GINGIVAL TISSUE MANAGEMENT covers entire tissue management

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1. GINGIVAL TISSUE MANAGEMENT ANIL KUMAR PULIDINDI

2. DETAILS OF PRESENTATION TOTAL NO OF SLIDES:116 TEXT SLIDES:76 ILLUSTRATIONS:40 TIME TAKEN:1HR 1/17/2017 2

3. TEXTBOOK REFERENCES MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION CLINICAL PERIODONTOLOGY – CARANZZA 10 TH EDITION FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION CONTEMPORARY FIXED PROSTHODONTICS – ROSENSTEIL 4 TH EDITION 1/17/2017 3

4. ARTICLE REFERENCES Prasad Adhapure , Jitendra Bhandari & Jitendra Shinde . Advances In Soft Tissue Management: A Review. International Journal of Basic and Applied Medical Sciences 2015; 5(3). M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7. 1/17/2017 4

5. Rajat R. Khajuria , Vikas Sharma, Sunil V. Vadavadgi Rishav Singh. Advances In Tissue Displacement – A Review. Annals of Dental Specialty July - Sept 2014 ; 2(3). Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402. 1/17/2017 5

6. Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014 , 11(4): 423–428. 1/17/2017 6

7. CONTENTS INTRODUCTION DEFINITION INDICATIONS NEED FOR GINGIVAL RETRACTION FEATURES OF GINGIVA AND PERIODONTIUM PRIOR TO MAKING THE IMPRESSION BIOLOGICAL WIDTH CLASSIFICATION 1/17/2017 7

8. PHYSIOCOMECHANICAL CHEMICAL SURGICAL ELECROSURGICAL LASERS NEWER SYSTEMS CONCLUSION 1/17/2017 8

9. INTRODUCTION Final result is most dependent on health and level of surrounding gingival tissues Key to success is effective soft tissue management and goal is to provide healthy gingival tissue covering sound smooth restorative margins 1/17/2017 9

10. DEFINITION Gingival displacement is defined as the deflection of the marginal gingiva away from the tooth (Glossary of prosthodontics ; The Academy of Prosthodontics,2005) Gingival tissue management refers to maintainence of soft tissue health during preparation, impression & provisionalization procedures. 1/17/2017 10 THE GLOSSARY OF PROSTHODONTIC TERMS

11. INDICATIONS Subgingival extensions of margins Control of gingival hemorrhage or fluid flow Increase length of clinical crown Enhancing restoration Recording preparation margins during impressions Removal of gingival overgrowth 1/17/2017 11 Google search

12. NEED FOR GINGIVAL RETRACTION To widen the gingival sulcus in order to provide access for impression material to reach the subgingival margins & to record the finish line accurately. Helps in obtaining a perfect die with accurate margins, which helps in margin placement & contouring of the restoration. Helps in blending of the restoration with the unprepared tooth surface. Helps in placement & finishing of the margins on the prepared tooth. 1/17/2017 12 Prasad Adhapure , Jitendra Bhandari & Jitendra Shinde . Advances In Soft Tissue Management: A Review. International Journal of Basic and Applied Medical Sciences 2015; 5(3).

13. After cementation it helps in easy removal of cement without tissue damage. It helps the dentist in visually assessing the marginal fit and any cervical caries if present. In situations where it is necessary to extend the restoration below the gingival margin to enhance retention. 1/17/2017 13 Prasad Adhapure , Jitendra Bhandari & Jitendra Shinde . Advances In Soft Tissue Management: A Review. International Journal of Basic and Applied Medical Sciences 2015; 5(3).

14. To enhance access and to prevent damage to the soft tissue during cavity preparation procedure, it may be desirable to carry out some degree of gingival retraction prior to commencement of preparation 1/17/2017 14 Prasad Adhapure , Jitendra Bhandari & Jitendra Shinde . Advances In Soft Tissue Management: A Review. International Journal of Basic and Applied Medical Sciences 2015; 5(3).

