Effects of Gingival Retraction Paste and Subsequent Cleaning

with Hydrogen Peroxide on the Polymerization of Three

Elastomeric Impression Materials: An In Vitro Study
Tariq S. Abduljabbar, BDS, MSc, DMSc,1 Mohammad D. Al Amri, BDS, MS, FRCDC,1 Mohammad Q. Al
Rifaiy, BDS, MSc,1 Zeyad H. Al-Sowygh, BDS, DMSc,1 Fahim A. Vohra, BDS, MSc,1
Moneeb A. Balous, BDS,2 Adel S. Alqarni, BDS,2 & Abdulmajeed O. Alotaibi, BDS2
1
Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
2
College of Dentistry, King Saud University, Riyadh, Saudi Arabia

Keywords
Expasyl; gingival displacement agents;
hydrogen peroxide; impression
polymerization; tissue retraction.
Correspondence
Dr. Tariq S. Abduljabbar, Department of
Prosthetic Dental Sciences, College of
Dentistry, P. O. Box 60169, King Saud
University, West King Abdullah Road, Riyadh
11545, Saudi Arabia.
E-mail: tajabbar@yahoo.com
The authors thank the Deanship of Scientific
Research at King Saud University, Riyadh,
Saudi Arabia, for funding this Prolific
Research Group (PRG-1437-38).
The authors declare that they have no conflict
of interest and that there was no external
source of funding for the present study.
Accepted March 1, 2017
doi: 10.1111/jopr.12641
Abstract
Purpose: It has been hypothesized that there are no effects of Expasyl and subse-
quent cleaning with hydrogen peroxide on polymerization of selected commonly used
impression materials. Therefore, the aim of this study was to evaluate the effect of
Expasyl paste on the polymerization of three impression materials with and without
subsequent cleaning using 3% hydrogen peroxide (H2 O2 ).
Materials and Methods: Nine standardized stainless steel specimens were fabricated.
One hundred and eighty impressions were made using 3 materials (60 each) as fol-
lows: group I: poly(vinyl siloxane) (PVS) (Virtual); group II: polyether (Monophase);
group III: polyether (Impregum). Groups were subdivided into 3 categories: control
without intervention (n = 20), pre-application of Expasyl and subsequent 1-minute
washing with water and air-drying (n = 20), and pre-application of Expasyl and sub-
sequent cleaning with 3% H2 O2 for 10 seconds (n = 20). All impressions were made
by one operator using auto-mixing cartridges under standardized conditions at room
temperature. Evaluation of the polymerization inhibition was blindly and indepen-
dently performed by three practitioners with comparable experience using a visual
scale. The observation was subjectively categorized as noninhibited or inhibited. Data
were tabulated and analyzed using Fisher’s exact test with significance level set at p
˂ 0.05.
Results: Significant differences were found between the control group and the impres-
sions made after contamination with Expasyl (p < 0.001). Polymerization inhibition
of PVS and Impregum was similar (in 85% and 90% of the specimens, respectively)
when washed with water. There was a statistically significant reduction in polymeriza-
tion inhibition in both upon cleaning with H2 O2 (p < 0.001); however, polymerization
inhibition occurred in 100% of Monophase specimens when contaminated with Ex-
pasyl despite the washing technique used.
Conclusions: Under these in vitro conditions, it can be concluded that the remnants
of Expasyl on specimens caused a significant polymerization inhibition of the 3
impression materials tested. Subsequent cleaning with 3% H2 O2 significantly reduced
this inhibitory effect on polymerization. Expasyl should not be used with Monophase
polyether material.

