Though tissue management is an essential part of impression-making and will largely produce more good than harm, the procedure isn't without inherent risks. As mentioned in a previous blog, patient gingival health should be thoroughly evaluated before beginning work to ensure the best possible outcome. If there are any indications that the gingiva is in less-than-ideal or poor condition, it may prove difficult or even impossible to properly displace tissue and control moisture and bleeding. This, in turn, negates obtaining an acceptable impression until the tissue is rehabilitated.
The most common method of tissue management involves placement of retraction cord which can cause damage to gingival tissue in the form of post-operative discomfort, inflammation and even marginal recession. Use of quality materials and instruments along with deliberate handling and careful placement of the cord can minimize negative effects, though some degree of trauma may occur regardless.
To support hemostasis and retraction, a chemical, either impregnated into the cord material or in the form of a fluid, gel or paste, is used. While primarily helpful, these chemicals do carry the potential for negative side effects. Among the most commonly used agents are aluminum chloride and ferric sulfate which cause minimal tissue damage when used within the sulcus for durations of less than 10 minutes. However, ferric sulfate has been shown to interfere with surface detail of impression materials and can potentially discolor dentin. Cords impregnated with racemic epinephrine have been reported to induce an elevation in blood pressure and tachycardia, especially if the gingival tissue has been lacerated during the procedure. It should also be noted that all of these agents are acidic and may result in postoperative sensitivity.
Gingival retraction pastes, such as Traxodent® by Premier Dental®, offer a means of simultaneously managing tissue and minimizing risk to tissue health. A clay-based paste, Traxodent delivers improved ion exchange of the astringent and provides “swelling” capacity for fluid control and drying due to its surface area. Traxodent contains 15% aluminum chloride which is widely regarded as the most desirable chemical for use in tissue management. Not only is aluminum chloride highly effective at constricting blood vessels and drying tissue, it causes minimal irritation and won’t discolor teeth or produce harmful systemic effects making Traxodent a safe option.
To learn more and purchase Traxodent and other tissue management products, please visit Premier’s website.