the profile of the gingival finish line.

After positionig and contouring it, it is filled with modelling compound

The tube is then seated along the path of insertion of the tooth preparation.

Retraction cords

Pressure packing the retraction ord into the gingival sulcus

Material used : cottonChemico – mechanical method of gingival

retraction: combining a chemical with pressure packing

This leads to enlargement of the gingival sulcus as well as control of fluids seeping from the sulcus.

Chemicals used-

the chemicals are generally vasoconstrictorsThey are-8 per cent Racemic epinephrineAluminium chlorideAlum(aluminium potassium sulphate)Aluminium sulphateFerric sulphate

Ideal requirements for chemicals

It should produce effective gingival displacement and hemostasis

Should not produce any irreversible damage to the gingiva

It should not have any systemic side effects

Contraindications for epinephrine

CVS diseaseHypertensionDiabetesHyperthyroidismHypersensitivity

Gingival retraction cords containing epinephrine effectively control bleeding

however,from 24 to 92 percent of the epinephrine may be absorbed systemically

The potential epinephrine reactions that can occur following systemic absorption include increased anxiety after cord placement, limb tremor, diaphoresis, headache, florid appearance, tachycardia and elevated blood pressure.

recommendations have been made to either limit or avoid use of such epinephrine impregnated retraction cords.

Retraction cord technique

Retraction cord is drawn from the dispenser bottle

A piece approximately 5cm in length is cut

The retraction cod is looped around the tooth and held tightly with thumb and forefinger

The cord is packed into the gingival sulcus starting from the mesial surface of the tooth and stabilised near the distal end of the tooth

The cord can be packed with special instruments liForce should be applied in a mesial direction so that

the preceding segment does not get dislodged

The instrument is held at an angle to the tooth surface

Excess cord is cut off near the interproximal areaAfter 10 minutes the cord should be removed to

avoid bleedingImpression is made only after cessation of bleeding

te retraction cord must be slightly moist before removal.

Rotary curettage(Gingittage)

It is a troughing technique wherein a portion of the epithelium within the sulcus is removed to expose the finish line.

Removes epithelium with a high-speed diamond bur.

It should be done only on healthy gingival tissue :

absence of bleeding upon probing from the gingiva

The depth of the sulcus is less than 3mmPresence of adequate keratinized gingiva

Technique

Done along with finish line preparationThe torpedo diamond point is extended into the

gingival sulcus to remove a portion of the sulcular epthelium

Abundant water should be sprayed during the procedure

A retraction cord impregnated with aluminium chloride can be used to control bleeding.

This technique can potentially damage the periodontium.

Electrosurgical retraction

It is surgical reduction of sulcular epithelium using an electrode to produce gingival retraction

Electrosurgery creates a trough around the tooth by removing superficial cell layers from the gingival sulcus’ inner lining through application of an electric current.

It is high wave radio transmitter that uses either a vacuum tube or a transistor to deliver a high frequency electrical current of at least 1 MHz

cords including propylhexedrine (e.g., propylhexedrine HCI) for providing hemostasis and retraction or displacement of gingival tissue

effective amount of propylhexedrine which avoids the negative side effects associated with the use of epinephrine, commonly used in conventional retraction cords

do not cause increased blood pressure or accelerated heart rate

cords may include astringents, such as iron (III) salts without causing discoloration of the retraction cord, the patient's teeth or gums, or the fingers of the dental practitioner, as would occur if one were to blend epinephrine with iron (III) salts. Wate

Aluminum chloride

Aluminum chloride is used commonly in gingival retraction because of its ability to cause contraction and shrinkage of tissue

act as hemostatic agents and astringents.its ability to precipitate protein, constrict blood

vessels and extract fluid from tissuesreported to be the safest and most effective

method of gingival retraction.presoaking in aluminum chloride removed

approximately 25 percent of the racemic epinephrine in the cord.

Controlling blood, crevicular fluid, water and saliva while taking impressions is critical.

Water and saliva can be controlled by air spray.

Blood and crevicular fluid can be controlled by retraction cords, hemostatic agents, electrosurgery or rotary gingival curettage.

Indications Contraindications

• In areas of inflamed gingival tissue where it is

impossible to use a retraction cord

• In case of gingival proliferation around the

prepared finish lines.

Patient with cardiac pacemakers

Use of topical anaesthetics such as ethyl chloride and other inflammable aerosols

should be avoided when electrosurgery is to be used

Basic principles to be followed during electrosurgical procedures

Local anaesthesia should be given peppermint oil can be applied to the vermillion border

of the lip to mask the unpleasant odour released during the procedure due to tissue necrosis.

The electrode should be applied with light pressure and swift strokes

Moist tissues can be cut best,a rest period of 8-10 sec should be allowed before beginning the second stroke.

The operator should stop frequently to clean fragments of tissue from the electrode with alcohol soaked sponge.

Technique

The electrode should be positioned parallel to the long axis of the tooth

The probe should b run at a minimal speed of 7mm per sec to avoid lateral heat dissipation.

Whole tooth can be covered in four motionsDebris in the sulcus should be removed using

a cotton pellet dipped in H2O2