2012 Gingival Retraction
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Transcript of 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