My Fourth Seminar - Anshu

8/10/2019 My Fourth Seminar - Anshu

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GINGIVAL TISSUE MANAGEMENT

CONTENTS:

Introduction

Periodontal aspects of restorative dentistry

Normal periodontium

Need for gingival tissue management

Gingival retraction

-Definition

-Requirements

Techniques of gingival retraction

-classifications

Methods of gingival retraction-

I. NON SURGICAL

1. Mechanical

2. Chemomechanical

II. SURGICAL

1. Rotary curettage

2. Electrosurgery

Armamentarium for gingival displacement

Techniques for gingival displacement

Recent Advances in Gingival retraction

References

Conclusion

Submitted by:

Dr. Anshuman Khaitan

Post graduate student

Department of conservative dentistry and endodontics

College of Dental Sciences, Davanagere



Gingival Tissue Management

INTRODUCTION:

High quality restorative dental procedures & gingival tissue management go hand in

hand. An objective of restorative dental procedures is the placement of dental

materials to restore teeth to proper form and function. The form and function must be

in harmony with the periodontium for a restoration to become an integral component

of total oral complex. The purpose of this seminar is to blend the microgingival

retraction methods with the principles of restorative dentistry to establish a sound

biologic approach.

PERIODONTAL ASPECTS OF RESTORATIVE DENTISTRY

-Microbial plaque is undoubtedly the primary etiological agent in periodontal disease.

Never the less, other factors do contribute to gingival inflammation and subsequent

loss of periodontal attachment.

-The production of plaque is not as important as the retention of plaque on and around

the tooth surfaces. This retention increases manifolds in case of calculus deposits,

poor margins of the restorations and perhaps the mere presence of dental restorations.

- The outer surface of a restoration is of significance from periodontal aspects.

- Therefore it is mandatory to have thorough knowledge of anatomy and morphology

of the tooth to be restored and also the techniques leading to the restoration of proper

cavosurface margins.

- The operative dentist should always take care of the health of the periodontium

during all restorative procedures.

Normal Periodontium

Before elaborating the restorative implications on gingival tissue & other

periodontal tissues let us have a brief knowledge of the normal

periodontium.

Dentogingival Unit




The dentogingival unit and its epithelial and connective tissue covering can be studied

as follows.

Gingiva

It is composed of free gingiva & attached gingiva

Attached gingiva is bound to the cementum and the underlying bone by means

of supra alveolar connective tissue and lamina propria.

If restorative procedure are to invade the gingival crevice, approximately 5

mm depth of gingiva is involved out of which 2mm is free gingival and 3mm

is attached gingiva.

A second dimension of gingival tissue to be evaluated is its thickness.

Along with the vertical dimension, the thickness of the gingiva to tolerate

intra-crevicular restorative procedures must also be taken into account.

Gingival sulcus

Crevice is lined with crevicular epithelium

It extends from the free gingival margin to the junctional epithelium

Two parameters are important

- Depth 2.00 mm &

- Circumference

Depth:

Excessive crevicular depth pathognomonic of periodontal disease &

restorative procedure should be avoided in such cases

A minimum of 1.5-2 mm of depth is essential for preparing intracrevicular

margins in a tooth

In case the depth is less & clinician tries to place the margins of restoration

apical to crevicular depth, there are chances of permanent damage to the

junctional epithelium and the underlying connective tissue.

Circumference:

In healthy gingival there is hardly any space separating the epithelial lining of

crevice from the tooth surface.




Care must be taken to avoid distension of crevicular epithelial lining.

Quantitative Violation: excessive material is being placed within the crevice

Qualitative Violation: poor adaptation/ roughness of the margins that leads to

both mechanical irritation and harbours microbial flora.

Biologic width:

Definition:

It is defined as “Combined dimension of the supra alveolar gingival

connective tissue and the junctional epithelium”.

Average measurement for the epithelial attachment and C/T attachment have

been found to be 0.97mm and 1.07mm is required.

A restoration that impinges upon biologic width will result in progressive

periodontal disease.