Accuracy in registration of the preparation gingival finish line
is an important factor for the marginal integrity and long-term
success of the final restoration.1 Because of their excellent
physical properties, elastomeric impression materials are com-
monly used for registering the preparation. During finish line
capture, impression materials come in direct contact with other
dental materials and oral fluids. Therefore, one requirement of
impression materials is the biocompatibility of these materials
with oral fluids and other dental materials; however, this re-
quirement is not always satisfied. For example, inhibition of
polymerization has been reported in relation to rubber dam ma-
terial, cements, gingival displacement cords and medicaments,
dentin bonding agents, flowable composite resins, and latex
gloves.2,3

Journal of Prosthodontics 00 (2017) 1–6 

C 2017 by the American College of Prosthodontists 1
Gingival Retraction Paste, H2 O2 and Polymerization Abduljabbar et al

Gingival retraction materials are used to expose the marginal

line of the prepared tooth to allow the impression material to
freely flow into the sulcus.1,4 Furthermore, cordless retraction
materials have been introduced and are claimed to have supe-
rior efficiency, better patient comfort and acceptance, and less
damage to the periodontium compared to traditional retraction
cords.5 Expasyl (Kerr Co., Orange, CA) is a cordless injectable
paste-like material commonly used for this purpose.6,7 Chemi-
cal and mechanical components of Expasyl lead to sulcus open-
ing and help in bleeding control. It contains kaolin to ensure
the consistency of the paste and its mechanical action and 15%
aluminum chloride to enhance the hemostatic action.8
Several studies have investigated the effect of gingival dis-
placement medicaments on the physical properties of impres-
sion materials.1,5,6,9-15 Negative effects of ferric subsulfate, fer-
ric sulfate, and aluminum chloride on the polymerization and
tear strength of different types of final impression materials
have been demonstrated.9,12 This is possibly due to sulfur that
delays or inhibits polymerization.9 Moreover, these medica-
ments were found to adversely affect the surface detail repro- Figure 1 Schematic design of stainless steel specimens used.
duction of poly(vinyl siloxane) (PVS) impression materials.1,10
Other studies have reported a significant difference on the set- r Group II: Polyether (Monophase; 3M ESPE, Seefeld,
ting of PVS materials when contaminated with Expasyl and Germany)
interim prosthodontic materials.2,6 However, there is also an r Group III: Polyether (Impregum; 3M ESPE)
alternative view with contradictory results.14-17 This suggests
Before each application, specimens were disinfected with
that in addition to variations in experimental methods, the effect
alcohol, steam cleaned, and air-dried to confirm removal of any
may be material- and brand-related.9
contaminants. Groups were subdivided into three categories
The retarding effect of the interim materials on polymeriza-
according to the exposure to Expasyl and washing technique.
tion was significantly reduced upon decontamination with 3%
Twenty impressions served as control without applying any
hydrogen peroxide (H2 O2 ), which has been identified as an
material on the stainless steel specimens. Twenty impressions
effective disinfection method for dental impression materials
were made after application of Expasyl on the top surface of
without adversely affecting their physical properties.2,18 It is
the specimen for 2 minutes and subsequent 1-minute washing
notable that few studies have evaluated the effect of cordless
with water and air-drying. Expasyl paste was slowly injected
retraction agents and the subsequent cleaning methods on the
into the grooves using the applicator and tips provided by the
polymerization of different types of impression materials. We
manufacturer. The last 20 impressions were made after the
hypothesized that there are no effects of Expasyl and subse-
application of Expasyl for 2 minutes and subsequent cleaning
quent cleaning with hydrogen peroxide on polymerization of
with water for 10 seconds and application of 3% hydrogen
selected commonly used impression materials. Therefore, the
peroxide with a brush for 10 seconds. The specimens were then
aim of this study was to evaluate the effect of Expasyl paste on
washed for 5 seconds and air-dried before making impressions.2
polymerization of three elastomeric impression materials with
For convenience, the sequence of the experiment started with
and without subsequent cleaning using 3% H2 O2 .
one material at a time. The decision on what material and group
to start with was made through picking a number from a hat.

