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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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Schmitz JH, Valenti M. Interim restoration technique for gingival displacement with a feather-edge preparation design and digital scan. J Prosthet Dent 2019; 123:580-583. [PMID: 31375275 DOI: 10.1016/j.prosdent.2019.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/24/2022]
Abstract
A straightforward and time-efficient technique is presented for recording digital scans in single- and multiple-unit tooth abutments with feather-edge finish lines. The margins of the interim restoration should be precise and sufficiently deep in the sulcus so that the tissues can be properly displaced. Definitive intraoral scans should be made approximately 3 to 4 weeks after the tooth (or teeth) has been prepared to allow healing of the soft tissues. The interim restoration is first removed and then reseated after removing cement residue. First, a scan is made with the interim restoration in place. The abutment tooth or teeth are then erased from the original digital file, the interim restoration is removed again, and a new scan enclosing only the abutment tooth is made.
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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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Abstract
Knowledge of the periodontal-restorative interface is critical in the fabrication of restorations that are functional and esthetic. Understanding biological principles allows the clinician to predict how the periodontium will respond to restorative therapy. Factors that influence the response to therapy in the periodontal-restorative interface are periodontal biotype, gingival architecture, alveolar crest position, gingival margin position, and gingival zenith.
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Affiliation(s)
- Ryan Cook
- Department of Restorative Sciences, School of Dentistry, University of North Carolina at Chapel Hill, 335 Brauer Hall CB 7450, Chapel Hill, NC 27599, USA.
| | - Kevin Lim
- Department of Restorative Sciences, School of Dentistry, University of North Carolina at Chapel Hill, 335 Brauer Hall CB 7450, Chapel Hill, NC 27599, USA
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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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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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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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Bennani V, Aarts JM, Schumayer D. Correlation of pressure and displacement during gingival displacement: An in vitro study. J Prosthet Dent 2016; 115:296-300. [DOI: 10.1016/j.prosdent.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
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Huang C, Somar M, Li K, Mohadeb JVN. Efficiency of Cordless Versus Cord Techniques of Gingival Retraction: A Systematic Review. J Prosthodont 2015; 26:177-185. [PMID: 26378615 DOI: 10.1111/jopr.12352] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Primarily to assess the efficacy of cordless versus cord techniques in achieving hemostasis control and gingival displacement and their influence on gingival/periodontal health. In addition, subjective factors reported by the patient (pain, sensitivity, unpleasant taste, discomfort) and operator's experience to both techniques were analyzed. MATERIALS AND METHODS An electronic database search was conducted using five main databases ranging from publication year 1998 to December 2014 to identify any in vivo studies comparing cord and cordless gingival retraction techniques. RESULTS Seven potential studies were analyzed. Out of the four articles that reported achievement of hemostasis control, three compared patients treated by an epi-gingival finish line and concluded that paste techniques were more efficient in controlling bleeding. Five studies reported on the amount of sulcus dilatation, with contrasting evidence. Only one study reported an increased gingival displacement when paste systems were used. Two studies did not observe any significant difference, although two showed greater gingival displacement associated with cords, particularly in cases where the finish line was placed at a subgingival level. Of the four studies that assessed the influence of both techniques on the gingival/periodontal health, three noted less traumatic injury to soft tissues when gingival paste was used. A paste system, in general, was documented to be more comfortable to patients and user-friendly to the operator. CONCLUSIONS Because of heterogeneity of measurement variables across studies, this study precluded a meta-analytic approach. Although both techniques (cord/cordless) are reliable in achieving gingival retraction, some situations were identified wherein each of the techniques proved to be more efficient.