According to Carranza:

Biologic width is defined as the physiologic dimension of the junctional

epithelium & c/t attachment.

- Relatively constant at 2mm

It has been theorized that infringement on the biologic width by the

placement of a restoration within its zone may result in gingival

inflammation and subsequently packet formation and bone loss.

Encroachment into this space is prevalent amongst restorative dentists as

they attempt to place a margin subgingival rather than intracrevicular.

Placement of the restorative margin upto 0.5mm into the sulcus helps in the

maintenance of the biologic width.

Need for soft tissue management

• Restore and maintain health, functional comfort and aesthetic appearance.

• Placement of proper cervical finish lines.

•

Helps in making accurate impressions.




• Helps in blending of the restoration with the unprepared tooth surface.

• To enhance access and to prevent damage to the soft tissue during cavity

preparation.

• While cementation it helps in easy removal of cement without tissue damage.

DEFINITION OF GTM:

“The procedure of temporary eversion or resection of gingiva away from the tooth

surface or deepening of gingival sulcus to expose the cervical portion of tooth in order

to have proper marginal finish of the restoration or by establishing a good cervical

cavosurface margin to the tooth preparation”

Gingival retraction:

Acc to GPT 8: “The deflection of the marginal gingiva away from a tooth.”

Gingival retraction is the process of exposing the margins of the prepared teeth.

Requirements:

• The gingival tissues must be healthy and free of inflammation.

• Cervical margins should be placed in the appropriate position.

– The optimum position of the margins is 0.5 mm from the healthy free

gingival margins or 3-4 mm from the crest of the alveolar bone.

– Quality provisional restoration

CLASSIFICATION:

a.) Barkmier W.W. and Williams H.W (1978)

1. Non-Surgical Methods

Rubber dam and clamps

Retraction cords

impregnated and




non-impregnated

Retraction rings

Copper bands

2. Surgical Methods

i.

Gingivectomy and Gingivoplasty

ii. Periodontal flap procedures

iii. Electrosurgery

iv.

Rotary Gingival Curettage

b.) Thompson M.J.(1959)

1. Conventional

2. Radical

c.) B.W.Benson et al (1986)

1. Mechanical method

2. Mechanico-chemical method

3. Rotary gingival curettage

4. Electrosurgical methods.

MECHANICAL METHODS

• Among the first to be developed

• Involve the physical displacement of the gingival tissue by placement of

materials within the gingival sulcus

• The various materials used :

A. Heavy weight Rubber dams.

B.

Copper bands.

C. Aluminum shell.




D. Retraction rings

E. Mechanical Pack of Zinc oxide eugenol.

F.

Rolled cotton or synthetic cord.

A. Heavy Weight Rubber Dam

• The retraction is produced when the heavy weight rubber dam compresses the

tissue.

• According to Gilmore , it can be called “Gum compression” rather than gum

retraction.

Indications

• Limited number of teeth in one quadrant are being restored and in

situations in which preparation do not have to be extended very far sub-

gingivally.

Contraindications

• Should not be used with polyvinyl siloxane impression material

Advantages

• Control of seepage and hemorrhage.

• Ease of application

Disadvantages

•

Full arch models cannot be made.

• Cannot be used in Severe cervical extension preparations.

B. Copper Band

•

It serves as a means of carrying the impression material as well as a

mechanism for displacing the gingiva.




• One end of the tube is festooned, or trimmed to follow the profile of the

gingival finish line, which in turn often follows the contours of the gingival

margin.

•

Impression compound and elastomeric materials are used. Band is seated

securely into its position & pressure is applied on the compound directly.

Chilling of the impression can be done with cold water.

• Copper bands are especially useful for situations in which several teeth have

been prepared.

• The use of copper bands can cause incisional injuries of gingival tissues but

recession followed by their use is minimal, ranging from 0.1mm in healthy

adolescent to 0.3mm in general clinical population.

C. Aluminum Shell

• Aluminum shell of correct size is selected, trimmed to conform to the gingival

contours and the margins are smoothened.