15. FEATURES OF GINGIVA AND PERIODONTUM PRIOR TO MAKING THE IMPRESSION In Crest of free gingiva -- no anticipated recession. Periodontium -- sound & undergo healthy healing Free gingiva should be temporarily reduced to expose preparation Crevicular fluids & bleeding – completely arrested. 1/17/2017 15 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

16. A temporary trough is prepared to expose circumferential tie Procedures without any detachement of epithelial attachement & PDL. 1/17/2017 16 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

17. BIOLOGICAL WIDTH GARGINGLO – showed biologial width Placement of gingival margins within this biological width leads to gingival inflammation, clinical attachement loss, Bone loss 1/17/2017 17

18. CLASSIFICATION According to MARZOUK Physico -mechanical Chemical Electro surgical Surgical According to SHILLINGBERG Mechanical Chemo-mechanical Rotary curettage Electrosurgery 1/17/2017 18

19. According to TYLMAN : Mechanical Mechanical-chemical Surgical - Electrosugery - Gingitage 1/17/2017 19

20. PHYSICOMECHANICAL MEANS Mechanically displace gingival tissues laterally & apically away from the tooth surface. Temporary restorations like ZOE Copper bands Rolled cotton/ snythetic cords Heavy weight rubber dam 1/17/2017 20 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

21. Temporary restorations like ZOE: Employs gentle pressure over a period of time. Uses custom temporary restoration Gingival ends covered with bulky temporary cements like ZOE It reflects the tissue laterally Results cant be observed for atleast 24hrs 1/17/2017 21 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

22. ROLLED COTTON/ SYNTHETIC CORDS: Are forcibly introduced into the gingival sulcus . Results are seen within 30 minutes 1/17/2017 22 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

23. HEAVY WEIGHT RUBBER DAM: It will necessitate multiple tooth isolation, has an immediate effect. Heavy (0.010 Inch or 0.25 mm) Extra Heavy (0.012 Inch or 0.30 mm) Special Heavy (0.014 Inch or 0.35 mm) 1/17/2017 23 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

24. Retraction is done by rubber dam or clamps (No. 212 cervical retainer). Full arch impressions are difficult Feasible for single tooth \ quadrent impressions only. 1/17/2017 24 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

25. COPPER BANDS: Oversized copper bands are contoured to the gingiva and restricted towards the cavity margin . The band should be about 2.0mm wider than the MD width of tooth. A resin or compound plug is placed on tip of the band for stability. 1/17/2017 25 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

26. DISADVANTAGES: Incisional injuries to gingival tissues. It is time consuming Tissue trauma Shrinkage of tissue 1/17/2017 26 MARZOUK - OPERATIVE DENTISTRY 1 ST EDITION

27. CHEMICAL These methods use retraction cords, drawn cotton rolls and cotton pellets impregnated with chemicals for stoppage of bleeding and seeping of crevicular fluid. VASOCONSTRICTORS FLUID-COAGULANTS SURFACE TISSUE LAYER COAGULANTS 1/17/2017 27 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014 , 11(4): 423–428

28. VASOCONSTRICTORS These physiologically restricts the blood supply to the area by  the size of the blood capillaries. ↓ haemorrhage ↓ tissue fluid seepage ↓ size of gingiva consequently. RACEMIC EPINEPHRINE, & NON-EPINEPHRINE 1/17/2017 28 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

29. EPINEPRINE SYNDROME: TACHYCARDIA HYPERVENTILATION RAISED BLOOD PRESSURE ANXIETY POSTOPERATIVE DEPRESSION 1/17/2017 29 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

30. CONTRAINDICATIONS: Patients with cardiovascular diseases. Hypertension Diabetes Hyperthyroidism Hypersensitivity to epinephrine 1/17/2017 30 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

31. FLUID COAGULANTS These coagulate blood and tissue fluids locally. Forms surface layer that is an efficient sealant against blood and crevicular fluid seepage These are safe agents in regards to systemic effects. 100% ALUM ; 15-25% ALUMINIUM CHLORIDE; 10% ALUMINIUM POTASSIUM SULPHATE; 15-25% TANNIC ACID 100% Alum is used most commonly used. 1/17/2017 31 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