Materials and methods Impression making

Specimen design and grouping
Nine standardized stainless steel specimens were fabricated
with a diameter of 38 mm with a 30 mm diameter step on the
superior surface treated by laser to make two vertical and three
horizontal lines on top of its surface according to the schematic
design shown in Figure 1. The 1-mm-wide and 2-mm-deep
horizontal (1, 2, and 3) and vertical lines (C-D and C-D) were
2.5 mm and 20 mm apart, respectively.1 The specimens were
numbered and highly polished with the horizontal and vertical
lines marked. One hundred and eighty impressions were made
using three impression materials (60 each) as follows:
r Group I: PVS (Virtual; Ivoclar Vivadent AG, Schaan,
Liechtenstein)
All procedures were made by one operator under standardized
conditions at room temperature. Auto-mixing cartridges were
used for making all impressions according to manufacturer in-
structions. The initial compound of the elastomeric impression
mix was discarded to eliminate any possible early unmixed
impression material. The impression material was injected ini-
tially in the grooves and then spread over the entire surface to
prevent void formation. An adhesive-painted hard acrylic cover
sheet (Triad VLC; Dentsply, York, PA) was placed on top of the
mold to keep a uniform 3-mm thickness of impression material.
Latex gloves were avoided to rule out latex’s detrimental effect
on polymerization of impression materials.3 The setting time
was predetermined to be, as per the manufacturer’s instruction,
multiplied by 1.5 to compensate for the intraoral environment

2 Journal of Prosthodontics 00 (2017) 1–6 

C 2017 by the American College of Prosthodontists
Abduljabbar et al Gingival Retraction Paste, H2 O2 and Polymerization

Table 1 Criteria-based scale used for polymerization inhibition evaluation

Category Description Score

Uninhibited Completely polymerized −

Inhibited Oily uncolored substance readily removed with cotton swab +
Oily colored substance readily collected by cotton swab when it is moved across the surface ++
Un-polymerized impression material adherent to the specimen surface and collected on a cotton swab +++

Table 2 Polymerization inhibition scores of impression materials after Expasyl application and cleaning with water or hydrogen peroxide

Inhibited [n (%)]

Impression material Medicament Washing technique Uninhibited [n (%)] + ++ +++ Total

Virtual (PVS) None None 20 (100%)ab 0 0 0 0

Expasyl Water 3 (15%)a 16 (80%) 1 (5%) 0 17 (85%)
H2 O2 20 (100%)ab 0 0 0 0
Monophase (Polyether) None None 20 (100%)abc 0 0 0 0
Expasyl Water 0a 5 (25%) 11 (55%) 4 (20%) 20 (100%)
H2 O2 0a 8 (40%) 10 (50%) 2 (10%) 20 (100%)
Impregum (Polyether) None None 20 (100%)ab 0 0 0 0
Expasyl Water 2 (10%)a 15 (75%) 3 (15%) 0 18 (90%)
H2 O2 19 (95%)ab 1 (5%) 0 0 1 (5%)

a
Significantly different from inhibited at p ˂ 0.05.
b
Significantly different from washing with water alone at p ˂ 0.05.
c
Significantly different from washing with H2 O2 at p ˂ 0.05.