• It is filled with compound or gutta percha and placed on the tooth under the

occlusal pressure.

•

The excess material from gingival end will displace the free gingiva.

D. Retraction Ring (Epipak Rings)

Dilatation of the sulcus via a retraction ring; the marginal gingiva is displaced

laterally and apically by a largely non-traumatic insertion of the ring using a

suitable retraction thread plugger, thus creating a barrier between the

preparation instrument and the periodontium which prevents an invasion into

the zone of the biological width as far as possible.

E. Rolled Cotton Or Synthetic Cord

• This is the method of choice as the availability is not a problem and the

application is exceedingly easy.

•

Plain cotton thread, Unwaxed Floss, Cotton synthetic cord, untreated surgicalsilk, and elastic retraction rings.




• Wet or dry.

• Thinner grade cord is used around the anterior teeth and thicker one around

the posterior teeth.

• Three varieties of cords are generally available.

•

Loose twisted

• Braided

• Knitted

• Braided and knitted variety does not separate when they are pushed into the

sulcus and so they are easier to use.

• Newer cords have fine copper wire within them to keep their shape & stay put

in the crevice.

Classification of retraction cords

A. Depending on the configuration

1.

Twisted2. Knitted

3.

Plain

B. Depending on surface finish

1. Waxed

2. Unwaxed

C. Depending on the chemical treatment

Plain

Impregnated

D. Depending on number strands

Single

Double-string




E. Depending on the thickness (color coded)

black 000

yellow 00

purple 0

blue 1

green 2

red 3

CHEMICO-MECHANICAL METHODS

This method aims at combining chemical action with pressure packing, enlargement

of the gingival sulcus as well as control of fluids seeping from the walls of the

gingival sulcus.

Chemicals used are broadly classified as:

–

Vaso-constrictors.

– Drugs with styptic action.

– Astringents.

Vaso Constrictors:

•

Physiologically restrict the blood supply by decreasing the size of the blood

capillaries.

•

The agents usually used are 1:1000 epinephrine and higher concentrations of

epinephrine.

It is contraindicated in some of the conditions such as:

Patients who are hypersensitive to epinephrine.

Patients with cardiovascular disorders.

Patients with pacemakers.

Hyperthyroidism.




Patients on drugs such as;

o Rauwolfia compound.

o Ganglionic blockers.

o

Epinephrine potentiating drugs.

Styptics:

They are biologic fluid coagulants that locally coagulate blood and tissue fluids

creating a surface layer which is an efficient sealant against blood and crevicular fluid

seepage.

Eg:

100% Alum solution (Potassium Aluminum sulfate).

5% - 25% aluminium chloride solution

13.3% ferric sulfate solution

8% - 40% zinc chloride solution

20% - 100% tannic acid solution

45% Negatol solution (45% condensation product of meta cresol

sulfonic acid and formaldehyde)

Caustic acids – sulfonic acid, trichloracetic acid.

Nasal and ophthalmic decongestants-

Oxymetazoline hydrochloride 0.05%

Tetrahydrozoline hydrochloride 0.05%

Phenylphrine hydrochloride 0.25%

Combinations of chemicals

Cocaine 10% with 0.1% epinephrine

Zinc chloride with 8% epinephrine




ARMAMENTARIUM

– Evacuator

–

Scissors

– Cotton pliers

– Mouth mirror

– Explorer

–

Fischer ultrapak packer (small)

–

DE plastic filling instrument IPPA

– Cotton rolls

– Retraction cord

– Hemodent liquid

–

Dappen dish

–

Cotton pellets

– 2 x 2 gauze sponges

TECHNIQUES

• Single cord technique.

• Double cord technique.

•

Infusion technique.

• The “every other tooth” technique.

1. Single cord technique

•

The operating area must be dry.

• A length of gingival retraction cord is selected to specifically match the

anatomy of each individual gingival sulcus.




• Retraction cord should be moistened by dipping it in buffered 25%

Aluminum Chloride solution in a dappen dish.

