Clinical In the pink with the right approach
Stuart Campbell assesses the effectiveness of a variety of different clinical techniques in the management of soft tissues, highlighting potential pitfalls along the way
M
anagement of the soft tissues is a frequent chal lenge
for the restoring dentist. An effective marginal seal is essential so that a restored tooth is protected from recurrent caries and gingival irritation. Overgrown gingival tissues must be effectively managed as they can create an obstacle to achieving marginal accuracy in direct and indirect restorations. There are several clinical
techniques to facilitate soft tissue management for direct and indirect restorations: • Mechanical • Surgical • Chemico-mechanical.
Mechanical Hovestad first described tech- niques to physically displace the gingivae in 1924. These
techniques were based on the use of a copper band filled with impression compound which displaced the free gingival margin. Contemporary versions
of this technique make use of preformed cotton wool cones which are filled with a non-haemostatic polyvinyl- siloxane impression material (Magic FoamCord – Coltene Whaledent) (Fig 1). Beier has reported that this technique may be a less traumatic means of gingival retraction compared with retraction cord.
Surgical Gingival rotary curettage describes a technique where a rotary instrument is used to remove a limited amount of epithelial tissue creating a wider gingival sulcus. The technique is indicated for placement of subgingival
preparation margins, and gaining access to deep cervical lesions. Ceramic burs (Tissue Trimmers, NTI) designed for use in the air rotor at 300,00- 500,000 rpm without coolant have been marketed for this technique (Fig 2). The technique has been
associated with a greater incidence of gingival reces- sion compared with other means of soft tissue control. For this reason rotary curet- tage should only be carried out on healthy, inflammation- free tissue because of the shrinkage that occurs when diseased tissue heals. Electrosurgery can be
used to remove inflamed, overgrown tissue, widen the gingival sulcus to facilitate impression taking, remove opercula and reshape inflamed tissue. A current is directed to a small cutting electrode, producing a rapid tempera-
ture rise at its point of contact with the tissue. Concerns have been raised about the potentially damaging effects of elevated temperatures created by this technique on the alveolar bone. Furthermore, electrosur-
gery is contra-indicated in patients with cardiac pace- makers and additional training in the proper use of the technique-sensitive equipment is recommended. The use of the CO2 laser
has been described as being an extremely effective tech- nique for the management of soft tissue. Compared with the previously mentioned surgical techniques, reduced inflammation, post-operative discomfort and a bloodless field have been reported as the main advantages of the CO2 laser. However, the rela-
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Scottish Dental magazine 53
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