Comparative evaluation of the effect of impregnated retraction cord versus laser on gingival attachment level and pain perception following retraction for subgingival margins - A prospective, split-mouth, controlled, clinical study.

AIM: To evaluate and compare the effect of impregnated retraction cord vs Laser on gingival attachment level and pain perception following retraction for subgingival margins. SETTINGS AND DESIGN: Many methods for achieving and measuring the amount of gingival retraction in fixed prosthodontic work have been advocated. Though the gingival attachment level is crucial in Periodontology, the literature available regarding the effect of these retraction methods on the same is scarce. Hence, this clinical study was designed to compare the pain perception and amount of gingival recession when impregnated cord and laser were used for retraction. MATERIALS AND METHODS: In 40 subjects (age range of 20 to 40 years) with single missing maxillary incisor, the abutments were prepared with subgingival margins, to receive a full coverage metal-ceramic fixed dental prosthesis. The gingiva was retracted on one of the abutments with impregnated retraction cord and on the other with diode laser. Gingival attachment levels were compared at six sites per abutment using superimposition of digital scans, preoperative and four weeks after cementation of final prosthesis. STATISTICAL ANALYSIS USED: Statistical analysis of the data for gingival recession was done using t-test. Pain perception was analysed with Chi-square test. Pain perception by patients following retraction was compared with VAS scale. RESULTS: The average values of gingival recession on buccal side were 0.61 mm and 0.38 mm and on the palatal side were 0.58 mm and 0.35 mm for impregnated retraction cord and laser respectively. The P values of <0.01 indicated a highly significant difference between the two groups. Intragroup comparison did not show significant differences between various sites. Pain and discomfort produced by cord method was moderate in comparison with mild/no pain with diode laser and the difference was highly significant.Conclusion: Retraction cord produced more gingival recession than the diode laser, which was statistically highly significant on both buccal and palatal aspects of the teeth. Patients experience with diode laser technique was less painful in comparison with retraction cord method.

Effect of Gingival Retraction Method to Lateral Gingival Displacement Width

Abstract Objective: To analyze the efficacy of retraction cord with a hemostatic agent in comparison with retraction paste on lateral gingival displacement, to achieve the success of fixed dental prostheses (FDP). Material and Methods: Test samples included 32 teeth that required treatment with metal-porcelain FDP at RSKGM FKG Universitas Indonesia. Impressions were taken before the gingival retraction procedure. From the 32 samples, 16 teeth were retracted using a combination of retraction cord and hemostatic agent, whereas the other half were retracted with retraction paste. Impressions were then taken. The sample was made using cutting die. Lateral gingival displacement width was measured on die-cast using an optical microscope Results: The mean value of group A before gingival retraction was 0.1695 mm, and after gingival retraction was 0.4705 mm. The mean value of group B before gingival retraction was 0.1767 mm, and after gingival retraction was 0.3289 mm. Lateral gingival displacement width between a combination of cord retraction and hemostatic agent group in comparison with the retraction paste group showed a significant difference (p<0.001). The combination of cord retraction and hemostatic agent group showed higher mean value Conclusion: Gingival displacement width as a result of cord retraction with the hemostatic agent was larger compared to the retraction paste. Even though both of them are still considered to be effective in providing access for impression material.

Comparison of Gingival Troughing by Laser and Retraction Cord.

This study was aimed at comparing the most common two methods for gingival troughing: presaturated cord and lasers (including diode, Nd:YAG, and Er:YAG). A total of 108 anterior teeth (58 maxillary and 50 mandibular) in 50 patients were included in this study. Gingival treatment was carried out in the following four groups: presaturated cord, diode laser, Nd:YAG laser, and Er:YAG laser. The gingival width and gingival recession (GR) were measured at different times (at the time of treatment, after 1 week, and after 4 weeks). The presaturated cord resulted in significantly higher (P < .05) GR than lasers and narrower gingival sulci. Er:YAG laser resulted in the quickest and most uneventful wound healing when compared to diode and Nd:YAG lasers.

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

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Preimpression troughing with the diode laser: A preliminary study.