temperature and to ensure adequate time for polymerization Results

before the impression material was evaluated.2
Evaluation of polymerization inhibition
Upon setting and removal of the impressions from the spec-
imens, evaluation of the polymerization inhibition was made
using a visual scale employed in previous studies.2,19-21 The
inhibition of polymerization is immediately evident as unset
residue or partially polymerized impression material, which
can be distorted by scraping with a blunt instrument.2 Impres-
sions were blindly evaluated and classified into four categories
according to the criteria presented in Table 1. Immediately after
separation all scores of polymerization inhibition were awarded
by three practitioners with comparable experience. All exam-
iners independently inspected the specimen at once without
communication between them. Then, each examiner scored his
grade separately. The inter- and intrarater reliability was ana-
lyzed with Kappa correlation analysis and confirmed through a
random pilot test on 10 predetermined impressions. The inter-
and intrarater reliabilities in scoring polymerization inhibition
were satisfactorily high (Kappa = 0.98 and +1, respectively).
Statistical analysis
Data were tabulated in categories and analyzed using SPSS
software for Windows (v19.0; SPSS Inc., Chicago, IL). Since
some of the cells in the tabulated results were <5.0, Fisher’s
exact test was used to determine any positive effect of Expa-
syl and subsequent cleaning method on polymerization at a
significance level of p ˂ 0.05.
All scores were achieved with complete agreement between
the three assessors (Kappa +1). For all materials, 100% of the
impressions in the control groups, where no medicaments were
used, underwent complete polymerization. Within all impres-
sion materials, significant differences were found between the
control group and the impressions made after contamination
with Expasyl and washing with water (p < 0.001). For the PVS
material, there was a mild (80%) to moderate (5%) polymer-
ization inhibition in 85% of the specimens when washed with
water, whereas no polymerization inhibition occurred in those
washed with hydrogen peroxide (Table 2). This 70% reduction
in polymerization inhibition was statistically significant (p <
0.001).
Polyether materials had different reactions to Expasyl and
H2 O2 . A more evident degree of polymerization inhibition was
demonstrated in 100% of polyether Monophase material when
contaminated with Expasyl despite the washing technique used.
This effect was significantly different from control (p ˂ 0.0001).
Polymerization inhibition ranged from mild to severe with in-
significant improvement (p = 0.82) upon cleaning with 3%
H2 O2 (Table 2). Polyether Impregum, however, had a similar
reaction to that of PVS Virtual material using both washing
techniques. There was a mild (75%) to moderate (15%) poly-
merization inhibition in 90% of the specimens when washed
with water, whereas complete polymerization occurred in 95%
of specimens washed with 3% H2 O2 (Table 2). This 85% re-
duction in polymerization inhibition between the two washing
techniques was statistically significant (p < 0.001).

