Tissue dilation

Tissue dilation = tissue displacement = tissue retraction

Definition: → it is the temporary pushing of gingival tissues from tooth

surface.
Indication:
1) During examination → for better diagnosis & detection of cervical
caries.
2) During preparation → for accurate preparation of subgingival
finish line without tearing of epithelial attachment & bleeding.
3) During impression → to expose preparation margin & finish line.
4) During try in → to check marginal accuracy.
5) During cementation → to make sure that there is no overhanging.
●Requirements of tissue dilation:
1) It must create proper space horizontally so that:
→ i) The impression material could record the tooth structure at &

beyond the margin.

→ ii) Provide sufficient strength of impression material …….why?

To prevent distortion or tearing the impression when removed or poured

with stone.

2) It must create clean & dry field → i.e free from blood.

3) It must protect & maintain the health of the supporting periodontal

tissues.

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● Methods of tissue dilation:
I] Mechanical method:

►This is done by using:

1)Rubber dam.
2)Un-waxed or waxed dental floss.
3)Copper band & softened gutta percha indicated when gingiva
(temporary crown & softened gutta percha ) hypertrophy involving
More than one surface.
4)Orthodontic elastic band.
5)Untreated strings or cords.
6)Zno pack→ indicated when gingival hypertrophy is confined to the
inter-proximal space.

►Any of the above is pushed in the gingival sulcus for 24 hrs → tissue
displacement.
But if last more than 24 hrs → permanent tissue displacement.

II] Mechano-chemical methods:

●This is done by using cord impregnated in :
1) Epinephrine 1/1000 contra-indicated in cardiac patient →
Otherwise epinephrine syndrome:
2) Epinephrine 8% i) Tachycardia
ii) ↑ blood pressure.
iii) Post operative depression.
iv)Nervosity.
3) Tannic acid (20-100%)  may cause tooth discoration

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 4) Aluminum chloride (5-25%)  may cause gingival inflammation

5) Ferric sulphate (13.3%)  may cause gingival inflammation

6) Alum solution → most safe (100%)

7) Negatol solution (45%)

●Any of the above → cords → mechanical action.

→ chemicals → chemical action (astringent action)
With vasoconstriction of blood vessels.
●advantages: → time saving requires only 5 minutes.
→ preparation & impression can be done in the same
Visit.
Recent retraction techniques:
●Recently retraction gel is available e.g expasyl /gingitic/ magic
foam  placed for 2 minutes then removed by irrigating water

 Advantages:
i)less pressure applied during application
ii)application time is 2 minutes only.
iii)effective tissue retraction
III] surgical method:
●Indicated in case of: generalized hypertrophy

Bleeding

Increasing the length of clinical crown

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●This is done by:
(a) Lancet or Scalpel

(b) Electro-surgery:
• Done by allowing high frequency current pass through a very small
electrode → generating heat therefore tissue in contact to the electrode
will be destroyed → cut away.→ then blood vessels are narrowed by
coagulation.

• Disadvantage: → need experienced hands to avoid destruction of

the periodontium due to over deepening of the sulcus.

• Contraindication:
i) In patient with pace maker.
ii) In patient with delayed healing e.g under radiation therapy.
iii) In thin attached on the labial surface of 3 3

• Steps:
i) Hold the electrode parallel to the long axis of the tooth.
ii) Irrigate with H2o.
iii) Adjust the current intensity because:
If ↑ density current →spark in patient's mouth
If ↓ density current →not cutting tissue properly.
iv) Start with the labial then mesial , lingual & finally the distal.
v) After removal of hyperplastic tissue → make mechano-
chemical displacement.

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 N.B. Oral exam
→ Electro cautary → a hot electrode is applied to the tissues to cut i.e
electrode itself is hot.
→ Electro surgery → use electrode of high current density therefore tissue
adjacent to the electrode will cut due to temperature rising i.e electrode
remains cold.

(c) Rotary curettage: (Gingettage) (Troughing)

• Removal of limited amount of inner epithelial tissue in the sulcus

while creating a chamfer F.L using → a Torpedo nosed diamond.
• Indications: → Sulcus depth < 3 mm.
→ Adequate keratinized gingival tissue.
→ No bleeding on probing.
• Steps:
i) F.L is prepared at the level of the gingival crest.
ii) A torpedo-nosed diamond with water spray → extend the F.L
subgingivally →while the air coming from the high speed hand
piece retract the gingival
IV] Laser gingival displacement:
• Removal of epithelial tissues using carbon dioxide / diode laser.
•Advantages: Faster

More efficient.

Painless.

More sterile. Bloodless

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