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Gupta PR, Kharat SS, Gangde P, Khan MR, Shaikh A, Raut MN. Efficacy of Conventional versus Cordless Displacement System on Gingival Retraction for Use with Intra-Oral Scanner: A Clinical Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2309-S2311. [PMID: 39346211 PMCID: PMC11426639 DOI: 10.4103/jpbs.jpbs_218_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 10/01/2024] Open
Abstract
Aim The present clinical study aimed to assess the efficacy of conventional versus cordless displacement systems on gingival retraction for use with an intra-oral scanner and changes in periodontal indices. Materials and Methods A total of 20 participants were selected for a split-mouth study (20 sites - Group Sc, 20 sites - Group Es). The outcomes were measured at day 0, day 1, and day 7 of follow-up in terms of Immediate horizontal displacement, Plaque Index, and Bleeding Index. Unpaired and Paired t-test was used as the parametric tests and statistical analysis was performed. Results A statistically significant change was observed in terms of BI on day 0, but no statistically significant change was observed for either group in terms of IHD and PI. Conclusion The cordless material caused the least trauma to gingival tissue and was more compatible with intra-oral scanning devices.
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Affiliation(s)
- Pratik R. Gupta
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
| | - Swati S. Kharat
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
| | - Pritesh Gangde
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
| | - Mehboob R. Khan
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
| | - Ahzam Shaikh
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
| | - Mrunal N. Raut
- Department of Prosthodontics and Crown and Bridge, Dr. Rajesh Ramdasji Dental College and Hospital, Akola, Maharashtra, India
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Desclos-Theveniau M, Abgrall H, Bar V, Basle F, Basle D, Dautel MJ, Rubin J, Delanoue F, Lefrançois E, Dautel A, Sérandour AL, Le Guicher G, Colombel H. Gingival displacement before impression making: A prospective, comparative randomized clinical trial. J Prosthet Dent 2023:S0022-3913(23)00644-3. [PMID: 37919130 DOI: 10.1016/j.prosdent.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
STATEMENT OF PROBLEM Gingival displacement is used in prosthodontics to obtain an accurate impression. However, randomized clinical trials to analyze the performance of different gingival displacement products are lacking. PURPOSE The purpose of this prospective, comparative randomized clinical trial was to evaluate the clinical effectiveness of 3 gingival displacement techniques: Racegel cordless, Racegel with a cord, and Racestyptine with a cord. MATERIAL AND METHODS A prospective, multicenter randomized, open label, 3-arm parallel group study was carried out in private dental practices. Patients with prepared teeth with healthy gingiva were recruited to make impressions before and after gingival displacement, which were digitized. Lateral and vertical gingival displacements were measured with computer-aided 3-dimensional analysis performed by a single operator who was blinded to the technique and the patient. For mean lateral gingival displacement, each gingival displacement method was compared with a required clinical value of 200 µm with the Student t test. The comparison of means among the 3 groups was performed using an ANOVA. Periodontal indices were recorded immediately and 7 to 14 days after gingival displacement. The percentages were compared with the chi-squared test or the Fisher exact test (α=.05 for all tests). RESULTS Eighty-eight participants were enrolled. The mean lateral gingival displacement obtained by Racestyptine with a cord (253 ±59 µm, P<.001) and by Racegel with a cord (247 ±61 µm, P<.001) were significantly higher than 200 µm. Lateral displacement observed with Racegel cordless was 207 ±57 µm (P=.53). For vertical gingival displacement, no difference among the 3 techniques was found. The astringent effect of these products was confirmed by the absence of crevicular fluid or bleeding. No periodontal damage was observed immediately or 7-14 days after displacement. CONCLUSIONS The study showed that cord impregnated with Racestyptine and Racegel with or without a cord provided a sufficient sulcus opening before impression making in prosthodontics, consistent with the clinical requirements for lateral displacement.
