Efficacy of conventional cord versus cordless techniques for gingival displacement: A systematic review and meta-analysis

Effectiveness of laser-assisted gingival troughing and conventional gingival displacement methods in fixed prosthodontics: A systematic review

STATEMENT OF PROBLEM

High-level evidence that gingival troughing using dental lasers has better outcomes for the management of gingival tissue surrounding prepared teeth compared with conventional gingival displacement methods is lacking.

PURPOSE

The purpose of this systematic review was to review in vivo studies on gingival troughing using dental lasers to compare achieved gingival displacement, influence on periodontal health, and other relevant clinical parameters with different existing gingival displacement methods.

MATERIAL AND METHODS

The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and identified studies through January 2022. An electronic search was conducted on the digital databases PubMed/MEDLINE, Web of Science, Scopus, and Embase to identify relevant studies with no limit on publication year.

RESULTS

Nine studies were included in this systematic review. Five studies measured achieved horizontal gingival displacement, where lasers show the highest pooled mean of 0.53 mm, among all other displacement methods. Six of the 9 included studies measured periodontal health parameters, with a follow-up time up to 1 year, and other clinically relevant parameters: hemorrhagic control, time needed, ease of use, tooth mobility, pain, and tooth hypersensitivity.

CONCLUSIONS

Gingival displacement and bleeding control appeared to be better achieved using lasers. The time needed to achieve gingival displacement was shortest and easiest with lasers. Lasers resulted in either less or comparable gingival recession, lower impact on tooth hypersensitivity, and less pain during the procedure than other methods.

Gingival displacement before impression making: A prospective, comparative randomized clinical trial

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.

Dentists' knowledge and preference regarding gingival displacement methods

INTRODUCTION

An accurate impression is an essential procedure for fabricating indirect fixed restorations. To achieve a precise final impression, the management of gingival tissue is without doubt a crucial.

AIM

To evaluate the use of different gingival displacement techniques among dental clinicians and to assess their associated knowledge and technique preferences.

METHODS

A self-designed survey was created electronically and sent to a list of dentists. The survey was composed of multiple sections. Participants who stated that they do not use GD methods were asked to answer the survey questions based on their knowledge. Descriptive statistics were generated, andChi-square test was used to examine the association between the different variables.

RESULTS

A total of 188 dentists participated in this study. The majority 144 (76.6%) use GD in their practice. When asked which technique yields a more accurate impression with lower incidence of repeating the impression, 93 (64.6%) reported retraction cord technique with a hemostatic agent results in a higher impression accuracy, while only 14 (9.7%) declared the retraction paste technique as being more accurate.

CONCLUSION

The cordless GD technique is believed to be easier, faster, and less traumatic to the gingival tissues, nevertheless, the outcome of dental impressions is believed to be more predictable with the use of conventional retraction cords and hemostatic medicaments.

Dentists’ Knowledge and Preference Regarding Mechanical Gingival Displacement Methods.. [DOI: 10.21203/rs.3.rs-2668816/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Introduction. An accurate impression is an essential procedure for fabricating indirect fixed restorations. To achieve an accurate dental impression, the management of gingival tissue is an important step. Aim. To evaluate the use of different gingival displacement techniques among group of dental clinicians and the associated knowledge and technique preferences. Methods. A self-designed survey was created electronically and sent to a list of dentists. The survey was composed of multiple sections. Participants who stated that they do not use GD methods were asked to answer the survey questions based on their knowledge. Descriptive statistics were generated, and the Chi-square test was used to examine associations between the different variables. Results. A total of 188 dentists participated in this study. The majority (76.6%) use GD in their clinics. When asked which technique yields a more accurate impression and a lower incidence of repeating the impression, 64.6% reported that the technique is retraction cords with a hemostatic agent, and only 9.7% said it was retraction paste. Conclusion. The cordless GD technique is believed to be easier, faster, and less traumatic to the gingival tissues, nevertheless, the outcome of dental impressions is believed to be more predictable with the use of conventional retraction cords and hemostatic medicaments.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Gingival Displacement in the Vertical and Horizontal Dimension under the Condition of Mild Gingivitis-A Randomized Clinical Study

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.

Influence of the Gingival Condition on the Performance of Different Gingival Displacement Methods-A Randomized Clinical Study

This randomized clinical study examined the influence of the gingival condition—healthy versus mild inflammation—on sulcus representation and possible gingival recession for two gingival displacement procedures prior to conventional impression making. The interventions double cord technique or a kaolin paste containing aluminum chloride were applied to 40 probands. The opposite quadrant served as intrapersonal reference (split-mouth design). Precision impressions were then made. Extraoral digitization of the plaster models resulting from the reference impression prior to gingival displacement, the intervention impression and control impressions were the basis for the computer-aided three-dimensional analysis. After six months, a mild artificial gingivitis was induced, and the contralateral quadrant (cross-over design) was examined for the intervention. The gingivitis deteriorated the sulcus representation for the double cord technique group but did not affect the paste technique group. The gingival condition had no influence on the marginal gingiva height changes. The minor extent of those changes, which were measured up to six months after intervention at the palatal study site, were not considered to be in the clinically relevant range for gingival recession. For healthy gingiva, the cord technique showed superior sulcus representation compared to the paste technique. This advantage was lost to a great extent under the conditions of mild gingivitis.