• Form the cord into a „U‟ and loop it around the prepared tooth.

• Hold the cord between the thumb and forefinger and apply slight tension

in an apical direction.

• Gently slip the cord between the tooth and gingiva in the mesial inter-

proximal area with a cord packing instrument.

• Once the cord has been tucked in on the mesial, use the instrument to

lightly secure it in the distal inter-proximal area.

• Proceed to the lingual surface and begin working from the mesio-lingual

corner around to the disto-lingual corner.

• The tip of the instrument should be inclined slightly towards the area

where the cord has already been placed; i.e. the mesial.

•

If the tip of the instrument is away then the cord may be displaced and

pulled out.

• Gently press apically on the cord with the instrument directing the tip

slightly towards the tooth.

• Continue packing the cord around the facial surface, overlapping the cord

in the mesial inter-proximal area.

• Pack all but the last 2 mm or 3 mm of cord should be left.

•

This tag can be grasped for easy removal.

• After the cord is in place, the tooth preparation is carefully inspected to

ascertain that the entire cervical margin can clearly be visualized and that

there is no soft tissue impediment to easy injection of the impression

material to capture all of the cervical margin detail.

• Wait 8 to 10 minutes before removing the cord and making the impression.




• The cord needs time to effect adequate lateral displacement, and the

medicament needs time to create hemostasis and crevicular fluid control.

2. Double Cord Technique

• The double cord technique is routinely used when making impressions of

multiple prepared teeth and when making impressions when tissue health

is compromised.

• Some clinicians use this technique routinely for all impressions.

• A small-diameter cord is placed in the sulcus.

•

The ends of this cord should be cut so that they exactly abut against

one another in the sulcus.

• A second cord, soaked in the hemostatic agent of choice, is placed in the

sulcus above the small-diameter cord.

• The diameter of the second cord should be the largest diameter that can

readily be placed in the sulcus.

•

After waiting 8 to 10 minutes after placement of the large cord, the second

cord is soaked in water and removed.

• The preparation(s) are dried, and the impression is made with the primary

cord in place.

•

After successfully making the impression, the small cord is soaked in

water and removed from the sulcus.

3. Infusion Technique

• Dan E Fisher in 1981 introduced a new concept for hemostasis known as

the infusion technique.

• The infusion technique for gingival displacement uses a significantly

different approach from the single or double cord techniques.




• After careful preparation of the cervical margins in an intra-crevicular

position, hemorrhage is controlled using a specifically designed Dento-

infusor TM with a ferric sulfate medicament.

•

Two concentrations of ferric sulfate, 15% and 20% are available.

• The infusor is used with a burnishing motion in the sulcus and is carried

circumferentially 3600 around the sulcus.

• The medicament is extruded from the syringe/infusor as the instrument is

manipulated around the gingival sulcus.

•

When hemostasis is verified, a knitted retraction cord is soaked in the

ferric sulfate solution and packed into the sulcus.

•

Technique recommended the cord be in place 1 to 3 minutes.

• The cord is removed, the sulcus is rinsed with water, and the impression is

made.

•

When using ferric sulfate materials patient should be warned that the

tissues may be temporarily darkened. The tissues take on a blue- blackappearance that usually disappears in a few days.

4. The “Every other tooth technique”

When making impressions of anterior tooth preparations it is critical that

no damage is done to the gingival tissues that may result in recession.

In teeth with root proximity, placing retraction cord simultaneously around

all prepared teeth may result in strangulation of the gingival papilla and

eventual loss of the papilla.

This creates unaesthetic black triangles in the gingival embrasures.

This undesirable outcome can be prevented with “every other tooth”

technique. This can be used with single/ double cord technique.

Retraction cord is placed around the most distal prepared tooth. No cord is

placed around the prepared tooth mesial to this tooth.

Retraction procedures are completed on alternate teeth.




For ex: teeth #5 through# 12 are prepared, cords will be placed around

teeth #5,#7, #9, #11

The impression is made; gingival displacement is accomplished on teeth

#6, #8, #10 & # 12 and a second impression is made.

