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ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 120-122

Gingival displacement methods used by dental professionals: A survey


Department of Prosthodontics, G. Pulla Reddy Dental College and Hospital, Kurnool, Andhra Pradesh, India

Date of Web Publication16-Dec-2016

Correspondence Address:
S V Giridhar Reddy
Department of Prosthodontics, G. Pulla Reddy Dental College and Hospital, Nandyala Road, Kurnool, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.195909

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  Abstract 

Aim: The aim of the present study was to identify the methods used by dental professionals for gingival displacement before making impressions for fixed prostheses. Materials and Methods: A printed questionnaire was distributed to over 600 dentists at a National Dental Conference held in Hyderabad. The questionnaire was designed to know the preferred method of gingival displacement, medicament used, frequency of performing gingival displacement, etc. The results were analyzed and represented in the form of percentage. This method of survey distribution was selected to reach dental professionals in a wide range. Results: Of 600 dentists who received the questionnaire, 63.3% returned properly filled forms. Sixty-eight percentage of respondents advocate gingival displacement for all fixed prostheses cases, 23% of respondents use for long span fixed prostheses cases, and 9% of respondents use gingival displacement only for selected cases. Among the respondents, 69% preferred to use chemicomechanical method, 16% surgical method, 9% of respondents preferred to use the mechanical method. Conclusion: The choice of technique and material for gingival displacement depends on the operator's judgment of the clinical situation apart from the availability of the materials.

Keywords: Gingival displacement, gingival retraction, retraction cord


How to cite this article:
Giridhar Reddy S V, Bharathi M, Vinod B, Reddy K R, Reddy N S. Gingival displacement methods used by dental professionals: A survey. J Orofac Sci 2016;8:120-2

How to cite this URL:
Giridhar Reddy S V, Bharathi M, Vinod B, Reddy K R, Reddy N S. Gingival displacement methods used by dental professionals: A survey. J Orofac Sci [serial online] 2016 [cited 2017 Mar 29];8:120-2. Available from: http://www.jofs.in/text.asp?2016/8/2/120/195909


  Introduction Top


Displacement of the gingival tissue is essential for obtaining accurate impressions for the fabrication of fixed prostheses, particularly when the finish line is at or within the gingival sulcus.[1],[2] Finish lines are frequently placed at or just below the crest of the gingival margin, meaning that, gingival retraction is usually necessary when impressions are taken.[3] Gingival displacement or gingival retraction is defined as the deflection of marginal gingiva away from the tooth. This is performed to create sufficient lateral and vertical space between the preparation finish line and the gingival tissue to allow the injection of adequate bulk of the impression material into the expanded crevice.[4] Impression along the subgingival margin is critical to the marginal fit and emergence profile of the prosthesis. The critical sulcular width has been reported to be approximately 0.2 mm at the level of the finish line.[5] Impressions with less sulcular width have higher incidences of voids, tearing of impression materials, and less marginal accuracy.[6] The techniques used to accomplish gingival deflection can be classified as mechanical, chemicomechanical, and surgical. The surgical techniques can be further broken down into rotary curettage and electrosurgery.[7]

The mechanical method of gingival displacement using plain retraction cord has been a standard for several years. It acts by physically pushing the gingiva away from the finish line, but its effectiveness is limited because of its inability to control the sulcular fluid seepage.[8],[9] The chemicomechanical method using retraction cords impregnated with hemostatic agents and astringents is the most commonly used method. Enlargement of gingival sulcus, as well as control of fluids seeping from the walls of gingival sulcus, is readily accomplished by combining chemical action with pressure packing.[10] The chemicals used along with retraction cords can be broadly classified into vasoconstrictors and astringents. Vasoconstrictors are epinephrine. Astringents are aluminum potassium sulfate, aluminum chloride, ferric sulfate, etc. The surgical retraction methods are rapid but destructive and involve excision of tissue. Gingival displacement paste (Expasyl, Pierre Rolland, France) which contains kaolin and aluminum chloride has been recently introduced.

The aim of this survey was to determine the frequency of using gingival displacement, the preferred method of gingival displacement, and the medicaments used by dental professionals.


  Materials and Methods Top


Printed questionnaires were distributed to 600 dental professionals at a National Dental Conference held in Hyderabad. The data collected and analyzed. The questionnaire contained the following questions:

  1. How often do you perform gingival retraction procedure before making impressions for fixed prostheses?
    1. For all fixed prostheses cases
    2. For long span fixed prostheses
    3. For only selected cases
    4. Never
    5. Others (specify)
  2. Your preferred method of choice for gingival displacement
    1. Mechanical
    2. Chemicomechanical
    3. Surgical
    4. Combination of the above
    5. Others (specify)
  3. If you prefer chemicomechanical method which chemical do you prefer to use?
    1. Epinephrine
    2. Aluminum chloride
    3. Ferric sulfate
    4. Aluminum potassium sulfate
    5. Tannic acid
    6. Others
  4. Do you wet the retraction cord before removal from the gingival sulcus?
    1. Yes
    2. No
  5. Do you ask for medical history?
    1. Routinely
    2. Occasionally
    3. Never
  6. Do you check pulse rate and blood pressure?
    1. Routinely
    2. Occasionally
    3. Never
  7. Have you ever had a patient complaining of any systemic manifestations as a result of gingival displacement?
    1. Yes
    2. No



  Results Top


A total 300 and 80 out of 600 questionnaires were returned, and the response rate was 63.3%. The data were presented in tables, and the frequency was represented in terms of percentage. The data were discussed as follows.