32. Use of the cord impregnated with aluminum chloride (5–10%) is the safest and most effective method of gingival displacement acts as hemostatic agent and astringent. It has ability to Precipitate protein,Constrict blood vessels Extract fluid from tissues 1/17/2017 32 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

33. SURFACE TISSUE LAYER COAGULANT These coagulates surface layer of sulcular and free gingival epithelium as well as seeped fluid. Creates temporary seal. 8% Zinc chloride & Silver nitrate used 1/17/2017 33 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

34. DISADVANTAGES: Ulceration. Local necrosis 1/17/2017 34 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

35. These chemicals can be carried to the field of operation in one of the 3 ways. C ords Drawn cotton rolls Cotton pellets. 1/17/2017 35 Pardis tarighi , Maryam khoroushi . A review on common chemical hemostatic agents in restorative dentistry. Dent Res J 2014

36. CORDS Used for the isolation and retraction in direct procedures of Treatment of cervical lesion, Facial veneering, Indirect procedures involving gingival margin. These are ready made cotton or synthetic woven cords. Some cords have a Metallic wire \ Resin wire around them for Compactness, Immobility, Non-shredding property 1/17/2017 36 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

37. The largest cord that can be atraumatically placed in the sulcus should be used. The small-diameter cords do not provide adequate lateral displacement 1/17/2017 37 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

38. CLASSIFICATION OF CORDS Depending on number of strands Single Double Depending on the configuration Twisted Braided Knitted 1/17/2017 38 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

39. Depending on the chemical treatment plain Impregnated Depending on surface finish Waxed Unwaxed 1/17/2017 39 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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41. Depending on thickness they are colour coded 1/17/2017 41 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

42. ARMAMENTARIUM: Evacuator (saliva ejector, svedopter ), Scissors, Cotton pliers, Mouth mirror, Explorer, Fischer Ultra Packer (small), Cotton rolls, Retraction cord, Hemodent liquid, Dappen dish. 1/17/2017 42 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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45. TECHNIQUES Single cord technique Double cord technique Infusion technique Every other tooth technique. 1/17/2017 45 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

46. SINGLE CORD TECHNIQUE For impression of one or three prepared teeth Simple, efficient & most commonly used method of achieving gingival displacement The largest-diameter braided or knit cord that fits in the sulcus should be used The cord is carefully packed into the sulcus in a counterclockwise direction. 1/17/2017 46 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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48. DOUBLE CORD TECHNIQUE A small-diameter cord with no medicament is first placed in the depth of the sulcus . A larger-diameter cord with the medicament is placed above the small-diameter cord. After waiting 8 to 10 minutes, the large-diameter cord is soaked in water and removed. . 1/17/2017 48 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

49. The preparation are dried, and the impression is made with the primary cord in place. The small-diameter cord is soaked in water and removed from the sulcus 1/17/2017 49 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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51. THE INFUSION TECHNIQUE Hemorrhage is controlled by using a specifically designed dento-infusor with ferric sulfate medicament(15% or 20% ). Knitted retraction cord is placed in sulcus , wait for 1 to 3 min. Effective ancillary for control of hemorrhage when using the single cord technique 1/17/2017 51 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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53. THE EVERY OTHER TOOTH TECHNIQUE It can be used with the single or double cord technique. Retraction cord is placed around the most distal prepared tooth. No cord is placed around the prepared tooth mesial to this tooth. Retraction procedures are completed on alternate teeth. 1/17/2017 53 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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57. DRAWN COTTON ROLLS Soft loose cotton rolls can be readily rolled to a desired diameter. They were already impregnated or to be impregnated with chemicals . ADVANTAGES: Easily compacted in the sulcus DISADVANTAGES : coagulated surface layer may get deeply incorporated in cotton. It initiates bleeding and fluid seepage called as cotton roll burn 1/17/2017 57