STATEMENT OF PROBLEM: The mechanical-chemical technique and the use of a laser are methods for displacing the gingiva to make an accurate impression of the preparation for a complete crown. The tissue needs to be displaced and the hemorrhage controlled to capture the prepared finishing line in the impression. The degree of undesirable gingival recession after these displacement techniques is unknown. PURPOSE: The purpose of this pilot clinical study was to clinically monitor and compare the regeneration of the gingival tissue by using 2 methods of gingival displacement in the same participant: the mechanical-chemical technique with double cords impregnated with aluminum chloride and the 810 nm diode laser (Odyssey; Ivoclar Vivadent AG). MATERIAL AND METHODS: A total of 6 participants needing 2 crowns on natural teeth were included in this study. At the first visit, the teeth were prepared with a 0.5-mm subgingival finishing line and interim crowns were fabricated. One of the teeth was randomly assigned to the double cord technique with 2 (# 000 and # 1) impregnated 5% aluminum chloride cords and the other to the 810 nm diode laser. An adjacent tooth served as a control. A device was made that would function as a fixed reference point for the measurements at different time intervals. A notch was created on the device to position the digital ruler between the occlusal notch and the free gingival margin to measure the distances. The measurements were recorded for each patient before displacement of the gingiva and at the time of cementation of the definitive crowns. The patients were followed at 1 week, 3 weeks, and 8 weeks after cementation of the definitive crowns. RESULTS: The amount of recession with the cord impregnated with aluminum chloride was 0.26 mm 8 weeks after cementation of the definitive crowns with a range between 0.00 mm and 0.72 mm. The diode laser showed an average recession of 0.27 mm with a range between 0.01 mm and 0.68 mm. CONCLUSIONS: This study found an average loss of gingival height of 0.26 mm for the double cord technique and 0.27 mm for the laser. The amount of recession was considered not clinically significant.

Correlation of pressure and displacement during gingival displacement: An in vitro study.

STATEMENT OF PROBLEM: Although numerous gingival displacement materials are available, information is limited regarding the pressures that can atraumatically produce sufficient gingival displacement for a successful impression. PURPOSE: The purpose of this in vitro study was to measure pressure and the resulting movement of artificial gingiva during simulated gingival displacement. MATERIAL AND METHODS: An idealized tooth model was made from acrylic resin and polyvinyl siloxane to simulate the free gingiva, sulcus, and attachment. The pressure and displacement achieved by 3 materials (Expasyl, Expasyl New, and KnitTrax Cord) were measured. A stereoscopic digital measuring microscope was used to quantify the space generated by the displacement material. A pressure gauge was used to measure the corresponding pressures. RESULTS: The injection of Expasyl resulted in a displacement distance of 1.31 mm, Expasyl New 1.07 mm, and KnitTrax Cord 0.85 mm, which are within acceptable clinical parameters. The correlation between pressure and gap showed that Expasyl and Expasyl New behaved similarly, while KnitTrax Cord was different. Expasyl, Expasyl New, and KnitTrax Cord all had maximum pressures that would be considered atraumatic to the epithelial attachment. CONCLUSIONS: An increase in pressure resulted in an increase in displacement for the 2 paste materials. However, contrary to expectation, displacement decreased as pressure increased for the cord material.

Clinical efficacy of polyvinyl siloxane impression materials using the one-step two-viscosity impression technique.

STATEMENT OF PROBLEM: Impression making is a challenging clinical procedure for both patients and dentists. PURPOSE: The purpose of this clinical study was to compare a recently introduced fast-setting polyvinyl siloxane (PVS) impression material with heavy body/light body (HB/LB) combination (Imprint 4; 3M ESPE) (experimental group) with a conventional PVS impression material with HB/LB combination (Imprint 3; 3M ESPE) (control group), using the 1-step 2-viscosity impression technique. MATERIAL AND METHODS: Two definitive impressions (1 of each material combination) were made of 20 crown preparations from 20 participants. The quality of impressions was rated by 3 evaluators (clinical evaluator, clinical operator, and dental technician) and by the patients for the level of comfort and taste of the impression materials. The order in which the 2 impressions were made with each material combination was randomized for each crown preparation. A paired t test for paired means and McNemar test for paired proportions were used for statistical comparisons (α=.05). RESULTS: Participants rated the comfort of the impression making with the experimental group significantly higher than that with the control group (P=.001). No significant differences were found in participants' rating for the taste of the impression materials (P=.46). The viscosity for tray material was rated as significantly better for the control group by the clinical operator (P=.004). The readability of the impression and visibility around the finish line were rated as significantly better for the experimental group than for the control group (P<.001). Except for the ease of removal of the stone (RS), the ratings for the 2 groups by the dental technician were similar. The ease of RS was rated as significantly better for the experimental group (P<.001). Eleven dies from the control and 9 from the experimental group were selected for fabrication of the definitive crowns (P=.65). CONCLUSION: Within the limitations of this clinical study, no significant differences were found in the overall clinical performance of the experimental and the control groups. Impressions made with both materials were clinically acceptable. Participants rated the comfort provided by the experimental group significantly better than that of the control group.