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Affiliation(s)
- Marie Desclos-Theveniau
- Associate Professor, Department of Prosthodontics, Nutrition Metabolisms and Cancer, U1317 INSERM, INRAE, UNIVREN, Rennes University Hospital Center (CHU Rennes), CIC 1414, Rennes, France.
| | | | | | | | | | | | | | | | - Etienne Lefrançois
- Assistant Professor, Department of Prosthodontics, Rennes University Hospital Center (CHU Rennes), Rennes, France
| | - Anne Dautel
- Associate Professor, Department of Restorative Dentistry, Rennes University Hospital Center (CHU Rennes), Rennes, France
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Kazakova R, Vlahova A, Tomov G, Dimitrova M, Kazakov S, Zlatev S, Forte M, Barile G, Corsalini M, Capodiferro S. A Comparative Analysis of Post-Retraction Changes in Gingival Height after Conventional and Surgical Gingival Displacement: Rotary Curettage, Diode and Er:YAG Laser Troughing. Healthcare (Basel) 2023; 11:2262. [PMID: 37628460 PMCID: PMC10454077 DOI: 10.3390/healthcare11162262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of the current article is to analyze and compare post-retraction gingival height changes resulting from six different types of gingival-displacement methods, encompassing both conventional and surgical approaches. The study involved a comparative analysis of 263 teeth (consisting of 128 front teeth, 69 premolars, and 66 molars) from 23 patients. For the investigation, three classic retraction methods were utilized, namely the single-cord technique, retraction paste Expasyl, and retraction paste Astringent. Additionally, three surgical techniques were employed, which included ceramic bur rotary curettage, Er:YAG laser troughing, and diode laser troughing. A randomized split-mouth design was implemented, and a significance level of 0.05 was used for the study. The recovery of the free gingival margin height was assessed on gypsum models that were scanned using an intraoral scanner during the first and second week after the retraction procedure. The results revealed that all retraction methods, except for ceramic bur rotary curettage, led to clinically insignificant levels of gingival recession. The article provides insights into the effectiveness and safety of various gingival-displacement techniques, highlighting that most methods tested in the study resulted in minimal or negligible gingival recession post-retraction.
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Affiliation(s)
- Rada Kazakova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria; (A.V.); (S.Z.)
- CAD/CAM Center of Dental Medicine, Research Institute, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria
| | - Angelina Vlahova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria; (A.V.); (S.Z.)
- CAD/CAM Center of Dental Medicine, Research Institute, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria
| | - Georgi Tomov
- Department of Periodontology and Oral Mucosa Diseases, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria;
- Laser Dental Center, Research Institute, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria
| | - Mariya Dimitrova
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria; (A.V.); (S.Z.)
| | - Stoyan Kazakov
- Oral Surgeon, Private Dental Practice–Sofia, 1000 Sofia, Bulgaria;
| | - Stefan Zlatev
- Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria; (A.V.); (S.Z.)
- CAD/CAM Center of Dental Medicine, Research Institute, Medical University–Plovdiv, 4000 Plovdiv, Bulgaria
| | - Marta Forte
- Department of Interdisciplinary Medicine, ‘Aldo Moro’, University of Bari, 70100 Bari, Italy; (M.F.); (M.C.); (S.C.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, ‘Aldo Moro’, University of Bari, 70100 Bari, Italy; (M.F.); (M.C.); (S.C.)
| | - Massimo Corsalini
- Department of Interdisciplinary Medicine, ‘Aldo Moro’, University of Bari, 70100 Bari, Italy; (M.F.); (M.C.); (S.C.)
| | - Saverio Capodiferro
- Department of Interdisciplinary Medicine, ‘Aldo Moro’, University of Bari, 70100 Bari, Italy; (M.F.); (M.C.); (S.C.)
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Gingival Displacement in the Vertical and Horizontal Dimension under the Condition of Mild Gingivitis-A Randomized Clinical Study. J Clin Med 2022; 11:jcm11020437. [PMID: 35054131 PMCID: PMC8779044 DOI: 10.3390/jcm11020437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023] Open
Abstract
This randomized clinical study aimed at quantifying the gingival displacement performance in the vertical and horizontal directions of the 3M™ Astringent Retraction Paste (3M Oral Care, Seefeld, Germany) in comparison with the double-cord technique with aluminum chloride as an astringent. Afterward, any soft-tissue changes were assessed for 12 months. After inducing mild gingivitis, 18 probands received the intervention ‘cord’ and 22 probands received the intervention ‘paste’ at the palatal half of upper premolars prior to conventional impression making. The resulting plaster casts were digitized and analyzed for the vertical and horizontal gingival displacement, applying a newly developed computer-assisted methodology. The entire palatal half of the tooth was evaluated instead of only single sites. Under the condition of mild gingivitis, the gingival displacement performance was comparable for both techniques in the horizontal direction (width) and only somewhat better for the cord technique in the vertical direction (depth). The magnitude of displacement was in a similar range in both directions, with somewhat higher values in the vertical direction. The marginal gingiva height changes were of such low extent during the follow-up period of 12 months with only minimally higher values for the paste that they cannot be considered as clinically relevant recessions.