A subsequent pick up impression allows fabrication of a master cast with

dies for all eight prepared teeth.

SURGICAL METHODS

1. Rotary Curettage

•

It was described by Amsterdam

in 1954, and subsequently modified by

Ingraham.

•

Rotary curettage is a “troughing” technique, also called as “gingettage”,

done to produce limited removal of epithelial tissue in the sulcus.

• The technique is used with the subgingival placement of restoration

margins.

Procedure:

•

It is usually done simultaneously along with finish line preparation.

• A torpedo diamond of 150 to 180 grit is used to extend the finish line

apically.

• Bur should be extended into the gingival sulcus to remove a portion

of the sulcular epithelium.

•

Cord impregnated with Aluminum Chloride or Alum is gently placed to

control hemorrhage.

• The cord is removed after 4 to 8 minutes, and the sulcus is thoroughly

irrigated with water.

• This technique is well suited for use with reversible hydrocolloid.

Disadvantages:




• There is poor tactile sensation when using diamond points on the sulcular

walls, which can produce deepening of the sulcus.

• The technique also has the potential for destruction of the periodontium if

used incorrectly, making this method harmful, that is probably best used

by experienced dentists.

2. Electrosurgery

-There are situations in which it may not be feasible or desirable to manage the

gingival tissues with retraction cord.

- When areas of inflammation and granulation tissues are present caused either

due to caries or overhanging restorations, it may be necessary to place the

finish line of the preparation near the epithelial attachment and it is impossible

to retract the gingival tissues sufficiently to get an adequate impression.

- In these cases it may be necessary to use some other means like

elctrosurgery.

-The use of electrosurgery has been recommended for enlargement of the

gingival sulcus & control of haemorrhage to facilitate impression making.

-It has also been recommended for removal of irritated tissue that has

proliferated over the preparation finish lines & it is commonly used for that

purpose.

History:

D‟ Arsonval, explained in 1891 that electricity at high frequency will pass

through a body without producing a shock, instead produced an increase in

temperature of the tissue. This discovery was used as the basis for the eventual

development of ELECTROSURGERY.

Mechanism of action:

Principle:

“Intentional passage of high frequency waveforms or the currents through thetissues of the body to achieve a controllable effect.”




• When these waveforms pass through it, intense intracellular heat is

produced within the tissues contacted by active electrode tip.

• This heat volatizes the cells and as the electrode is guided through the

tissue, it leaves a path of cell destruction in the path of the incision.

• By varying the mode of this current, the clinician can use electro-surgical

unit for cutting or coagulation of soft tissues.

• The use of electro-surgery has been recommended for enlargement of the

gingival sulcus and control of hemorrhage to facilitate impression making.

Electro-surgery Unit:

• It is a high frequency oscillator or a radio-transmitter that uses either a

vacuum tube or a transistor to deliver high – frequency electrical current at

atleast 1.0 MHZ.

• It generates heat in a way that is similar to a microwave oven or a

diathermy machine producing heat in muscle tissue for physical therapy.

•

Electro-surgery has been also called as surgical diathermy.

• Electro-surgery produces a controlled tissue destruction to achieve a

surgical result.

• Current flows from a small cutting electrode that produces a high current

density and a rapid temperature rise at the point of contact with tissue.

• Five commonly used electro-surgical electrodes.

•

Coagulating electrode

• Diamond loop

• Round loop

• Small straight electrode

• Small loop

•

Electro-surgical currents are used for…….




• Electro-section or incision

• Coagulation

•

Fulguration

• Desiccation

Advantages:

• Excellent vision of margins.

•

Immediate hemostasis.

•

Predictable healing of the tissues.

• Improved accuracy of the impression by providing more bulk of material

at the margins.

• Decreased chair time and stress for the dentist and the patient.

• Ability to remove irregular or excess tissue around the teeth.

• Minimal postoperative discomfort for the patient.

• Decreased cross infection.

Disadvantages:

• Unpleasant odour

• Slight loss of crestal bone

•

Burn mark on root surface

• Not suitable for thin gingiva

Contraindications:

• Patients with cardiac pace makers.

