Gingival Retraction: Maximizing Efficacy and Efficiency
Selecting the right gingival retraction technique can be a challenge.
Many times, when trying to achieve an ideal impression on the first attempt, dentists will simply utilize whichever method they are most familiar with. Other times, clinicians might implement every technique at their disposal, only determining the best option through trial and error. But is there a better, more methodical way to approach tissue management?
Today, tissue management techniques can be broadly divided into two categories—cord and cordless techniques.
The former utilizes the oldest and most common method of tissue management, the gingival retraction cord. Up to 98% of practitioners opt to use either a single or double cord technique to achieve gingival displacement. Sometimes cords are impregnated with or used concurrently with a chemical agent to provide hemostasis or fluid control for improved efficacy. A significant downside of this method, however, is that it may prove injurious to gingival tissues, and often requires that the tissues be anesthetized with local anesthesia.
The alternative approach—the cordless method—generally refers to the use of a gingival retraction paste. A more modern innovation, gingival retraction pastes are placed in and around the sulcus to promote displacement, hemostasis, and drying. They can be paired with a cotton pellet and direct pressure to enhance retraction.
Gingival retraction pastes often contain an astringent to facilitate fluid management: for example, Traxodent®, an award-winning, clay-based paste by Premier Dental, contains 15% aluminum chloride.
Compared to cord techniques in cases with a slightly subgingival finish line, gingival retraction pastes were gentler on soft tissues without a compromise in clinical performance.1
Research shows that gingival retraction pastes like Traxodent can effectively achieve a dry field without causing harm to soft tissues.2 This suggests that a cordless approach should be prioritized over a cord technique whenever possible. However, because each clinical situation is unique, clinicians must consider the extent of tissue management required to successfully capture an impression. This determination dictates which technique, or combination of techniques, must be used to maximize efficacy.3
After all, maximizing the efficacy of tissue management techniques is essential to attaining an outstanding final impression.
And, by doing so, we can improve efficiency in our crown and bridge procedures. It’s important to remember, however, that efficiency in dentistry involves two things: minimizing the time needed to achieve the desired result and getting the procedure right the first time. Gingival retraction pastes can help with both. Using a gingival retraction paste like Traxodent does not necessitate the tedious and time-consuming process of packing cord. Likewise, it generally only entails two minutes of contact time and does not require local anesthesia.
For the clinician, this means that gingival retraction pastes can be a highly effective means to achieve a great clinical result.
For patients, this equates to time savings, decreased local trauma, and a better overall experience.1
In situations where the need for gingival displacement is greater, such as patients presenting with a deep subgingival finish line, beveled tooth preparation, or a thick gingival biotype, cords may be more effective. Under such circumstances, cords can also be doubled or used in conjunction with a paste like Traxodent to displace gingiva and achieve hemostasis and drying. However, when equi-gingival finish lines or thin and flexible gingiva are present, paste systems alone not only offer adequate hemostasis and retraction but simultaneously better preserve gingival health.2
To learn more and purchase Traxodent and other tissue management products for your practice, visit Premier’s website.
Acar O, et al. A clinical comparison of cordless and conventional displacement systems regarding clinical performance and impression quality. J Prosthet Dent 2014;111(5):388-94.
Kazemi M, Memarian MA, Loran V. Comparing the effectiveness of two gingival retraction procedures on gingival recession and tissue displacement: a clinical study. Res J Biol Sci 2009;4(3):335-9.
Huang C, et al. Efficiency of Cordless Versus Cord Techniques of Gingival Retraction: A Systematic Review. J Prosthodont 2017;26(3):177-185.