Journal of Prosthodontics 00 (2017) 1–6 

C 2017 by the American College of Prosthodontists 3
Gingival Retraction Paste, H2 O2 and Polymerization
Discussion
The aim of this study was based on the hypothesis that there are
no effects of Expasyl and subsequent cleaning with hydrogen
peroxide on polymerization of three final impression materials;
however, the present results suggested an adverse effect of Ex-
pasyl on polymerization of impression materials tested with and
without subsequent H2 O2 cleaning. Therefore, the hypothesis
was rejected in full. This finding is in line with that demon-
strated by Albaker,6 who evaluated polymerization based on
the setting time using an oscillating rheometer. Decontami-
nation with 3% hydrogen peroxide was suggested in another
study2 to improve polymerization of PVS impression materi-
als after contamination with interim prosthodontic materials.2
However, the current study was the first to simultaneously in-
vestigate both effects on polymerization using the visual scale
method.
Retardation on polymerization of impression materials af-
ter sulfur-based gingival retraction agents has been previously
demonstrated.9,15 Claims have been attributed to the effect of
sulfur radicals. Although Expasyl does not contain sulfur, retar-
dation has also been shown.6 However, Expasyl contains alu-
minum chloride that acts as astringent by precipitation of tissue
proteins22 and to a lesser extent through vasoconstriction.23
This agent proved more effective in keeping the sulcus open
after clinicians removed the cord (10% to 20% of original open-
ing 8 minutes after the cord is removed) than are epinephrine-
medicated cords (50% closure of sulcus observed over a sim-
ilar duration).24 However, it possesses a vital shortcoming of
inhibiting the polymerization of PVS and polyether impres-
sion materials.9,25 In this study, most inhibitions were mild for
Virtual and Impregum materials (80% and 75%, respectively).
Although Impregum and Monophase are polyether materials
produced by the same manufacturer (3M ESPE), Monophase
surprisingly underwent an acute negative skew (100% inhi-
bition), even after decontamination with 3% H2 O2 . This in-
hibitory effect could be ascribed to the reaction of aluminum
chloride, which is a strong Lewis acid, with ethers (Lewis bases)
to protonate the oxygen and give onium ions. Another pos-
sibility is that ethers undergo rapid cleavage with aluminum
chloride.26 The contact angle and viscosity are lower for Im-
pregum compared to Monophase, which means a more hy-
drophilic behavior during the process of setting and can there-
fore be expected to exhibit better flow, wettability, and shear-
thinning properties.27-29 However, the exact rationale behind the
different responses of Impregum and Monophase is not com-
pletely understood, suggesting that a material’s performance
could be brand-specific. In addition to the aforementioned vari-
ables, PVS materials contain chloride radicals that may interact
with the catalytic sites and block setting in the same way sulfate
radicals do.
Furthermore, it is pertinent to consider the difficulty in the
elimination of residues of aluminum chloride from speci-
mens.24,25 The two washing techniques tested showed a varia-
tion in Expasyl remnants decontamination from specimens in
favor of diluted H2 O2 over water alone. Hydrogen peroxide, be-
ing a strong disinfectant, exhibits oxidizing and reducing prop-
erties that might dissolve the organic oily constituents, clean the
residues of aluminum chloride, and reduce the surface tension
4 Journal of Prosthodontics 00 (2017) 1–6 
Abduljabbar et al
of surfaces to be impressed; however, the exact mechanism
is not yet recognized. The significant reduction in polymer-
ization inhibition upon H2 O2 -cleaning suggests the significant
impact of cleaning method. Direct contact of impression mate-
rials happens when adequate air and water are not used. Expasyl
in its paste-like form is injected directly into the gingival sul-
cus and left for 1 to 2 minutes to open the sulcus around the
prepared tooth margins. In addition to the inherent properties
of the material in question, a variety of factors can contribute
to the difficulty in removing retraction materials from the gin-
gival crevice.6 The size and depth of the sulcus, roughness and
concavity of the cervical region, location of the tooth and ac-
cessibility, and crowding and malalignment of teeth can make
complete elimination of the retraction material difficult. More-
over, Expasyl absorbs sulcular fluid to swell and expand and
dissipates and diffuses in crevicular tissue, making complete
elimination almost impossible.6 In Chang et al’s study,4 all the
specimens exposed to Expasyl retained some residual elemen-