58. COTTON PELLETS Used to carry the chemicals to the already compacted, inserted cords or drawn cotton rolls. If they are allowed to remain on top of the cord/cotton they provide a continuous source of chemical 1/17/2017 58

59. SURGICAL TECHNIQUES Techniques are used for gingival tissue management Electro/ Radio surgery Surgical knives Laser surgery Rotary gingival curettage 1/17/2017 59

60. ELECTRO SURGICAL TECHNIQUE Arsonvol (1891) demonstrated that electricity at high frequency will pass through a body without producing a shock (pain or muscle spasm), producing instead an increase in the internal temperature of the tissue 1/17/2017 60 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

61. The electrosurgical unit is a high frequency oscillator or radotransmitter which uses either a vacuum tube or a transmitter. Current flows from a small cutting electrode which producesHigh current densityRapid temperature rise at the contact point 1/17/2017 61 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

62. INDICATIONS: Areas of inflamed Gingival tissues Gingival proliferations around finish lines CONTRAINDICATIONS: Cardiac pace makers Flammable aerosols should be avoided 1/17/2017 62 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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66. Dental impressions ideally extend 0.3 – 0.5 mm below the cavity margin to ensure accuracy. Electrosurgery removes a ribbon of tissue around the cavity margin After impression making ORABASE ( Benzocaine ) is placed – Subgingival trough heals in 5 – 7 days 1/17/2017 66 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

67. CURRENTS There are 4 main types of electrosurgical wave forms : Depending on the type of machine and circuit. Unrectified damped current Partially rectified damped Fully rectified current Fully rectified filtered 1/17/2017 67 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

68. UNRECTIFIED DAMPED CURRENT Characterized by recurring peaks of power which diminish rapidly Gives rise to intense dehydration and necrosis. Considerable coagulation. Healing is slow and painful 1/17/2017 68 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

69. PARTIALLY RECTIFIED DAMPED Waveform with damping in second half of each cycle Advantage: Good coagulant and hemostasis Disadvantage: lateral penetration of heat and slower healing 1/17/2017 69 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

70. FULLY RECTIFIED CURRENT Continuous flow of energy ADVANTAGES: Good cutting characteristics Hemostasis is achieved Better gingival enlargement is observed 1/17/2017 70 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

71. FULLY RECTIFIED FILTERED Continuous wave Excellent cutting. Histologically healing was not as better as the fully rectified current 1/17/2017 71 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

72. TYPES OF ACTION ELECTROSECTION/ ACUSECTION:2-4 Cutting current Bloodless with minimal tissue involvement 1. Gingival troughing 2. Planing tissue Biterminal current used 1/17/2017 72 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

73. ELECTRO COAGULATON:3-5 Hemostasis Destroy necrotic tissue Uses Ball/bar electrode If overdone - CARBONIZATION Biterminal current 1/17/2017 73 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

74. FULGERATION:2 Tip remains 1/8 inch above tissue Fistula tracts ; Papillomas ; Hemorrhage Always accompanied by carbonization Uses wire electrode Monoterminal current used 1/17/2017 74 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

75. DESSICATION:6 Massive tissue involvement [depth and surface area] Most unlimited & uncontrolled of all Tissue reactions are unpredictable Monoterminal current used 1/17/2017 75 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

76. Gingival crevice enlargement Small ; Straight electrode Sulcus is enlarged 1/17/2017 76 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

77. SURGICAL GINGIVECTOMY Gingival Pockets Suprabony Pockets & Gingival Enlargement Aesthetic considerations Bone loss 1/17/2017 77 CLINICAL PERIODONTOLOGY – CARANZZA 10 TH EDITION

78. INSTRUMENTS USED: Kirkland& Orban knives #11, #15 & #12 BP blades Scissors 1/17/2017 78 CLINICAL PERIODONTOLOGY – CARANZZA 10 TH EDITION