Gingival displacement: Survey results of dentists' practice procedures.

STATEMENT OF PROBLEM: A high percentage of fixed prosthodontic restorations require a subgingival margin placement, which requires the practice of gingival displacement or a deflection procedure to replicate the margins in impression. PURPOSE: The purpose of this study was to learn the different gingival displacement techniques that are currently used by dentists in their practice and to compare the current concepts of gingival displacement with previously published articles. MATERIALS AND METHODS: A survey of questions pertaining to gingival deflection methods was distributed as part of continuing education (CE) course material to dentists attending CE meetings in 7 states in the U.S. and 1 Canadian province. Question topics included initial patient assessment procedures, gingival displacement methods, dentist's knowledge and assessment of systemic manifestations, and brand names of materials used. RESULTS: Ninety-four percent of the participants were general practitioners with 24.11 ± 12.5 years of experience. Ninety-two percent used gingival displacement cords, while 20.2% used a soft tissue laser and 32% used electrosurgery as an adjunct. Sixty percent of the dentists used displacement cords impregnated with a medicament. Of the preimpregnated cords, 29% were impregnated with epinephrine, 13% with aluminum chloride, and 18% with aluminum potassium sulfate. CONCLUSION: The study showed a steady decrease compared with results of previously published articles in the use of epinephrine as a gingival deflection medicament.

Virtually designed and CAD/CAM-fabricated lithium disilicate prostheses for an esthetic maxillary rehabilitation: a senior dental student clinical report.

During their education, dental students seek to be involved in comprehensive esthetic treatment for the rehabilitation of lost, damaged, or discolored tooth structure. Due to technological advances and patient exposure to dental advertising, recent dental school graduates can find themselves under great expectations with limited clinical experience. With the implementation of an oral health and rehabilitation department at the University of Louisville Dental School, dental students have the opportunity to plan treatment and treat such patients under the supervision of faculty with advanced training in prosthodontics and restorative dentistry. The work flow of multiple consecutive lithium disilicate ceramic prostheses using a digital impression, virtual CAD/CAM design, and milled fabrication as planned and executed by a senior dental student is presented.

[Gingival displacement techniques in daily practice. Survey among dental surgeons in Abidjan, Ivory Coast]. / Réalisation des techniques d'ouverture sulculaire en pratique quotidienne. Enquête faite auprès des chirurgiens-dentistes d'Abidjan, Côte d'Ivoire.

INTRODUCTION: Access to cervical margins allows the practitioner to record the entire cervical margin in order to provide a true copy to the technician. This requires a gingival displacement obtainable by different techniques. This study aimed to assess the implementation of gingival displacement methods prior to impression taking in fixed prosthodontics. MATERIALS AND METHODS: This is a descriptive and cross-sectional survey of sample of 71 dentists practising in Abidjan, Ivory Coast; which ran from October 2nd, 2010 to November 14th, 2010. A survey form was administered to dentists. The questionnaire was organised around the following headings: identification of dentists and practice of gingival displacement methods. The data processing done using software Epi Info 6 and Excel XP on Window XP, allowed calculation of frequencies, means and proportions and the establishment of connection between variables with the chi2 test. The significance level was set at p < 0.05. RESULTS: The results of the survey indicate that non-surgical methods of gingival displacement, including retraction cords and temporary crowns are those they use most frequently (76.4%) because the vast majority of practitioners (87.22%) believe the most traumatic to the periodontium are surgical methods. CONCLUSION: Our study showed that the gingival displacement methods are frequently carried out in daily practice, regardless of the topography of the abutment teeth and their number, but with a preference for non-surgical methods, particularly those using retraction cords and temporary crowns. The use of injectable gingival displacement paste is not harmful to the periodontal tissues, easy to use and have a very efficient haemostatic action. It should also be known and practiced.

