Gingival retraction
Last reviewed: 07.06.2024
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In dental practice, gingival retraction is a procedure that widens the gingival sulcus - the space between the tooth surface and the surrounding gum tissue - by pulling or pushing back (trahere means "to drag" or "to pull" in Latin) the edge of the gum adjacent to the necks of the teeth. [1]
Indications for the procedure
Indications for this adjunctive procedure are:
- the need to make dental impressions (casts) for prosthetic teeth. To obtain an accurate impression with a tight marginal fit, it is necessary to expose the necks of the teeth and ensure accessibility of the gingival margin, which is achieved with a gingival sulcus width of at least 0.15-0.2 mm;
- fixation of fixed prosthetic structures (crowns, bridges, dental implant abutments) in close proximity to the gingival tissues;
- preparation of carious cavities and their subsequent filling - in the treatment of tooth decay;
- removal of sub-gingival tartar;
- Restoration of incisors (front teeth) using fixed onlays - veneers.
Preparation
Since gingival retraction is an auxiliary dental procedure, no separate preparation for it is required (except for general oral hygiene and brushing soft plaque from the teeth), and the decision on the need for retraction before taking an impression is made by prosthodontist. The prosthodontist also prescribes all necessary examinations related to the prosthetic teeth and evaluates the gum tissue and adjacent supporting structures.
If it's a matter of tooth decay or tartar, the oral cavity - the teeth and gums - are examined by a general dentist. [2]
Technique of the gingival retraction
While there are various methods of retraction - mechanical, chemical and surgical - the technique of retraction always depends on choosing the most optimal method for each particular case. Therefore, it is necessary to consider the main methods and techniques of gingival retraction, as well as the most commonly used means of gingival retraction. [3]
The most common and simple method is mechanical gingival retraction. This is gingival retraction with dental retraction floss, which is used by most prosthodontists. A suitably thick gingival retraction floss is placed under the gum margin around the tooth by tamponization (under local anesthesia). The floss is used alone (e.g. Ultrapak) or in combination with hemostatic agents (e.g. Aluminum sulfate-impregnated GINGI-Aid floss) in two ways: single floss or double floss. The depth to which the dentist tamponizes it (with a special instrument - a flat dental packer) is determined by the depth of the furrow and the condition of the periodontal tissue surrounding the teeth.
Recently, sponge tapes for gingival retraction (Merocel tape) made of biocompatible polymer material, which, in contact with moisture, swell and widen the gingival sulcus without damaging the soft tissues, have been used.
Chemical gum retraction is performed by applying hemostatic (styptic), astringent or vasoconstrictive agents to the gum tissue adjacent to the teeth. Hemostatic agents primarily include aluminum sulfate. [4]
The group of astringent compounds includes solutions of metal salts - aluminum chloride, iron sulfate, alum alum solution, tannin (tannic acid). In dentistry, hemostatic liquid Racestiptin, Alustat or Hemodent is used, as well as gingival retraction liquid Technodent - with aluminum chloride; solutions with iron sulfate - Alufer and Hemostab.
Widely used gum retraction gel with aluminum sulfate - Alu-Jen, ViscoStat Clear Ultradent; Hemosthase and Retragel gum retraction gels - with aluminum chloride; gel with iron sulfate - Viscostat Ultradent.
Retraction with vasoconstrictors involves the use of adrenaline hydrochloride, which causes local vasoconstriction (vasoconstriction) and tissue ischemia. But its use is limited by its side effects, so aluminum chloride is most often used.
Increases the comfort of patients and greatly simplifies the procedure for the doctor gingival retraction paste of various compositions (Traxodent, DMG Retraction Paste, FS Hemostatic, Astringent Retraction Paste, Gingi Trac, Expasyl), which is inserted into the gingival sulcus for a few minutes, then removed, followed by rinsing the gingiva with water and air drying it. As noted by dentists, it is a simple, quick and painless method that does not cause any chemical reactions, tissue inflammation or trauma. [5], [6], [7]
Surgical gum retraction (which is performed under local anesthesia) includes:
- rotary curettage of the gingival sulcus;
- electrosurgery (using a small curved electrode moved parallel to the long axis of the tooth);
- use of laser (under the action of which there is vaporization of surface tissues in the gingival sulcus and its expansion). [8]
Contraindications to the procedure
Gingival retraction is not performed in case of oral infections (gingivitis, stomatitis, candidiasis), as well as inflammatory periodontal diseases and a large accumulation of soft plaque.
The use of adrenaline hydrochloride as a retraction agent is contraindicated in patients with arterial hypertension, depression, as well as in cases of taking drugs of the group of beta-adrenoblockers and MAO inhibitors.
Electrosurgical retraction should not be performed on patients with a pacemaker.
Consequences after the procedure
Mechanical flossing may cause temporary swelling and inflammation of the gums, inflammation of the gingival sulcus, and if excessive force is used during flossing or if the double floss is placed too deep, the risk of permanent periodontal damage and gingival recession increases.
More than one-third of patients with floss retraction - after removal - experience bleeding from the gingival sulcus.
If an adrenaline-impregnated retraction thread is used, blood pressure and heart rate may increase, and blood glucose levels may increase in diabetic patients.
After using ferrous sulfate to impregnate the filament, discoloration of soft and hard tissues in the oral cavity is observed.