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Retraction in the Digital Workflow

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TraxodentOver the years, technological advancements have given way to a multitude of changes in dental practice and patient care. A restorative digital dentistry (RDD) workflow is a result of these changes, an ever-evolving practice model that allows for more accurate and less invasive impression capture, improved restoration design and, ultimately, better procedural outcomes.

RDD can be divided into two workflows: “partially digital” and “totally digital.” The partially digital workflow more closely adheres to traditional workflows in that it uses impression material to capture dentition chairside. Digital processes are incorporated after the physical impression is sent to a laboratory where digital scanning, printing, designing and milling occurs. Totally digital RDD forgoes a physical impression and instead utilizes intraoral scanning technology to obtain a digital impression. Instead of capturing a negative image of dentition with impression materials, intraoral scanners produce a virtual replica of the clinical situation. This approach offers a potentially more accurate depiction of dentition and can solve a number of issues associated with traditional impression-taking techniques, including errors caused by impression materials and trays, and die stone setting.

Despite the fact that intraoral digital imaging has advanced to the point of “‘over-delivering’ by consistently and quickly acquiring quality data,” the technology still has its limitations. Currently, intraoral scanners don’t allow for visibility through gingiva. This means that without soft tissue displacement, it is not possible for the scanning device to “see” the actual margins of the tooth and an accurate impression cannot be captured.

To displace tissue prior to an intraoral scan, retraction methods used in traditional impression-taking should be implemented. Approaches include the single- or double-cord retraction technique (wherein the second cord is removed immediately prior to scanning) and tissue removal with a diode laser. Gingival retraction paste, such as Traxodent® by Premier Dental, can also be used for tissue management before scanning. Traxodent, wither alone or with the aid of a Retraction Cap, can help gently retract gingival tissue allowing for an unimpeded view of the preparation by the scanning device.

Another limitation of intraoral scanners is that they cannot scan through blood, saliva, or fluids.  So in addition to tissue retraction, the area being scanned must be dry and hemostasis achieved before scanning can be completed. Featuring aluminum chloride and proprietary clay, Traxodent is designed to deliver predictable hemostasis and drying by absorbing excess fluids without irritating or discoloring surrounding tissue.

After placing Traxodent in the sulcus for just two minutes, the paste expands, gently opening the sulcus for capture. Rinsing with water, Traxodent is easily removed and leaves no residual material behind.  The result is a clean and dry field ready for the perfect digital impression.

To learn more and purchase Traxodent and other tissue management products for your practice, visit Premier’s website.

 

Sources:

https://www.nycdd.org/articles/2016/10/1/restorative-digital-dentistry-part-1-the-journey-to-new-paradigms

http://www.dentalproductsreport.com/dental/article/state-intraoral-scanning?page=0,0

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