Clinical
easily seen and removed from the gingival sulcus. However, it has been
reported that Expasyl produces greater amounts of post-operative gingival inflammation and is not as effective at displacing the gingivae as compared to retraction cord and chemical retraction materials (Fig 3). Aluminium sulphate
(Gingi-Aid, Belport Co) and ferric sulphate (Viscostat, Ultradent) have both demon- strated excellent haemostatic ability, control of tissue fluids and temporary shrinkage of the soft tissues. However, recent research, has reported the cytotoxic effects of both of these materials. Wassell et al have observed severe gingival inflammation and tissue necrosis when aluminium sulphate astringents are used to aid tissue management. Chemico-mechanical methods of tissue manage-
“The chemico-mechanical technique has been described as the most commonly used form of soft tissue management ”
ment are readily available, easily practiced and provide reliable results. However, there are risks of damage to the soft tissues with an improper technique. A systematic approach
to chemico-mechanical tissue management has been described. The cord must first be
prepared. I prefer Ultrapack cords (Ultradent) which are available in sizes 00,0,1 and 2 (Fig 4). These cotton cords are non-impregnated, easily inserted, colour coded, can be soaked as desired and are easily differentiated from the
ginigivae. Cords are cut into lengths
appropriate to the tooth or teeth to be isolated. Suitable lengths have been recom- mended by Wise (see table below). A double cord technique
has been shown to be more effective for tissue manage-
Teeth
Maxillary anterior Maxillary premolars Maxillary molars
Mandibular anterior Mandibular premolars Mandibular molars
ment than using a single piece of cord. For this reason, two lengths of cord of different thickness are cut. A length of 00 cord is cut and laid aside, a length of either 0,1 or 2 cord is cut and soaked in a Dappens dish containing astringent solution for 10 minutes (Fig 5). After this time, the cord is
dabbed against a facial tissue to remove excess solution. The clinician now takes
the non-impregnated 00 cord and places it at the gingival margin. The cord is packed into the gingival sulcus using a Fischer UltraPak Packer. This
Continued »
Length of cord 30mm 25mm 40mm 17mm 25mm 40mm
Scottish Dental magazine 55
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