tal components of the retraction paste. All the aforementioned
factors elucidate the significant difference between the laser-
engraved stainless steel grooves and tooth-gingival complex,
which may have affected the results. Disparity is not limited
to the anatomical, physiological, and chemical variations, but
also includes dissimilarity of surfaces to be impressed.
A minimum of 0.2-mm sulcular width is obligatory for
enough thickness of the material to be there at the margins
of impressions so that they can endure tearing or distortion on
removal of the impression.24,30 Specimen grooves used in this
investigation were made 1-mm wide to obtain enough bulk
of material for evaluation of polymerization inhibition and
2-mm deep to reflect the clinical scenario; however, impres-
sion materials may behave differently at different thicknesses.
All three categories of inhibited specimens were considered
unpolymerized, since the impressions were not up to the ac-
ceptable standards for accurate cast production. As time is a
critical factor here, all the examiners were sitting in the same
area and giving scores simultaneously without communication
between them, where each examiner scored his grade sepa-
rately. This concurrent inspection was practiced to preclude
changes over time, if any, during swabbing impressions among
examiners and to standardize the allotted time for inspection;
however, it is uncertain that an improvement in polymeriza-
tion occurs over time, since this assumption is beyond the
aim of this investigation. Future research is recommended to
test the changes over time in polymerization and if the in-
hibitory effect could be minimized by delaying the pouring of
impression.
For proper interpretation, it is pertinent to recognize a num-
ber of limitations to this study. Although inter- and intra-rater
agreements were satisfactorily high in this study, the subjec-
tivity of evaluation and the inability to quantify the extent of
polymerization inhibition could be considered a limitation. An-
other limitation was that the employed study design was limited
to the material brands included, which have reacted differently
to the same material. Therefore, the reported findings cannot
generalize to other materials or dissimilar conditions and should
be interpreted with caution. Moreover, in vitro testing of mate-
rials does not necessarily represent their behavior in vivo. As
this in vitro testing was conducted under dry conditions, oral
C 2017 by the American College of Prosthodontists
Abduljabbar et al
humidity, temperature, and crevicular fluids may alter a ma-
terial’s consistency and flow behavior.31 Therefore, the same
materials may perform differently under clinical conditions. 10.
The practitioners may be instructed to use material brands
known for biocompatibility to the oral tissues and to each other.
Furthermore, 3% H2 O2 may be recommended for decontam-
ination after Expasyl application. Further clinical studies are 11.
required to confirm these in vitro findings and their clinical
relevance.
12.
Conclusions
Within the limits of the in vitro conditions, it can be concluded
that:
13.
1. The remnants of Expasyl on specimens caused a signif-
icant polymerization inhibition of the three impression
materials tested.
2. Expasyl should not be used with Monophase polyether
material. 14.
3. Thorough removal of Expasyl is a mandatory prerequisite
to impression making with PVS and polyether materials.
Subsequent cleaning with 3% H2 O2 significantly reduced
the inhibitory effect on polymerization.
15.
Acknowledgments
The authors thank the Deanship of Scientific Research at King 16.
Saud University, Riyadh, Saudi Arabia, for funding this Prolific
Research Group (PRG-1437-38).
References 17.
1. Vaishnav KC, Patel PR, Shah DS, et al: Effect of 3 different
medicaments on dimensional stability and surface detail 18.
reproduction of polyvinyl siloxane impression material. Natl J
Integr Res Med 2012;3:124-130
2. Al-Sowygh ZH: The effect of various interim fixed prosthodontic 19.
materials on the polymerization of elastomeric impression
materials. J Prosthet Dent 2014;112:176-181
3. Peregrina A, Land MF, Feil P, et al: Effect of two types of latex 20.
gloves and surfactants on polymerization inhibition of three
polyvinyl siloxane impression materials. J Prosthet Dent
2003;90:289-292 21.
4. Chang YS, Bennani V, Tawse-Smith A, et al: Effect of a cordless
retraction paste material on implant surfaces: an in vitro study.
Braz Oral Res 2011;25:492-499 22.
5. Acar Ö, Erkut S, Özçelik TB, et al: A clinical comparison of
cordless and conventional displacement systems regarding 23.
clinical performance and impression quality. J Prosthet Dent
2014;111:388-394
6. Albaker A: Effect of gingival retraction material on the physical 24.