79. PROCEDURE: 1/17/2017 79 CLINICAL PERIODONTOLOGY – CARANZZA 10 TH EDITION

80. ROTARY GINGIVAL CURRETAGE “ Gingettage ” or “ Denttage ” Troughing technique It prepares the tooth subgingivally while simultaneously curetting the inner lining of the gingival sulcus with rotary diamond instrument. Amsterdam gave the concept,further developed by Hansing and Ingraham 1/17/2017 80 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

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82. CRITERIA: Must be done on healthy and inflammation free tissue to prevent tissue shrinkage Absence of bleeding on probing Sulcus depth less than 3.0 mm . 1/17/2017 82 FUNDAMENTALS OF FIXED PROSTHODONTICS – SHILLINGBURG 3 RD EDITION

83. LASERS 1960 - first working laser –Ruby crystal - Theodore H.Maiman 1/17/2017 83 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

84. LASER WAVELENGTH USED IN DENTISTRY: Argon laser: 488 nm (blue) Diode: 810 nm & 830 nm Neodymium: Yttrium aluminum garnet ( Nd : YAG):1064nm Erbium: Yttrium aluminum garnet laser ( Er : YAG): 2940nm CO2 laser: 10,600 nm 1/17/2017 84 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

85. LASER TISSUE INTERACTION: ABSORPTION TRANSMISSION REFLECTION SCATTERING 1/17/2017 85 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

86. Lasers work through Photo-ablation and produce Completely blood free incisions Painfree healing no underlying inflammation. This effect depends on the degree of temperature rise and the corresponding reaction of the interstitial and intracellular water . 1/17/2017 86 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

87. ADVANTAGES: Excellent hemostasis is provided by CO2 laser There is reduced shrinkage of tissue There is comparatively less pain and the sulcus is also sterilized. 1/17/2017 87 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

88. DISADVANTAGES: Er : YAG lasers are not good for producing hemostasis CO2 laser provides no tactile feedback, leading to risk of damage to junctional epithelium. 1/17/2017 88 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

89. NEWER RETRACTION SYSTEMS EXPANSYL RERACTION PASTE MAGIC FOAM CORD MEROCEL STRIP STAY PUT RETRACTION CORD MATRIX IMPRESSION SYSTEMS RACEGEL GINGITRAC 1/17/2017 89 Hugh D. Flax . Soft and Hard Tissue Management Using Lasers in Esthetic Restoration. Dent Clin N Am 20 11; 55:383–402.

90. EXPANSYL RERACTION PASTE It gives excellent retraction. It physically displaces tissue for marginal access. It is absolutely safe. It requires minimal pressure & causes no damage to epithelial tissue. It significantly saves time. It can be placed quickly. It also has hemostatic action hence controls bleeding & crevicular seepage. 1/17/2017 90 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

91. Expasyl is injected into the sulcus , physically displacing the tissue. It is left for 1-2 minutes and then rinsed. 1/17/2017 91 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

92. Expasyl’s 15% aluminum chloride controls bleeding and crevicular seepage. After rinsing, Expasyl leaves the sulcus open and dry. Elastomeric materials can be used. 1/17/2017 92 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

93. CONTRAINDICATIONS: Presence of periodontal pocket & furcation involvement. Known allergy to aluminium. 1/17/2017 93 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

94. MAGIC FOAM Designed for easy and fast retraction of the sulcus without the potentially traumatic & time consuming packing of retraction cord. It is a non-traumatic method of temporary gingival retraction. 1/17/2017 94 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

95. It has easy & fast application directly to the sulcus without pressure or packing. No special training or technique is required. It is comfortable to the patient. It contains no hemostatic chemicals that may contaminate the impression site. There is no need for extensive rinsing of residue or hemostatic chemicals. 1/17/2017 95 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

96. Crown preparation is completed prior to retraction. Pre-fit Comprecap per each crown preparation is selected. Apply Magic Foam Cord around the crown preparation. 1/17/2017 96 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

97. Place Comprecap & have the patient bite & maintain pressure on the Comprecap . 1/17/2017 97 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

