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Recent Case Study Rethinks Retraction

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Technological advancements in dentistry aren’t all about imaging and CAD/CAM. Much progress is being made in bonding systems and restorative materials, providing more choice and flexibility to dentists in everyday procedures. This was the topic of a recent peer-reviewed publication, “Leveraging Advances in Restorative Dentistry.” 

In this CE course from Dental Learning, Scott Coleman, DDS, MAGD, discussed modern materials and techniques at length. One case, in particular, seemed both challenging and timely, given the rise of an aging population here in the U.S. and abroad.1 The materials Dr. Coleman used helped him to treat an elderly patient with confidence and achieve an esthetic outcome. 

In this case, the elderly patient, suffering from an initial onset of dementia, presented with broken maxillary left cuspid #11. The tooth has an existing composite restoration with recurrent decay, and because of the extensive damage, Dr. Coleman recommended a full-coverage ceramic crown. However, the patient’s caregiver wanted a less expensive and quicker solution, at which point, a bonded anterior composite was recommended. Dr. Coleman used a CO2 laser to remove the decay and existing composite and followed it with gingival recontouring, without anesthesia and within a 5-minute timeframe. 

At this point, a low-viscosity, hemostatic retraction paste was used for isolation to help secure optimal bonding, and a universal bond was used for the restoration utilizing dentin shade A-3.5 with enamel shade A-3 as the final layer. Dr. Coleman used carbide finishing burs and a disk and cup to bring the restoration to a final luster. He concluded, “It shined like the grill on a low rider, and the patient was thrilled.” 

In this case, it was evident that the high-tech device, the CO2 laser, was not the only advanced technology at work. Although it was unspecified, a closer examination of the retraction technique revealed that the product was Take 1 Retraction Paste from KaVo Kerr

As described by the manufacturer, Take 1 Retraction Paste is available in thinner and thicker viscosities and is designed to deliver quick and easy tissue replacement to replace or enhance a cord technique. For Dr. Coleman, “quick” was an important factor in treating this patient, and he reached for the thinner viscosity, which was sufficient for retraction and hemostasis.

In his discussion of materials, Dr. Coleman cited a systematic review by Huang et al.2 that supports the notion that gingival retraction paste can more effectively assist in achieving a dry field, while being less injurious to the gingiva. However, the authors went on to state that cord was more effective in displacing gingival tissue. Thus, they recommend both practices depending on the situation and how much gingival displacement is needed.

It’s important to have options, and modern advancements in restorative materials are providing that. The fact that the materials in this case, particularly the retraction paste, worked optimally in a short amount of time is worth noting, given the patient’s condition of early onset dementia and the caretaker’s request for a faster solution. 

When KaVo Kerr says, “It’s Time to Rethink Retraction,” it’s an encouraging sign of future innovation from this manufacturer and others. As technology improves, so will restorative products and techniques. This will be important for challenging clinical scenarios, which may become more prevalent with the aging population. 

1. https://www.prb.org/insight/featured-graphic-many-countries-populations-are-aging/

2. Huang C, Somar M, Li K, Mohadeb JVN. Efficiency of cordless versus cord techniques of gingival retraction: A systematic review. J Prosthodont. 2017;26(3): 177-185.

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