properties of polyvinyl siloxane impression material. Egypt Dent
J 2011;57:899-905
7. Al Baker AMA, El Araby A, Al Amri MD, et al: The impact of 25.
Expasyl R
gingival retraction paste on the bond strength of
self-etch and total-etch systems. J Contemp Dent Pract 26.
2015;16:335-339
8. Lesage P: Expasyl protocol for use with fixed prosthodontics.
Clinic (Paris) 2002;23:97-103 27.
9. Sabio S, Franciscone AP, Mondelli J: Effect of conventional and
experimental gingival retraction solutions on the tensile strength
Journal of Prosthodontics 00 (2017) 1–6 
C 2017 by the American College of Prosthodontists
Gingival Retraction Paste, H2 O2 and Polymerization
and inhibition of polymerization of four types of impression
materials. J Appl Oral Sci 2008;16:280-285
Singh R, Singh J, Gambhir RS, et al: Comparison of the effect of
different medicaments on surface reproduction of two
commercially available polyvinyl siloxane impression
materials—an in-vitro study. J Clin Exp Dent 2013;5:e138-43
O’Mahony A, Spencer P, Williams K, et al: Effect of 3
medicaments on the dimensional accuracy and surface detail
reproduction of polyvinyl siloxane impressions. Quintessence Int
2000;31:201-206
Nowakowska D, Raszewski Z, Saczko J, et al: Polymerization
time compatibility index of polyvinyl siloxane impression
materials with conventional and experimental gingival margin
displacement agents. J Prosthet Dent 2014;112:
168-175
Nowakowska D, Saczko J, Kulbacka J, et al: Chemical retraction
agents—in vivo and in vitro studies into their physico-chemical
properties, biocompatibility with gingival margin tissues and
compatibility with elastomer impression materials. Mini Rev
Med Chem 2017;17:435-444
Nowakowska D, Raszewski Z, Zietek ˛ M, et al: The setting time
of polyether impression materials after contact with conventional
and experimental gingival margin displacement agents. J
Prosthodont 2016 Jun 22. https://doi.org/10.1111/jopr.12471.
[Epub ahead of print]
Machado CE, Guedes CG: Effects of sulfur-based hemostatic
agents and gingival retraction cords handled with latex gloves on
the polymerization of polyvinyl siloxane impression materials.
J Appl Oral Sci 2011;19:628-633
de Camargo LM, Chee WW, Donovan TE: Inhibition of
polymerization of polyvinyl siloxanes by medicaments used on
gingival retraction cords. J Prosthet Dent 1993;70:
114-117
Tarighi P, Khoroushi M: A review on common chemical
hemostatic agents in restorative dentistry. Dent Res J (Isfahan)
2014;11:423-428
Choi YR, Kim KN, Kim KM: The disinfection of impression
materials by using microwave irradiation and hydrogen peroxide.
J Prosthet Dent 2014;112:981-987
Jones RH, Cook GS, Moon MG: Effect of provisional luting
agents on polyvinyl siloxane impression material. J Prosthet Dent
1996;75:360-363
Kahn RL, Donovan TE, Chee WW: Interaction of gloves and
rubber dam with a poly (vinyl siloxane) impression material: a
screening test. Int J Prosthodont 1989;2:342-346
Browning GC, Bromme JC Jr, Murchison DF: Removal of latex
glove contaminants prior to taking polyvinyl siloxane
impressions. Quintessence Int 1994;25:787-790
Löe H, Silness J: Tissue reactions to string packs used in fixed
restorations. J Prosthet Dent 1963;13:318-323
Polat NT, Ozdemir AK, Turgut M: Effects of gingival retraction
materials on gingival blood flow. Int J Prosthodont
2007;20:57-62
Prasad KD, Hegde C, Agrawal G, et al: Gingival displacement in
prosthodontics: a critical review of existing methods. J
Interdiscip Dentistry 2011;1:80-86
Csempesz F, Vag J, Fazekas A: In vitro kinetic study of
absorbency of retraction cords. J Prosthet Dent 2003;89:45-49
McOmie JFW, West DE: 3,3 -Dihydroxybiphenyl. In
Baumgarten HE (ed): Organic Syntheses Collective (Vol 5). New
York, Wiley, 1973, pp. 412-414
Mondon M, Ziegler C: Changes in water contact angles during
the first phase of setting of dental impression materials. Int J
Prosthodont 2003;16:49-53
5
Gingival Retraction Paste, H2 O2 and Polymerization
28. Richter B, Klettke TH, Kuppermann B, et al: Flow properties of
light bodied impression materials during working time. CED/
NOF/IADR, Istanbul, 2004; Abstract 142
29. El Deeb ME, Waly GH, Habib NA: Evaluation of rheological
properties of two elastomeric impression materials during
working time. J Am Sci 2011;7:94-100
30. Laufer BZ, Baharav H, Cardash HS: The linear accuracy of
impressions and stone dies as affected by the thickness of the
6 Journal of Prosthodontics 00 (2017) 1–6 
Abduljabbar et al
impression margin. Int J Prosthodont 1994;7:247-
252
31. Wadhwani C, Pineyro A, Hess T, et al: Effect of implant
abutment modification on the extrusion of excess cement at the
crown-abutment margin for cement-retained implant restorations.
Int J Oral Maxillofac Implants 2011;26:1241-
1246
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