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Evaluation of gingival displacement methods in terms of periodontal health at crown restorations produced by digital scan: 1-year clinical follow-up. Lasers Med Sci 2021; 36:1323-1335. [PMID: 33566189 DOI: 10.1007/s10103-021-03266-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
The purpose of this clinical study was to compare the effects of the gingival displacement techniques of retraction cord, cordless paste system, and Er,Cr:YSGG laser troughing on the periodontal tissues around the crown restoration produced using a digital scan. This was analyzed by recording the probing depth (PD), plaque index, gingival index (GI), mobility, sensitivity, and bleeding on probing (BOP) index. This study included 60 mandibular 1st molars from 52 participants (20 males and 32 females) requiring crown restoration. The margin lines of the crown preparations were placed 1 mm subgingivally. Based on the gingival displacement technique used, the patients were divided into three groups: retraction cord, cordless paste system, and Er,Cr:YSGG laser troughing. A digital scan of the prepared tooth was performed. Follow-up appointments were scheduled at five different times: 1st day, 1st month, 3rd month, 6th month, and 1st year. Six periodontal indices were used to assess the periodontal health. The chi-square test was used to compare categorical variables depending on the groups. There was a significant difference in the PD, GI, and BOP index scores among the three techniques during the 1-year clinical monitoring (p < 0.001). The PD in the three zones of the buccal surface showed a significant increase with time in the retraction cord and cordless paste system groups (p < 0.001). The highest GI scores were observed in the retraction cord group on the 1st day. The Er,Cr:YSGG laser troughing procedure produced lower PD, GI, and BOP index scores as compared to the retraction cord and cordless paste system procedures in the 1-year period.
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Bennani V, Aarts JM, Brunton P. A randomized controlled clinical trial comparing the use of displacement cords and aluminum chloride paste. J ESTHET RESTOR DENT 2020; 32:410-415. [PMID: 32442353 DOI: 10.1111/jerd.12581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/11/2020] [Accepted: 03/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This clinical study measured the change in opening and height of the displaced gingiva using paste and cord retraction materials for definitive impression making of natural teeth and assessed if they were comparable and clinically acceptable. METHODS Impressions of 4 maxilla premolars from 10 participants were taken using a split-mouth protocol. All participants were free of periodontal disease, had a thick biotype, a minimal of 3 mm height of keratinized gingival tissue and gingival sulci depths of 2 mm. The bleeding index (BI), gingival index (GI) plaque index (PI), sulcular depth, level of attachment and tooth sensitivity were recorded at baseline, just after retraction, at 24 hours and at 2 weeks. Impressions were poured in stone and then after initial analysis were cross-sectioned to allow measurements of the gingival height change and gap size to be recorded. RESULTS The paste produced a slightly smaller gap compared to the cord (0.041 mm less, P = .014) whilst the mean displacement for the cord was 0.282 mm and paste was 0.241 mm respectively. Gingival height with the paste was 0.047 mm lower than that achieved by the cord (P = .208). CONCLUSIONS Cord and paste retraction produced comparable clinically acceptable gingival gaps, with the cord producing statistically larger gap size. CLINICAL SIGNIFICANCE The cord and paste retraction materials produced comparable clinically acceptable gingival retraction.
