Gingival tissue management

UNDER THE GUIDANCE OF:

PRESENTED BY:
“GINGIVAL
“GINGIVAL DISPLACEMENT
DISPLACEMENT /RETRACTION
/RETRACTION IS
IS THE
THE
DEFLECTION
DEFLECTION OF
OF THE
THE MARGINAL
MARGINAL GINGIVA
GINGIVA AWAY
AWAY
FROM
FROM AA TOOTH.”
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 consuming
Painful in absence of anaesthesia
Risk of epithelial detachment
Risk of irreversible gingival retraction and excessive
bleeding
 Recent advances: expasyl

Comprises of:
Kaolin : consistency of paste and mechanical action
Aluminium chloride : hemostatic
Air water spray application removes the material from the
sulcus
Expayl paste is injected in the sulcus exerting a pressure of
0.1N/nm
The product is left for 1 min there is sulcus widening of
0.5mm for 2 min
It is available in reusable capsules
Equipment: capsules, injection canulas,applicator
 Techniques for gingival
retraction

Chemico-
Mechanical methods mechanical Surgical methods
methods

Copper bands Gingival retraction

Retraction cords Rotary curettage
cords
Rubber dams 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 : cotton
Chemico – 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 vasoconstrictors

They are-
8 per cent Racemic epinephrine
Aluminium chloride
Alum(aluminium potassium sulphate)
Aluminium sulphate
Ferric 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 disease
Hypertension
Diabetes
Hyperthyroidism
Hypersensitivity
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

A piece
approximately
5cm in length is
Retraction cord cut
is drawn from
the dispenser
bottle

The cord is
packed into the
gingival sulcus
starting from the
mesial surface of
The retraction cod is the tooth and
looped around the tooth stabilised near the
and held tightly with distal end of the
thumb and forefinger tooth
The cord can be packed with special instruments li
Force 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 area
After 10 minutes the cord should be removed to avoid
bleeding
Impression 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 3mm
Presence of adequate keratinized gingiva
 Technique

Done along with finish line preparation

The 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 tissues
reported 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

Patient
Patientwith
withcardiac
cardiac
• In areas
• In of of
areas inflamed
inflamed gingival
gingival pacemakers
pacemakers
tissue where
tissue where it is
it impossible
is impossible to to Use of of
Use topical anaesthetics
topical anaestheticssuch
such
useuse
a retraction
a retraction cord
cord as as
ethyl chloride
ethyl chlorideand other
and other
• In case
• In of of
case gingival
gingival proliferation
proliferation inflammable
inflammable aerosols should
aerosols bebe
should
around
around thethe
prepared
prepared finish lines.
finish lines. avoided
avoidedwhen
when electrosurgery is is
electrosurgery
to to
bebeused
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 motions
Debris in the sulcus should be removed using a
cotton pellet dipped in H2O2