  Discussion Top


There is a variety of techniques and materials that allow the clinician to manage the gingival tissues during restoration and when making the impression. No scientific evidence has established the superiority of one technique over the other. The selection of any one of the various methods of soft tissue management to control the operative site depends on the clinical situation and the preference of the operator. In the present survey, the majority of the respondents perform gingival displacement procedure for all fixed prostheses cases. Twenty-three percentage of respondents only for long span fixed prostheses cases and 9% only for selected cases.

In the present survey, chemicomechanical method was preferred by the majority (69%) of the dentists. This could be due to the marketing and availability of various medicaments more than before. Mechanical method of gingival displacement was preferred by nine percent of the respondents. Donovan et al. reported 16.97% of dentists using plain cords for a mechanical method of gingival retraction. In the present study, 16% of respondents preferred to use the surgical method of gingival displacement. This was also shown by Azza Al-Ani et al.[11] that a relatively high number of participants using surgical method for gingival displacement.

In the present study, 51% of respondents preferred to use aluminum chloride as a medicament. On the other hand, Donovan et al. reported only 19.39% of dentists using aluminum chloride. In the present survey, majority of the respondents preferred to use aluminum chloride. This could be due to the increased level of awareness regarding the side effects of epinephrine.

In the present survey, 24% of respondents preferred to use epinephrine. Donovan et al. reported 79.3% of dentists using epinephrine. Shaw and Krejci [12] reported that epinephrine impregnated cord was used by 55% dentists as the method of the first choice for gingival retraction.

In the present study, aluminum potassium sulfate, ferric sulfate, and tannic acid were preferred by 11%, 9%, and 5%, respondents, respectively. A very less number of respondents is using tannic acid. This could be because of the fact that it has a minimum effectiveness as a gingival displacement medicament.

In this study, the majority of the respondents check the medical condition of the patients only occasionally. Donovan et al. reported a much higher percentage of dentists checking the medical condition of the patients.

Removing a dry cord from the gingival crevice can cause injury to the delicate epithelial lining.[13] In the present study, 69.2% of respondents wet the retraction cord before removal from the gingival sulcus. Donovan et al. reported that only 33.94% of respondents wetting the cords before removal from the sulcus.

In this study, only 2.8% of respondents reporting systemic reactions in the form of increased pulse rate, increased blood pressure, palpitations, and syncope as a result of gingival displacement procedure. Donovan et al.[10] reported a much higher percent of dentists who reported patients that experienced some systemic manifestations to gingival displacement procedures.


  Conclusion Top


Within the limitations of the survey, the following conclusions were drawn.

  1. Majority of the respondents advocate the gingival displacement procedure for all the fixed prostheses cases and approximately 69% prefer to use chemicomechanical method for gingival displacement.
  2. Aluminum chloride was preferred by many than other medicaments. About 69.2% respondents wet the retraction cord before removal from the gingival sulcus.
  3. The majority of the respondents check the medical condition of the patient occasionally.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Goldberg PV, Higginbottom FL, Wilson TG. Periodontal considerations in restorative and implant therapy. Periodontol 2000 2001;25:100-9.  Back to cited text no. 1
    
2.
Rosensteil SF, Land MF, Fujimoto J. Management of Soft Tissues and Impression Making. Contemporary Fixed Prosthodontics. 4th ed. St. Louis: Mosby; 2006. p. 431.  Back to cited text no. 2
    
3.
Thompson MJ. Exposing the cavity margin for hydrocolloid impressions. J South Calif Dent Assoc 1951;19:17-22.  Back to cited text no. 3
    
4.
Nemetz H, Donovan T, Landesman H. Exposing the gingival margin: A systematic approach for the control of hemorrhage. J Prosthet Dent 1984;51:647-51.  Back to cited text no. 4
    
5.
Al Hamad KQ, Azar WZ, Alwaeli HA, Said KN. A clinical study on the effects of cordless and conventional retraction techniques on the gingival and periodontal health. J Clin Periodontol 2008;35:1053-8.  Back to cited text no. 5
    
6.
Laufer BZ, Baharav H, Langer Y, Cardash HS. The closure of the gingival crevice following gingival retraction for impression making. J Oral Rehabil 1997;24:629-35.  Back to cited text no. 6
    
7.
Benson BW, Bomberg TJ, Hatch RA, Hoffman W Jr. Tissue displacement methods in fixed prosthodontics. J Prosthet Dent 1986;55:175-81.  Back to cited text no. 7
    
8.
Harrison J. Effect of retraction materials on the gingival sulcus epithelium. J Prosthet Dent 1961;11:515-21.  Back to cited text no. 8
    
9.
Woycheshin FF. An evaluation of drugs used for gingival retraction. J Prosthet Dent 1964;14:769-76.  Back to cited text no. 9
    
10.
Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent 1985;53:525-31.  Back to cited text no. 10
    
11.
Al-Ani A, Bennani V, Chandler NP, Lyons KM, Thomson WM. New Zealand dentists' use of gingival retraction techniques for fixed prosthodontics and implants. N Z Dent J 2010;106:92-6.  Back to cited text no. 11
    
12.
Shaw DH, Krejci RF. Gingival retraction preference of dentists in general practice. Quintessence Int 1986;17:277-80.  Back to cited text no. 12
    
13.
Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence Publishers; 1997. p. 262-4.  Back to cited text no. 13
    




 

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Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References

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