2012 Gingival Retraction

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    GINGIVALRETRACTION

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    GIVGIVAL RETRACTION

    Done after a tooth is prepared for a crown to ensure that an

    impression with clear margins can be obtained No hemmorage present

    All hard & soft tissue to be reproduced must be clean & dry

    Ideal margins are supragingival

    Many may be subgingival

    Tissue displaced vertically- to expose margin

    Tissue retracted horizontally- allow room for impression material

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    GINGIVAL RETRACTION

    Retraction- can be done chemically, mechanically,

    surgically, or combination

    Retraction cord- available in variety of sizes,

    configurations, and chemical treatments

    Comes in dispensing package for easy use May be twisted, braided, or woven to hold its shape

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    TYPES OF RETRACTION

    Two types of retraction

    1. Mechanical

    Non-impregnated to displace tissue to

    allow access to margin

    2. Chemical

    Impregnated with chemical agent

    added

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    MECHANICAL Retraction cord placed in sulcus of

    healthy, inflamed-free gingiva

    Cotton left in place 10-15 minutes

    Too deep- crevice open at bottom,narrow at top (material will fracture at

    edge of prep)

    Too shallow- space inadequate to allow

    accurate reproduction of the margin of

    the prep

    Proper position- 1-3 mm into the v-

    shaped crevice

    MECHANICAL RETRACTION

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    MECHANICAL RETRACTION

    Another way to lengthen atemporary crown form to cause

    tissue displacement and take the

    impression at a later date

    Dental dam clamp and rubberdam to displace tissue

    Clamp & dam placed and

    removed prior to taking final

    impression

    Both these techniques may cause

    tissue to bleed and impression

    distortion

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    CHEMICAL RETRACTION

    May be done prior toplacement of the cord

    By impregnating cord,

    then placing it, or both

    Newer way- use a

    topical hemostatic

    solution astringent

    with dento-infusiontubes and plastic lure

    lock syringe

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    NEWER CHEMICAL RETRACTION PROCEDURE

    1. Place solution using a disposable metal tip bent to thedesired area

    2. Blood & solution merge together and are washed

    away with air/water syringe

    3. Temporary seal left that does not allow any seepage

    4. Retraction cord of interwoven cotton with or without

    solution placed vertically to expose prepared margin

    5. This packing allows for horizontal retraction

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    6. Cord could also have aluminum chloride or

    astringent of aluminum salts for chemicalretraction (this technique causes ischemia)

    Epinephrine

    An astringent and vasoconstrictor

    Provides hemostasis and shrinks tissues

    constricting the blood vessels

    Causes tachycardia

    Contraindicated for patient with heart disease,diabetes, hyperthyroidism

    NEWER CHEMICAL RETRACTION PROCEDURE

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    NEWER CHEMICAL RETRACTION PROCEDURE

    7. Dual astringent and hemostatic action of aluminum

    chloride plus kaolin clay Controls bleeding

    Absorbs fluids to ensure a clean, dry sulcus

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    SURGICAL RETRACTION

    Use surgical knife or electrosurgery to remove tissue

    and preparation

    Area may bleed and cause additional treatment

    Electrosurgery unit- cauterizes tissues as it removesthem (no bleeding)

    Must have soft tissue anesthesia Not used with patients receiving radiation therapy,

    have cardiac pacemakers, or slow healing diseases

    Non-metal HVE tip during surgery reduces odor if

    placed near surgical site Rinse sulcus with hydrogen rinse

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    ELECTROSURGERY

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    PLACING AND REMOVING RETRACTION CORD

    EQUIPMENT NEEDED HVE tip and air/water syringe tip Scissors

    Hemostat

    Retraction cord

    Retraction cord placement instrument or plastic instrument

    Cotton rolls 2x2 gauze sponges

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    STEPS FOR PLACING AND REMOVING

    RETRACTION CORD

    1. Tooth prepared for crown

    2. Rinse and dry area

    3. Place cotton rolls, dry area

    4. Dentist selects retraction cord5. Length determined by

    circumference of toothanterior tooth

    Wrap around small finger Posterior tooth: larger finger

    6. Cut cord to appropriate length

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    STEPS FOR PLACING AND REMOVING

    RETRACTION CORD

    7. Twist cord ends to compress fibers together

    8. Cord is looped and placed in a hemostat orcotton pliers

    9. Cord looped around margin of prepared toothand tightened slightly

    10. Release ends of hemostat or cotton pliersleaving cord in sulcus

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    STEPS FOR PLACING AND REMOVING

    RETRACTION CORD CONTD

    11. Pack retraction cord into position with packing instrument orplastic instrument

    12. Pack cord around cervical area, apical to preparation

    13. Pack cord around tooth and overlap on facial surface

    14. Leave tip of cord showing out of sulcus in order to remove justprior to taking impression

    15. Placement time

    5 minutes left in place-for chemical retraction

    10-15 minutes- for mechanical retraction

    16. Remove end of cord in a circular motion prior to impressionbeing placed

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