Recommended Reading

Prosthodontics Theoretical
Soft Tissue Management Contemporary fixed
prosthodontics Rosenstiel et al
Ch 14 - Tissue Management and
Berkman ALBAYRAK
Assistant Professor Impression Making

Bahçeşehir University
School of Dental Medicine
Department of Prosthodontics
berkman.albayrak@dent.bau.edu.tr
Fundamentals of fixed prosthodontics.
Herbert T. Shillingburg
Ch 16 - Fluid Control and Soft
Tissue Management

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

DEFINITION NEED AND IMPORTANCE OF DISPLACEMENT

↳
O ⑦
• Gingival Retraction is the deflection of • Adequate access to the prepared tooth.
the marginal gingiva away from a G • Reproduction of the finish line.

Glo'
tooth (GPT8) ⑦ • For accurate duplicating the subgingival
• Also called as gingival displacement -
margins.
or tissue dilation ⑲ • Providing the best possible condition for
• Gingival retraction is a process of the impression material, fluid control.
exposing margins when making
④• Precision of the restoration for
impression of prepared teeth. prevention of periodontal disease.

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
AIMS AND OBJECTIVES OF DISPLACEMENT TYPES OF GINGIVAL DISPLACEMENT

• Reflect gingiva and produce enlargement or ①

dilate gingival sulcus
• To expose the prepared finish line
⑦ Retraction
sc7.B
• To control the gingival crevicular fluid (GCF)
Relapsing
• Provides access for the impression materials ④
to record accurately the finish margins Displacement
⑤
• Helps to obtain accurate marginal fit which
Collapsing
will reduce marginal leakage and
subsequent deterioration of tooth

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

CLASIFICATION OF DISPLACEMENT MECHANICAL GINGIVAL DISPLACEMENT

dum

/Inkuener Files One of the first and earliest methods used for physically
L

M strings.
A

CH EC
-
IC

EM H A 1. Mechanical, displacing the gingiva.

N
A

IC NO
H
EC

AL -
2. Mechanico-chemical 1. Rubber dam ↓
M

3. Chemical 2. Impression material filled copper band/metal band/ rings

CH

L
A
IC
EM

4. Surgical. 3. Strings or fibers

G
IC

R
SU
A

4. Magic foam
L

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
 limited num ofToothaudiantbeing prepared.
in
rubber daw ->
[* extrachearyRubber duns were used.
->
heaving
-> Refraction by (Rubbedam-clamps C

-> produceretraction -

by
compression.

RUBBER DAM RUBBER DAM

Advantages ① ⑦
• It is used when limited number of teeth in one 7 • Control of seepage and hemorrhage.
quadrant are being restored and when ⑦• Ease of application. - 9
③• Asset during tooth preparation as it exposes the finish line. - G
perforations do not have to extend subgingivally
④• Excellent impressions are obtained due to fluid control
• Heavy and extra heavy rubber dams were used Disadvantages

• Retraction is done by rubber dam and clamps

-
(No. 212 cervical retainer)
• Produced retraction by compression
Soft Tissue Management
o •
•
Full arch models cannot be made.
Severe cervical extension preparations. ①
• Cannot be used with polyvinyl-siloxane impression materials ③
• Useful only when limited number of teeth in one quadrant are being restored. ④
• Used in simple preparations with minimal sub-gingival preparations. ⑤
DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

cause injury

copper band. Formultiple have not recoved 17 Te om lineanimal

-
COPPER BAND inxxxil COPPER BAND Joh ①
be use
theseen
Effective
can

①
sine when
waswin
Disadvantage:
• Means of carrying the impression • Can cause injury to the gingiva and and retraction
⑦ material
-

and a mechanism for is also minimal

- -
r
gingival retraction. Advantages:
• Effective for single crown ④
• Indication: with(multiple abutments ↓ ·• Can be used in situations where margins are
and when full arch impressions of subgingival

C multiple abutmentsL have not

[ Various Impression Materials Used: 7
-
• -
Impression compound, elastomeric material,
recorded one/ two teeth properly
• Gutta-percha or auto polymerizing resin.

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
COPPER BAND STRINGS OR FIBERS
① • Retraction achieved is purely physical
⑦ • No hemostasis

BO o ③• Very less retraction and transient

Examples
• Plain cotton thread -
• Un-waxed floss
-
-
⑧ •
•
Cotton cord
2/0 untreated Surgical Silk
-
• Elastic retraction rings

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

⑧cotton
Hollow

⑩umMAGIC FOAM
⑨⑧ joins
- music
MAGIC FOAM 7 sins.
↑

• Consists of a ‘comprecap’- a hollow cotton

*
and ‘Magic
material
*
Foamcord’- a polyvinyl siloxane
⑧ ⑭
Limitations
⑭
⑲dry
·O
• Limited clinical indications ①
• Less hemostatic ⑦ ③
• No improvement in speed/quality compared
to cord
①• Less effective on subgingival margin G

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
 MAGIC FOAM MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT

•*
Gingival retraction cord is a tapered diameter cord that
-

->
can be wrapped several times about a tooth that
>
. .
-

causes flared gingival crevice

-

- • Most popular method 2

3

⑦ • Physically pushing away the gingiva from the finish line

- -

• Are arbitrarily numbered by their manufacturers

according to their diameter
-> • Plain cords contain-no retraction chemical
• Does not control sulcular fluid seepage ↳
↑
Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

involve he's re
mailofsting into six

~
MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT
io The 'Treatures' ofstring with one

compond.
MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT

⑨
or more chemical
①
The mechanical aspect involves placement of a string into the ⑧ Classification
gingival sulcus to displace the tissues.
1. Surface texture: wet/dry
2. Design: twisted, braided or knitted
①
•The chemical aspect involves treatment of the string with one
⑦
3. Surface finish: waxed/ unwaxed ③
or more number of chemical compounds that will induce
4. Thickness (colour-
coded)
i) Temporary shrinkage of the tissues &
5. Chemical treatment- plain/ impregnated. ⑤
ii) Control the hemorrhage & fluid seepage
Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
Retraction cord' Thickness: small medium ⑨
large

beused withcousin
paskia(ee.(h.
·

issueon
one
used
/
with action Teeshi indicate where
I should

Tissues Twin
creater bulk is
are ·

encountoned

MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT

RETRACTION CORD THICKNESS RETRACTION CORD DESIGNS

->
The cord that can be atraumatically placed • Twisted, ①
into the(sulcus3 should be used. • Knitted ⑦
③
- >

Twisted cord
⑦
Knitted cord
↳ - SMALL - to be used in anterior teeth, • Braided
where thin firmly tissue is present - does not separate when inserted into the
sulcus and much easy to use.
z - MEDIUM - indicated where greater ⑦ - larger sizes should be⑧
avoided as they tend
bulk is encountered e.g. posterior teeth to double up and leads to traumatic -
Braided cord
- LARGE - should be used with caution
-

3 placement
-

as can produce soft tissue trauma

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT

①
KNITTED RETRACTION CORD
TWISTED RETRACTION CORD
↓ ④ - Interlocking loops ⑦
- Allow the dentist to customize
⑳ -
-1
the cord as individual strands
-
⑨-
Longitudinally elastic
- >

Transversely resilient 0
- can be removed
- Transport greater amount of
Twisted cord - Knitted cord
-
&chemical agent
-

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
 ④
points.
MECHANICO-CHEMICAL GINGIVAL DISPLACEMENT TECHNIQUE

BRAIDED RETRACTION CORD Criteria for selecting size of cord

⑥
- Firm 0 ①- The largest cord that can be placed in the sulcus
⑦
- Flexible
③
atraumatically is chosen

⑧
-
Multistrand K ⑤ - Smaller cords cause little trauma but the lateral
- &
Do not separate easily and do displacement is inadequate
not unravel while being ③ - Larger cords can cause trauma and even-
lead to recession
Braided cord
inserted (iatrogenic cause)
-

and
Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

i a l n i n e,
a
splitinalbach
~xicauldno
①

inspess alDop
10
① in
Connective
igomW,

TECHNIQUE TECHNIQUE 127

incki
Instrument
- Fischer’s cord packer
is

IO
- Gingival retraction cord should be placed with a small thin bladed
instrument, using a gentle packing force to minimize soft tissue
&a trauma ↓
⑤
- Both smooth and serrated edges are available
o
o
↑
-
Thin bladed
in and
. -
. . .

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management m DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
Techniques we have Two singLord Tec.

↳ Double cord Tec,

TECHNIQUE TECHNIQUE

·you 19

- Single cord technique. - Double cord technique (DEKNATEL technique)

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

CHEMICAL GINGIVAL DISPLACEMENT CHEMICAL GINGIVAL DISPLACEMENT

before
↳ Injected into sulcus --
prior to impression
• Recent development ① making 9insulus.
3-

↑
• Retraction achieved using only • Left in sulcus for 3-4 min
• washed off > impression is made
o
chemicals
• Advantage- good hemostasis, less

>20
-

• Aluminium chloride containing paste trauma

(expasyl) • Disadvantage: retraction is less
compared to cord

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
CHEMICAL GINGIVAL DISPLACEMENT CHEMICAL GINGIVAL DISPLACEMENT

-
⑥ -> X

•
The cords are used to keep the chemicals in contact with the ②
⑧
tissue and confine them to the application site.
limit
->
=
&
↓
⑫ • By combining chemical action with pressure packing, -

--)enlargement of the gingival

- sulcusLas well as fluid control is 3
more readily accomplished.
M
Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

CHEMICAL GINGIVAL DISPLACEMENT CHEMICAL GINGIVAL DISPLACEMENT

↓
CHEMICAL BRAND &
· chemicals
0.1-0.8% Racemicepinephrine RACORD, GINGI-PAK, SIL-TRAX,SULPAK

100% Alum sol. POT. ALUM. SULFATE RASTRINGENT II,FLEXI-BRAID,GINGI YARN

5%-25% Aluminum chloride sol. HEMODENT,GINGI-AID, GINGI-GEL

Ferric Sub-sulfate MONSEL’S SOL. -

13.3% Ferric sulfate sol. ASTRINGEDENT, VISCOSTAT

8%-40% Zinc chloride sol. -

⑪asmineoulfula,
20%-100% Tannic acid -

45% Negatol sol. NEGATAN chlorid.

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
⑭
Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK
SURGICAL GINGIVAL DISPLACEMENT SURGICAL GINGIVAL DISPLACEMENT

• Electrosurgery ↳G
/
.
.
• Rotary curettage (gingittage)
• Electrosurgery

,s
• Soft tissue lasers

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK

SURGICAL GINGIVAL DISPLACEMENT

• Dental Laser

Soft Tissue Management DENT2001 Prosthodontics © Assist. Prof. Berkman ALBAYRAK