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Affiliation(s)
- Vincent Bennani
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - John M Aarts
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Paul Brunton
- Pro Vice Chancellor Health Sciences, University of Otago, Dunedin, New Zealand
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Martins FV, Santana RB, Fonseca EM. Efficacy of conventional cord versus cordless techniques for gingival displacement: A systematic review and meta-analysis. J Prosthet Dent 2020; 125:46-55. [PMID: 32008797 DOI: 10.1016/j.prosdent.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Unsatisfactory adaptation of restorations with subgingival margins can cause problems such as accumulation of biofilm, secondary caries, and inflammation of the periodontal tissue. Therefore, special attention should be given to gingival displacement and impression procedures to optimize marginal fit. PURPOSE The purpose of this systematic review and meta-analysis was to compare gingival displacement with conventional cords and cordless techniques and determine the reliability of the measurement methodologies. MATERIAL AND METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and identified studies through September 2018. The studies were submitted to the Cochrane risk-of-bias assessment. The gingival displacement was evaluated by using the Review Manager Software. RESULTS Nine studies were selected, and the most common risks of bias were random sequence generation, blinding of outcome assessment, and absence of sample size calculation. Most of the studies reported obtaining a width greater than 0.2 mm. CONCLUSIONS The cord technique resulted in increased displacement when compared with the cordless technique. The evaluation of sulcular width with digital microscope images obtained from sectioned gypsum casts is an adequate and versatile experimental methodology for measuring displacement.
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Affiliation(s)
- Felipe V Martins
- Postgraduate student, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil.
| | - Ronaldo B Santana
- Professor, Department of Periodontology, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Edgard M Fonseca
- Professor, Department of Dental Technique, Federal Fluminense University (UFF), Niteroi, Rio de Janeiro, Brazil
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Dederichs M, Fahmy MD, Kuepper H, Guentsch A. Comparison of Gingival Retraction Materials Using a New Gingival Sulcus Model. J Prosthodont 2019; 28:784-789. [PMID: 31206914 DOI: 10.1111/jopr.13093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the pressure generated by different retraction materials using a novel gingival sulcus model. MATERIALS AND METHODS A gingival sulcus model was made using a polymer frame filled with silicon. A pressure sensor and a sulcus-fluid simulation were embedded into the silicon chamber to evaluate the pressure generated by different retraction materials. Six sizes of Ultrapak retraction cords (Ultradent, sizes #000 - 3), 4 retraction pastes (Expazen, Expasyl, Acteon, Access Edge, Traxodent) and 2 retraction gels (Sulcus Blue, Racegel) were analyzed. The mean and median pressure, interquartile range, and standard deviation (SD) of n = 10 repeated measurements were calculated. Statistical analysis was conducted by Kruskal-Wallis test for differences between the main groups of retraction materials, and Mann-Whitney U-test was performed to analyze differences between the single retraction materials. RESULTS Pressure (mean ± SD) generated by retraction cords increased with increasing size (48.26 ± 11.29 kPa, size #000 to 149.27 ± 28.75 kPa for #3). There was a significant difference between sizes (p < 0.01), except in #0 versus #1, and #2 versus #3. Retraction pastes generated pressures that ranged from 82.74 ± 29.29 kPa (Traxodent) to 524.35 ± 113.88 kPa (Expasyl). Retraction gels generated pressures from 38.96 ± 14.68 kPa (Racegel) to 95.15 ± 24.18 kPa (Sulcus Blue). Pressure generated by Expasyl was significantly higher than pressure generated by all other tested materials (p < 0.001). CONCLUSION Pressure generated by retraction pastes and gels depends on the consistency of the retraction material, while pressure generated by retraction cords increased with increasing size of cords. Expasyl was found to generate the highest pressure compared to all other retraction materials.