Cirurgia periodontal estética em dentes anteriores / Esthetic periodontal surgery in anterior teeth

As cirurgias pl sticas periodontais vˆm sendo muito valorizadas e cada vez mais procuradas por pessoas que alegam querer corrigir o “sorriso gengival”, que ocorre quando ao sorrir, mostram mais gengiva do que os dentes. Existem diversas causas para o sorriso gengival, e este artigo aborda um caso de erup‡Æo passiva alterada dos dentes com excesso de gengiva ceratinizada. Um comprometimento do sorriso harm“nico ‚ um desconforto est‚tico que incomoda principalmente as mulheres. Diante dos fatos, este trabalho tem como objetivo relatar um caso cl¡nico de cirurgia est‚tica com osteoplastia. Essas t‚cnicas promovem uma exposi‡Æo dent ria mais adequada proporcionando um sorriso mais harm“nico ao paciente. O presente caso ‚ de uma paciente do sexo feminino, 23 anos, que queixava-se da insatisfa‡Æo que o sorriso gengival a proporcionava. Atrav‚s da an lise do sorriso foi indicado o procedimento cir£rgico. Ap¢s o procedimento cir£rgico, p“de-se concluir atrav‚s do grau de satisfa‡Æo da paciente que as t‚cnicas empregadas foram adequadas para se obter um sorriso est‚tico.

Periodontal plastic surgery have been highly valued and increasingly sought by people who want to fix the “gummy smile”. There are several causes for gummy smile, and this article will discuss a case of altered passive eruption of teeth with excessive keratinized gingiva. An aesthetically compromised smile bothers mostly female patients. Given the facts, this paper aims to report a case of clinical cosmetic surgery with osteoplasty. These techniques promote a more adequate dental exhibition providing a more harmonious smile to the patient. This case was a 23 years old female patient, displeased with her gummy smile. After the analysis of the smile, surgical treatment was indicated. After surgery it was concluded that, according to the patient’s satisfaction, the utilized techniques were adequate to obtain an aesthetically harmonious smile.

Evaluation of a novel compule-based gingival retraction system in UK general dental practices.

Twelve members were selected at random from the PREP panel, a group of UK-based dentists who are prepared to carry out research in their practices. A questionnaire was designed to determine the views of the participants, who were asked to use the retraction paste capsules where clinically indicated. They were asked to return the questionnaire after 8 weeks and the information contained therein was collated and presented mainly on visual analogue scales (VAS). A total of 160 impressions were taken using the Astringent Retraction Paste (3M ESPE, Seefeld, Germany) plus use in the placement of 25 restorations. Of evaluators, 83% (n = 10) agreed that Astringent Retraction Paste was a suitable product for gingival retraction and 75% (n = 9) agreed that it had good haemostatic properties. Overall dispensing and handling of the paste was rated as 4.9 on a VAS scale where 1 = Inconvenient and 5 = Convenient. The viscosity of the paste was rated as 3.6 on a VAS where 1 = too thin and 5 = too thick. Good scores were achieved across all criteria for the product. Clinical Relevance: Practitioners may wish to be aware of a novel compule-based gingival retraction system.

A simplified pocket reduction procedure around a stud attachment without suturing.

Plaque accumulation on the implant titanium surface plays a critical role in the initiation and progression of periimplant disease. Removing plaque and calculus deposits, and reducing the periimplant probing depth, therefore, are important. The reduction of the periimplant probing depth in periimplant disease by using a cord and a surgical dressing pack has not been previously reported. This procedure is useful for periimplant mucositis and mild periimplantitis before a surgical intervention and can maintain a narrow keratinized mucosa with less pain than surgical intervention.

Comparison of pressure generated by cordless gingival displacement materials.