• Should not be used in conjunction with flammable gases and also the use

of topical anesthetics such as ethyl chloride.




• Patients with expected abnormal healing process such as diabetes mellitus,

and blood dyscrasias.

• Irradiated patients.

• Patients with collagen disturbances.

Precautions:

• Tooth and adjacent area are to be properly isolated with only minimal

moisture content.

• Use only fully, rectified, un-damped, filtered current with the minimum

energy output required for the desired purpose.

• Only shallow part of the sulcular epithelium should be involved,

the crest of the free gingiva should not be involved in the cutting line of

the electrode.

• For coagulation, specially shaped bulky electrodes are used with a partially

rectified, partially damped output from the apparatus.

•

The tooth metallic restorations should not be touched. This can create a

short circuit.

• The attached gingiva or periodontal ligament should never be approached.

The separation that may occur will be permanent.

•

The debris from the electrodes should be cleaned using alcohol soaked

gauze.

Procedure:

• The working electrode must be clean.

• Cutting electrode must be applied with very light pressure and should be

guided, not pushed through the tissue.

• To prevent lateral penetration of heat into tissue with subsequent injury,

the electrode should be kept moving and strokes should not be repeatedimmediately.




• At least 5 seconds of gap should be given before repeating the stroke.

• For a proper technique, the following are important:

1. Proper power setting

2. Quick movement of the electrode

3. Adequate time interval between strokes

• The electrode should be parallel to the long axis of the tooth so that the

tissue is removed from the inner wall of the sulcus.

• The whole tooth should be encompassed in four separate portions: facial,

mesial, lingual and distal.

• A cotton pellet dipped in hydrogen peroxide is used to clean debris from

the sulcus.

• The tissue healing is rapid, the „subgingival trough‟ heals in 5 – 7 days.

Other applications of Electrosurgery:

•

Removal of edentulous cuff of tissue.

•

Crown lengthening.

• Exposure of sound tooth structure.

• Excessive tissue removal.

• Hypertrophied/ malpositioned papilla correction.

RECENT ADVANCES

• Gingifoam.

• ExpasylTM

.

• Affinis/Magic foam cord.

• Merocel.

• Gel-cord.




• Stay-put retraction cord.

• Gingipak.

• Lasers.

Gingifoam

•

Principle: Dilation of the gingival sulcus by expansion.

• Gingifoam is a silicone elastomer that vulcanizes at room temperature; it is

composed of two components.

–

poly-dimethyl siloxane base.

– Catalyst based on Tin.

Gingifoam has the characteristic of increasing its volume by four times after

its polymerization.

It is totally free of irritant qualities and the ability to absorb liquids render the

material particularly useful for insertion into the gingival margins

ExpasylTm

• Is an innovative system for access to the gingival margin.

• It contains a paste that opens the sulcus by physically displacing the tissues

and leaving the field dry, ready for impression making or cementation.

• The paste has to be placed in sulcus for 2 minutes and rinsed.

Compend Contin Educ Dent. 2002 Jan;23(1 Suppl):13-7;18-9.

Affinis/Magic FoamCord

• Unique expanding silicone „foam‟ for sulcus enlargement without cord or

instrumentation.

• Simple, non invasive, technique gives excellent patient acceptability.

•

Sulcus enlarged quickly to give a perfect “margin” and impression.




• Easy application with conventional dispenser.

Merocel

A tissue retraction or displacement sponge comprising a rigid dry absorbentshaped sponge. The sponge when hydrated substantially expands thus

displacing the tissue.

The main advantage of Merocel retraction material is that it is capable of

innocuously expanding the gingival sulcus.

Merocel was evaluated in a clinical trial with 10 selected abutments, each

selected abutment required an anterior single unit crown.

This preliminary study suggested that a Merocel strip was a predictable

retraction material in conjunction with impression procedures.

Gel-cord Technique

• Unique 25% Aluminum Sulfate Gel.