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Affiliation(s)
- Cui Huang
- Department of Prosthodontics, Wuhan School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Mirinal Somar
- Department of Prosthodontics, Wuhan School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Kang Li
- Department of Prosthodontics, Wuhan School and Hospital of Stomatology, Wuhan University, Wuhan, China
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Gingival displacement: Survey results of dentists' practice procedures. J Prosthet Dent 2015; 114:81-5.e1-2. [PMID: 25917854 DOI: 10.1016/j.prosdent.2014.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM A high percentage of fixed prosthodontic restorations require a subgingival margin placement, which requires the practice of gingival displacement or a deflection procedure to replicate the margins in impression. PURPOSE The purpose of this study was to learn the different gingival displacement techniques that are currently used by dentists in their practice and to compare the current concepts of gingival displacement with previously published articles. MATERIALS AND METHODS A survey of questions pertaining to gingival deflection methods was distributed as part of continuing education (CE) course material to dentists attending CE meetings in 7 states in the U.S. and 1 Canadian province. Question topics included initial patient assessment procedures, gingival displacement methods, dentist's knowledge and assessment of systemic manifestations, and brand names of materials used. RESULTS Ninety-four percent of the participants were general practitioners with 24.11 ± 12.5 years of experience. Ninety-two percent used gingival displacement cords, while 20.2% used a soft tissue laser and 32% used electrosurgery as an adjunct. Sixty percent of the dentists used displacement cords impregnated with a medicament. Of the preimpregnated cords, 29% were impregnated with epinephrine, 13% with aluminum chloride, and 18% with aluminum potassium sulfate. CONCLUSION The study showed a steady decrease compared with results of previously published articles in the use of epinephrine as a gingival deflection medicament.
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Bennani V, Inger M, Aarts JM. Comparison of pressure generated by cordless gingival displacement materials. J Prosthet Dent 2014; 112:163-7. [DOI: 10.1016/j.prosdent.2013.09.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 09/11/2013] [Accepted: 09/15/2013] [Indexed: 10/25/2022]
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Cooper K, Bennani V, Tawse-Smith A, Reid M, Stirling C, Dias G. Effect of a cordless retraction paste on titanium surface: a topographic, chemical and biocompatibility evaluation. Braz Oral Res 2014; 27:211-7. [PMID: 23739788 DOI: 10.1590/s1806-83242013000300002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/22/2013] [Indexed: 11/21/2022] Open
Abstract
Good exposure of the preparation margins and haemostasis in the sulcular gingiva are necessary for accurate impressions to produce precise restorations. The use of cordless retraction paste material in implant dentistry is a relatively novel application. However, few studies have been conducted on the use of retraction pastes and their possible interaction with implant surfaces. Recent literature has described remnants on titanium implant surfaces and expressed the need for an assessment of the biocompatibility of the exposed surface (Chang et al.). This in vitro study evaluated the effect of a cordless gingival retraction paste on sterile titanium disks. Surface chemistry was determined using energy-dispersive X-ray spectroscopy (EDS), and further investigated using laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). After exposure to retraction paste, surface chemistry alterations were identified. A fibroblast cell line (L929) was exposed to the disks and the live/dead viability/cytotoxicity assay was used to determine any effects on the proliferation and health of cells. The disks exposed to the retraction paste showed fewer dead cells compared to the unexposed disks. This was statistically significant.
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Affiliation(s)
- Katherine Cooper
- Department of Oral Rehabilitation, School of Dentistry, Univ of Otago, Dunedin, New Zealand
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Baba NZ, Goodacre CJ, Jekki R, Won J. Gingival displacement for impression making in fixed prosthodontics: contemporary principles, materials, and techniques. Dent Clin North Am 2014; 58:45-68. [PMID: 24286645 DOI: 10.1016/j.cden.2013.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The clinical success and longevity of indirect restorations depend on the careful and accurate completion of several procedures. One of the challenging procedures is management of the gingival tissues and gingival esthetics. The goal for management of gingival tissues and gingival esthetics is to maintain the normal appearance of healthy gingival. Achieving this goal requires optimal health before treatment and minimal trauma during treatment. The best way of optimizing health and minimizing trauma is to avoid contacting the gingiva with restorative materials.
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Affiliation(s)
- Nadim Z Baba
- Hugh Love Center for Research and Education in Technology, Loma Linda University, School of Dentistry, 11092 Anderson Street, Loma Linda, CA 92350, USA.
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