STATEMENT OF PROBLEM: Because pressure generated by a displacement cord may traumatize the gingiva, cordless gingival displacement materials are available to the clinician as atraumatic alternatives. However, whether the pressures produced by the different systems are equivalent is unclear. PURPOSE: The purpose of this study was to investigate the pressures generated by 4 different cordless gingival displacement materials. MATERIAL AND METHODS: A chamber with a dimension of 5 × 5 × 2 mm was made from Type IV stone and silicone material to simulate a rigid and elastic environment. A pressure gauge was embedded into the wall of the chamber, and 4 materials (Expasyl, Expasyl New, 3M ESPE Astringent Retraction Paste, and Magic FoamCord) were injected into the chamber. The maximum and postinjection pressures were recorded with Chart 5 software and the Power Lab system. The pressures generated by the different materials were compared with a post hoc Mann-Whitney U test (α=.05). RESULTS: The median postinjection pressures generated by Expasyl (142.2 kPa) and Expasyl New (127.6 kPa) were significantly greater than the pressures generated by 3M ESPE Astringent Retraction Paste (58.8 kPa) and Magic Foam Cord (32.8 kPa). Expasyl generated a maximum pressure of 317.4 kPa and Expasyl New of 296.6 kPa during injection, whereas 3M ESPE Astringent Retraction Paste generated 111.0 kPa, and Magic Foam Cord generated 17.8 kPa. CONCLUSIONS: All cordless systems produced atraumatic pressures, with Expasyl New and Expasyl generating the highest pressures and, therefore, can be considered the most effective material.

A clinical comparison of cordless and conventional displacement systems regarding clinical performance and impression quality.

STATEMENT OF PROBLEM: It is not clear whether newly introduced cordless displacement systems are better able to manage gingiva than conventional systems. PURPOSE: The purpose of this in vivo study was to evaluate the gingival management ability of 4 different displacement methods with a standardized subgingival preparation finish line. MATERIAL AND METHODS: The effects of 4 displacement techniques on gingival management and impression quality were evaluated by means of 6 evaluation criteria. A subgingival preparation finish line of between 1 and 2 mm was ensured, and the buccal aspects of 252 (n=63) teeth were clinically assessed for ease of application, time spent, bleeding, remnants, and dilatation. The complete reproduction of the preparation finish line and the bubble and void formations on polyether impressions were also evaluated. The data were statistically analyzed with the χ(2) test (α=.05). The Bonferroni correction was used to control Type I error for the pairwise comparison groups (α=.008). RESULTS: Statistically significant differences were found for all criteria among the groups (P<.05). The nonimpregnated displacement cord group was the least effective group in terms of bleeding and impression quality (P<.008). The aluminum chloride impregnated cord group and the displacement paste with cap group were found to be comparable in terms of remnants, dilatation, and impression quality (P>.008). The retraction cap with paste group showed better results for ease of application, time spent, and bleeding than the aluminum chloride impregnated cord group (P<.008). Although the group with aluminum chloride impregnated cord, displacement paste, and cap showed better results for dilatation, it was time consuming and difficult (P<.008). CONCLUSIONS: Except for the nonimpregnated cord group, all of the groups were comparable and clinically useful, with perfect or acceptable impression qualities.

Accurate transfer of soft tissue morphology with interim prosthesis to definitive cast.

With conventional fixed dental prostheses, the interim restoration is a valuable diagnostic tool in the evaluation of esthetics and function. To achieve predictable definitive esthetic results, information about the subgingival and the supragingival contour of a properly designed restoration should be communicated to the dental laboratory technician. The technique described enables the accurate transfer of the soft tissue morphology developed with an interim prosthesis to the definitive cast. This modified definitive cast allows the dental laboratory technician to fabricate a restoration with an emergence profile identical to that of the interim prosthesis.

Local and systemic effects of mechanico-chemical retraction.

The process of recording an acceptable fixed prosthodontic impression must include appropriate tissue management. This article reviews the effects of mechanical and chemical tissue retraction for fixed prosthodontics, specifically discussing the use of retraction cord with or without chemicals to control sulcular hemorrhage and moisture. Common astringents, hemostatics, and vasoconstrictors used in dentistry as gingival retraction agents are discussed, and recommendations for modification of patient and treatment management are provided.