•

Aluminum Sulfate has proven to be a successful hemostatic agent with

reduced tissue trauma and no adverse reactions to impression materials.

Advantages:

•

Stays where you place it - will not run or dilute like liquid astringents.

• Reduces tissue trauma. No tissue necrosis or blackening of tissue.

• No adverse reaction to impression materials.

• Blue in color for easy visibility and placement.

•

Makes initial cord packing easier by providing lubrication when packing

cord, allowing the cord to glide into the sulcus

Procedure:

•

Pre-filled Disposable Syringe

• Application of the gel




• Placement of the retraction cord

• Completed impression

Stay put retraction cord:

•

It is a revolutionary cord.

• Stay – put is a unique combination of softly braided retraction cord and

ultra fine copper filaments.

•

When the stay – put cord is shaped, it remains in shape and does not

deform.

Advantages

•

Can be easily adapted.

• Can be preformed.

• Does not lift in the sulcus.

• No overlapping required.

Gingi – Pak Tm

retraction materials:

Includes:

•

Kutter Kap®,

• Original Retraction Cords.

•

Soft-Twist cords, &

• Z-Twist weave.

Kutter Kap®

•

Gingi-Pak's patented packaging design includes the Kutter Kap on every bottle

of retraction cord.

•

The Kutter Kap cuts the cord without the need for scissors and automatically

holds and stores the cord to prevent cross-contamination.




• It is a time-saving, ergonomic feature.

Original Cords - Adjustable and Easy to Pack

•

Gingi-Pak Original 2-Ply and Crown-Pak ® 4-Ply retraction cords were the first

impregnated dry pack cords produced for the dental profession.

•

The 2-ply and 4-ply cords are loosely wound and the strands are easily

separated, twisted or combined to make it readily adaptable for use in the

gingival sulcus, regardless of the sulcus size and is suitable for all techniques,

including the 2-cord technique.

Soft-Twist Cords - 3 Easy-to-Pack-Sizes

• Gingi-Pak Soft-Twist cord is firmly twisted for easy packing, yet absorbent

and adaptable to the sulcus.

• Made of 100% cotton, the cord stays positioned and will not pop out of the

sulcus.

•

Soft-Twist cords, offered in 3 sizes, are suitable for all techniques including

the 2-cord technique.

Z-Twist Weave - Easy to Pack and See

• Z – twist weave is a 4th Generation, state of the art retraction material.

• Its unique braided configuration helps in excellent handling of the 100%

cotton cord.

• The tight weave resists the penetration even by the smallest packing

instrument.

Just arrived !!!

Lasers

• Soft tissue reduction with lasers in the field of dentistry has been subjected to

intense scrutinization in recent years.

•

Types of soft tissue Lasers used in dentistry are




– Co2

– Nd – YAG (Neodymium-Yittrium-Aluminium-Garnet).

–

Argon

• Lasers work through Photo-ablation and Produce Completely blood – free

incisions followed by rapid, Pain – free healing with no underlying

inflammation.

• The laser technique is a little slower than using a scalpel but produces a very

controlled tissue removal free of hemorrhage and pain. Healing is rapid and

uneventful.

CONCLUSION:

Gingival displacement is an important procedure for fabricating indirect

restorations. Several techniques have proven to be relatively predictable, safe, and

efficacious. No scientific evidence has established the superiority of one technique

over the other, so the choice of technique depends on the presenting clinical

situation & operator preference.

REFERENCES

1. Principles & practice of operative dentistry- 3 rd ed: Gerald A Charbeneau

2. Periodontal therapy-Vol -1: clinical approaches &evidence of success: Myron

Nevis, James T Melloning

3. Text Book of Operative Dentistry- 2nd Ed- Vimal K.Sikri

4. Fundamentals of Fixed prosthodontics- 3rd Ed: Herbert T.Shillinburg, Sumiya

Hobo.

5. Current concepts of gingival displacement, DCNA vol-48 (2):433-444

6. www.google.com

7. www.pubmed.com

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My Fourth Seminar - Anshu