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Affiliation(s)
- Marco Dederichs
- Policlinic of Prosthetic Dentistry and Material Science, Centre for Dental Medicine, Jena University Hospital, Jena, Germany
| | - Mina D Fahmy
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN
| | - Harald Kuepper
- Policlinic of Prosthetic Dentistry and Material Science, Centre for Dental Medicine, Jena University Hospital, Jena, Germany
| | - Arndt Guentsch
- Department of Surgical Sciences, School of Dentistry, Marquette University, Milwaukee, WI
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Rayyan MM, Hussien ANM, Sayed NM, Abdallah R, Osman E, El Saad NA, Ramadan S. Comparison of four cordless gingival displacement systems: A clinical study. J Prosthet Dent 2018; 121:265-270. [PMID: 30722986 DOI: 10.1016/j.prosdent.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 05/22/2018] [Accepted: 05/22/2018] [Indexed: 11/16/2022]
Abstract
STATEMENT OF PROBLEM Although the conventional chemicomechanical cord technique is widely used, packing the cord into the sulcus may cause pain and bleeding. Cordless displacement techniques have been introduced, but a comparison of these systems is lacking. PURPOSE The purpose of this clinical study was to evaluate the efficiency and gingival response of 4 cordless gingival displacement systems. MATERIAL AND METHODS One hundred twenty teeth in 30 participants were allocated to 4 groups according to the material used: Tr (Traxodent; Premier Dental Products Co), Es (Expasyl; Acteon UK), Ez (Expazen; Acteon UK), and Mr (3M Retraction; 3M ESPE). Baseline measurements of periodontal indices and a digital scan were acquired. The cordless displacement pastes were applied according to the manufacturer's instructions. After removal, a second scan was acquired. Participants were recalled on the 2nd and 14th day to measure periodontal indices and for scans. Screenshots were superimposed to measure changes in the gingiva. Statistical differences among the different materials in achieving lingual and buccal vertical gingival displacement were tested using the related-samples Friedman 2-way ANOVA test by ranks at 3 time points such as immediate, at 2 days, and at 14 days (α=.05). RESULTS Immediate gingival displacement varied with the system used. For horizontal displacement, median values ranged between 150 μm (Tr) and 725 μm (Ez) for buccal displacement and between 93 μm (Tr) and 550 μm (Ez) for lingual displacement. Minimum and maximum displacements also varied and followed a similar trend, with Traxodent providing the lowest displacement. The plaque index and attachment level did not statistically differ before and after the treatment. The periodontal parameters were not statistically significant among the groups at all time intervals, except for the gingival index that increased for all the groups after 2 days. CONCLUSIONS Significant differences were found among the 4 tested systems in both vertical and horizontal gingival displacement. Expasyl, Expazen, and 3M Retraction exceeded the 200-μm requirements for horizontal displacement. Traxodent provided the least displacement in both vertical and horizontal dimensions.
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Affiliation(s)
- Mohammad M Rayyan
- Associate Professor, Prosthodontics, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon.
| | - Ahmed Naguib M Hussien
- Professor, Fixed Prosthodontics, Faculty of Dentistry, Cairo University; Future University, New Cairo, Egypt
| | - Nagwa M Sayed
- Associate Professor, Prosthodontics, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | - Rima Abdallah
- Clinical Assistant Professor, Periodontology, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon; Lecturer, Department of Periodontology, Lebanese University School of Dentistry, Beirut, Lebanon
| | - Essam Osman
- Professor, Dental Biomaterials, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | - Nayer Abo El Saad
- Associate Professor, Periodontology, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon; Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Samiha Ramadan
- Head, Diagnosis Clinics, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
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Einarsdottir ER, Lang NP, Aspelund T, Pjetursson BE. A multicenter randomized, controlled clinical trial comparing the use of displacement cords, an aluminum chloride paste, and a combination of paste and cords for tissue displacement. J Prosthet Dent 2017; 119:82-88. [PMID: 28478985 DOI: 10.1016/j.prosdent.2017.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
Abstract
STATEMENT OF PROBLEM Gingival recession after soft tissue displacement for impression making in fixed prosthodontics may pose a problem for treatment success in the esthetic areas of the mouth. Knowledge about the soft tissue reaction of common gingival displacement methods is limited. PURPOSE The purpose of this clinical randomized controlled trial (RCT) was to evaluate changes in the marginal soft tissue height with 3 different gingival tissue displacement techniques for definitive impression making of natural teeth. MATERIAL AND METHODS A total of 67 individuals were randomized to 3 groups. In test group 1 (P; n=22), only aluminum chloride paste was used to displace the gingiva. In test group 2 (CP; n=23), a cord was inserted, and aluminum chloride paste was also used. In the control group (C; n=22), 2 cords were used to displace the gingiva (double-cord technique). Clinical measurements of the gingival position were made before treatment began and at 30 ±10 days after prosthesis delivery. Study casts were fabricated at different stages of the treatment, standardized photographs were made, and changes in the buccal gingival position were measured using graphics editing software. In addition, the participants' perception of the