98. Remove Comprecap after 5 minutes. The result is a wide open sulcus with clear access for the wash material. 1/17/2017 98 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

99. LIMITATIONS: Hemostasis cannot be achieved. Less effective on subgingival margins 1/17/2017 99 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

100. MEROCEL STRIP Merocel retraction strips are a synthetic material that is specifically chemically extracted from a biocompatible polymer ( hydroxylate polyvinyl acetate) that creates a netlike strip without debris or free fragments 1/17/2017 100 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

101. It can be easily shaped & adapted around the tooth. It is highly effective in absorption of oral fluids. It is not abrasive and hence provides a gentle displacement 1/17/2017 101 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

102. A 2 mm thick Merocel retraction strip is inserted around the tooth and the provisional crown is reinserted 1/17/2017 102 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

103. The patient is asked to maintain pressure on the artificial crown & concomitantly on position is sustained for 10 to 15 minutes. The Merocel retraction strips tend to expand with absorption of selected oral fluids, exerting pressure on surrounding tissues to provide gingival retraction. 1/17/2017 103 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

104. STAYPUT RETRACTON CORDS It is a unique combination of softly braided retraction cord & ultra fine copper filaments When it is shaped, it remains in shape & does not deform Can be Impregnated/ Non-impregnated. Aluminum chloride hexahydrate 1/17/2017 104 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

105. ADVANTAGES: Hemostasis is fast Possible to be preshaped Pliable and can be adapted Relatively safe for cardiac patients 1/17/2017 105 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

106. MATRIX IMPRESSION SYSTEMS Clear plastic carrier is selected from assortment of premade forms. Carrier may also be made of wax Matrix is made in carrier with polyvinyl siloxane material before soft tissue is retracted 1/17/2017 106 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

107. Registration of gingival crest is primary objective. Tissue under planned pontics and precision attachments should be included 1/17/2017 107 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

108. Matrix is painted with polyether adhesive to generate more secure bond with nonbonding materials. Impression syringe is used to fill matrix with high viscosity impression material 1/17/2017 108 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

109. Matrix impression is seated with light pressure. Axial walls and positive vertical stops make proper seating easily discernible. Mark may be lacked on facial surface for proper orientation, because many references are covered with impression material 1/17/2017 109 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

110. OVERCOMES THE DRAWBACKS: Registration of subgingival margins Gingival retraction & relapse Hemostasis & sulcular cleansing Delivery of impression material subgingivally Strengthening the sulcular flange of the impression & Simplification for making complex impressions. 1/17/2017 110 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

111. RACEGEL It contains 25% aluminum chloride, oxyguinol, and excipients . Aluminum chloride is an astringent. The bright orange color makes it easy to dispense, place, and rinse Used with or without gingival retraction cords 1/17/2017 111 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

112. Before impression making,it is used to obtain hemostasis and dry field in the sulcus . Racegel becomes more viscous on tissue contact because of its thermodynamics. Produces finish line exposure with minimum bleeding. It is easily rinsed, leaving no irritation of the surrounding tissue. Its thermal effect is reversible when rinsed with water. 1/17/2017 112 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless , and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

113. GINGITRAC Gingitrac is a paste system that uses a syringe to apply the paste around the margins. The syringe is preloaded with the paste. The paste contains aluminum sulfate as an astringent. If necessary, a hemostatic agent can be applied before its use. 1/17/2017 113 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

114. 1/17/2017 114 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

115. ADVANTAGES: Easier to express from automix gun Longer shelf life Faster setting time Controls oozing of blood Removal is fast and easy Materials slip cleanly out of sulcus without trauma. 1/17/2017 115 M.Aarti Rajambigai , S.Ramesh Raja, S. I.Joephin Soundar , M.Kandasamy . Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioall Sci 2016;8:55-7.

116. CONCLUSION Atraumatic gingival tissue management for impression making provides greater patient comfort during and after impression making. Soft tissue mismanagement will produce inaccurate impressions and hamper the long term success of the restorations. 1/17/2017 116