GINGIVAL RETRACTION

Full control of the environment at the operation site is essential during restorative procedures. Saliva and water from handpieces must be removed from the mouth for the comfort and safety of the patient, and for the dentist’s access and clear vision. Controlling the oral environment also includes managing the gingiva...
Dentist, orthodontics and hands, patient mouth and medical tools, surgery and dental health. Tooth
GINGIVAL RETRACTION
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Full control of the environment at the operation site is essential during restorative procedures. Saliva and water from handpieces must be removed from the mouth for the comfort and safety of the patient, and for the dentist’s access and clear vision. Controlling the oral environment also includes managing the gingiva surrounding the teeth being restored.

Gingival retraction is the process of slightly separating the gingival tissue from the tooth’s margin to allow for accurate impression taking, preparation completion, and cementation.

Control of Oral Fluids

  • During cutting, it’s necessary to control the tongue to remove excess water from the handpiece and prevent accidental harm. The amount of fluid that needs to be removed during impression taking or cementation is less, but the required degree of dryness is much higher. Various methods are employed for removing oral fluids at different stages of prosthetic treatment:
  • Rubber Dam
  • Cotton rolls
  • Aspirators
  • Saliva ejectors
  • Svedopter
  • Agents inhibiting saliva secretion (Antisialogogues)

Gingival Retraction

  • Retraction is recommended in two different phases:
  • During the preparation phase, to visualize the area clearly for accurate and definite step preparation.
  • During the impression phase, to accurately and completely capture the step or finish line.

Methods of Gingival Retraction

  • Mechanical Method
  • Mechanical-Chemical Method
  • Surgical Method
  • Electrosurgical Method
  • Laser Method
  1. Mechanical Method

  • Mechanical gingival retraction involves pushing the free gingival tissue away from the tooth’s margin using mechanical methods. An important aspect is not to irritate the pocket epithelium. Dental floss is inserted directly into the dried gingival pocket with a mouth spatula or special spatulas and left for 5-10 minutes to provide mechanical separation.
  1. Mechanical-Chemical Method

  • This method uses a chemically impregnated string to displace the free gingival edge from the tooth’s cervical and to stop any bleeding or tissue fluid leakage that may occur during the procedure. The string physically and chemically displaces the gingiva from the tooth, and the pressure created by the string in the area helps control fluid seeping from the gingival sulcus walls.
  • Chemicals used to saturate retraction cords include:
  • Epinephrine
  • Alum (Aluminum Potassium Sulfate)
  • Aluminum Chloride
  • Aluminum Sulfate
  • Ferric Sulfate
  • The preparation area is isolated with cotton rolls to prevent saliva from contacting the cord, as saliva can reduce or negate the effectiveness of the chemicals.
  • Approximately 10-20 mm of string is cut and pushed into the pocket with a blunt mouth spatula. The free ends are passed around the collar mesially and distally, leaving one end 2-3 mm out. The retraction cord should be pushed into the pocket until the finish line of the preparation is felt.
  • Chemical agents for retraction can also be applied in gel form with a syringe. When the hemostatic agent is injected into the gingival sulcus with very little pressure (0.1 N/mm) with the syringe, the gingiva retracts by 0.5 mm within 2 minutes, and its pink color turns white. Aluminum trichloride in the gel acts as a hemostatic agent, while the thick consistency of the gel provides a mechanical effect. This syringe technique for retraction is applied not only for impression taking but also in situations requiring a hemostatic environment, like bonding.
  1. Surgical Method (Periodontal Surgery)

  • If periodontal reasons necessitate subgingival positioning of the finishing edge and ideal preparation or impression taking is impossible without some gingival removal, the periodontal surgical method is used. In cases of significant periodontal issues, excessive tissue removal, and when the free alveolar mucosa is very close to the gingival crest, periodontal surgery may be necessary.
  1. Electrosurgical Method

  • Used when inflammation or granulation tissue is present around the teeth, or when retraction is not possible due to the finishing line of the preparation being very close to the epithelial attachment. This method facilitates the expansion of the gingival sulcus and controls bleeding. It should not be used in patients with pacemakers.
  1. Laser Method

  • An erbium laser (480-510 nm) is used for this purpose. Stimulation occurs with high electric current. It provides hemostasis in vessels up to 1-2 mm due to its absorbability by blood. It causes capillary drying and protein coagulation in vascular lesions until it undergoes a certain absorption in the skin. The advantage of retraction performed using the laser system is the achievement of adequate hemostasis. Scott et al., in their study, compared the erbium laser technique with the double cord technique and indicated that the erbium laser technique is much better than traditional methods. They specifically noted the absence of postoperative discomfort and unwanted gingival recession.

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