clinical procedure and the technicians' evaluation of the die preparation were recorded. One-way ANOVA models were applied to compare the response variables among the groups: (a) the position of the gingival margin (millimeters), (b) mean probing pocket depth (millimeters), (c) gingival thickness (millimeters), (d) amount of keratinized tissue (millimeters), and (e) mean changes in gingival margin height (millimeters). Unpaired t tests were also used to compare the mean values between groups. For comparisons between different categories, chi-square tests were performed (α=.05 for all tests). RESULTS In the period between impression and delivery, a minor gain in gingival height of 0.058 mm (±0.13 SD) for P and 0.013 mm (±1.19 SD) for CP. However, a minor gingival recession of 0.049 mm (±0.13 SD) was reported for group C. The results for all groups showed that 21% of abutment teeth gained >0.1 mm in gingival height, 58% had stable gingival height (0 ±0.10 mm), 21% showed minor gingival recession (0.1 to 0.5 mm), and no abutment teeth showed moderate or severe gingival recession (>0.5 mm). The incidence of minor gingival recession was 8% in group P, 23% in group CP, and 32% in group C (P=.015). Fifteen participants (24%) experienced some discomfort after the procedure. The differences between the groups were not significant (P>.05). The laboratory technicians found the definitive die preparation significantly more challenging for group P (visual analog scale [VAS], 79) and CP (VAS, 82) than group C (mean VAS, 93; P=.003). CONCLUSIONS Minor or moderate gingival recession (<1 mm) is more likely to occur when conventional cords are used during impression making. However, the laboratory technicians found the die preparation significantly less challenging when the double-cord technique was used than when impressions were made using the paste displacement technique.
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Affiliation(s)
- Erna R Einarsdottir
- Instructor, Division of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.
| | - Niklaus P Lang
- Professor Emeritus, University of Berne, Berne, Switzerland; and Professor Emeritus, University of Zurich, Zurich, Switzerland
| | - Thor Aspelund
- Professor, Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Bjarni E Pjetursson
- Professor, Division of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
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Bennani V, Ibrahim H, Al-Harthi L, Lyons KM. The periodontal restorative interface: esthetic considerations. Periodontol 2000 2017; 74:74-101. [DOI: 10.1111/prd.12191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 12/14/2022]
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12
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Cai H, Yang S, Pei X, Qing H, Wang J. Practice-based preclinical instruction for gingival displacement with animal models. J Prosthet Dent 2016; 117:405-409. [PMID: 27677218 DOI: 10.1016/j.prosdent.2016.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Gingival displacement is recognized as a substantive and difficult procedure in fixed prosthodontics. However, a realistic simulation of gingival displacement is unavailable for preclinical dental students. PURPOSE The purpose of this study was to evaluate whether practice-based preclinical instruction of gingival displacement with animal models could improve students' skill in patient care. MATERIAL AND METHODS Isolated bovine mandibles (calves were younger than 6 months of age) and isolated porcine hemimandibles were prepared for this study. Twenty-two general dental practitioners with at least 5 years of experience were randomly selected and assigned to perform gingival displacement on both bovine and porcine jaws. Those practitioners were then asked to assess the clinical similarity of gingival displacement between human teeth and animal teeth. The data were analyzed with the paired t test (α=.05). Upon confirmation that the animal jaw provided a similar gingival displacement environment to that of human teeth, 80 predoctoral dental students were enrolled and randomized into 2 groups. Half of them underwent the new practice-based instruction, while the others underwent traditional preclinical teaching only (lectures, online video, or live demonstration). After preclinical learning, clinical performance in gingival displacement was evaluated for all students in terms of the effect of gingival displacement and quality of impression. The data were analyzed with the chi-square test (α=.05). RESULTS The dentogingival environments of porcine and bovine jaws were similar to those of human jaws, and no significant difference was detected between these 2 animal models (P=.178). A significant increase occurred in the acceptable rate of the effect of gingival displacement (P<.001) and the quality of impression (P<.001) among students who received the practice-based instruction compared with those who received traditional teaching. CONCLUSIONS These findings suggest that this practice-based instruction of gingival displacement with animal models is an effective method of promoting dental students' learning of gingival displacement.
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Affiliation(s)
- He Cai
- Graduate student, Graduate Prosthodontics, Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Shuying Yang
- Lecturer, Department of General Dentistry and Emergency, State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi'an, China
| | - Xibo Pei
- Lecturer, Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China
| | - Hai Qing
- Assistant Professor, Department of Restorative Dentistry, Temple University Kornberg School of Dentistry, Philadelphia, Penn
| | - Jian Wang
- Associate Professor, Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China.
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