Clinical
Fig 8
Fig 9
Fig 10
Fig 11 Continued »
instrument has a serrated edge allowing for effective cord placement (Fig 6). The 00 cord is packed to its
full thickness, starting from the mesial or distal surface so that the overlapping cord ends are not located on the buccal aspect of the tooth. The 00 cord can be left in place during impression- taking, the placement of direct restorations and when final- ising preparation margins. The thicker impregnated
cord (0, 1 or 2) is then packed into the gingival sulcus to half of its thickness. The thicker cord is packed on top of the 00 cord and is left in place for no longer than five minutes. It is removed prior to impression taking or placement of direct restorations. This technique facilitates
the temporary retraction of overgrown gingivae, place- ment of subgingival marginal finishing lines, accurate impressions and haemostasis.
Case study A 57-year-old gentleman presented in practice with a lost direct composite restora- tion from unit 13. The patient reported no symptoms from
Fig 12
Fig 13
“The effective management of overgrown soft tissue is a prerequisite for direct and indirect restorative procedures ”
the tooth but was anxious for a cosmetic replacement as he had a job interview the next day. The patient’s medical
history was unremarkable. He had a medium lip-line but the lost restoration in 13 was clearly visible during conver- sation. The intra-oral examination
revealed a heavily restored but intact dentition. Unit 13 was root filled and restoration of the tooth was complicated by localised gingival over- growth (Figs 7 and 8). To comply with the
patient’s wishes of an expe- dient cosmetic restoration, a direct composite restoration was planned. Management of the soft tissues and haemo- static control were planned using a double retraction cord technique. An adrenaline containing
local anaesthetic was infil- trated around 13 and the
defect ive restorat ion removed. The cavity was assessed for caries removal using caries indicator dye (Snoop, Pulpdent). Once caries removal was
complete, a shade was agreed with the patient. A 30mm length of 00 retraction cord was cut and packed to its full thickness in the gingival sulcus, using the technique described. A second 30mm length of size 1 cord was soaked in astringent (Visco- stat) for 10 minutes, then packed to into the gingival sulcus as before (Fig 9). Once control of the over-
grown gingiva and localised bleeding was assured, a clear mylar strip was placed. The cavity was etched and rinsed, dentine was rehydrated and a fifth generation bonding agent was placed (Scotchbond, 3M Espe). A direct composite restoration (Filtek Supreme, 3M Espe) of the appropriate
shade was placed using an incremental technique. A final cure was carried out after the appication of glycerin. Final finishing and polishing was completed using composite finishing burs, polishing discs, interproximal strips and sili- cone points (Figs 10-13). The effective management
of overgrown soft tissue is a prerequisite for direct and indirect restorative proce- dures. Several techniques are available to the clinician to achieve this aim. This case study demonstrates a system- atic approach to the double retraction cord technique which provides an effective, economical and simple method of tissue management and haemostatic control for restorative procedures.
ABOUT THE AUTHOR
Stuart Campbell qualified from University of Dundee in 2001 and is a vocational trainer and partner at Loanhead Dental Prac- tice in Midlothian. He is currently studying for an MSc in Implant Dentistry at the University of Central Lancashire.
Scottish Dental magazine 57
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78