Tissue diplacement/ dentistry orthodontics

Tissue DisplacementTissue Displacement
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Tissue DisplacementTissue Displacement
• Change in the form or position of tissues as
a result of pressure
• Deflection of marginal gingiva away from a
tooth
• Synonyms
– Gingival retraction
– Gingival displacement

AIMS & OBJECTIVESAIMS & OBJECTIVES
• Reflect gingiva and produce enlargement or
dilate gingival sulcus
• To obtain 0.2 - 0.4 mm of horizontal
displacement of marginal gingiva
• To achieve 0.5 mm of vertical exposure of
unprepared portion of tooth

METHODSMETHODS
Mechanical
Mechanochemical
Surgical

Mechanical MethodsMechanical Methods
Rubber damRubber dam
Retraction cords - PlainRetraction cords - Plain
Copper bandCopper band
Temporary acrylic resin copingTemporary acrylic resin coping

Rubber DamRubber Dam

Retraction CordsRetraction Cords

• ClassificationClassification
– Surface texture - Wet or Dry
– Configuration - Twisted, knitted or plain
– Surface finish - Waxed or unwaxed
– Thickness (colour
coded) - Black 000 (extra small)
Yellow 00 (small)
Purple 0
Blue 1
Green 2
Red 3 (extra large)
– Chemical treatment - Plain or impregnated
– Number of strands - Single or Double string

IDEAL REQUIREMENTSIDEAL REQUIREMENTS
Safe locally , and systemically
Effective for its intended use
Effects should be spontaneously reversible
Absorbent
Provide hemostasis
No chemical injury to gingival tissues

AdvantagesAdvantages
(Plain cord)(Plain cord)
 Tissue recovery is excellentTissue recovery is excellent
 Provide pressure hemostasisProvide pressure hemostasis
 Ease of manipulationEase of manipulation
 Commonly usedCommonly used

DisadvantagesDisadvantages
Poor in its ability to displace gingiva
Trauma and recession from packing
pressure

Copper BandCopper Band

 Advantages
– To retrieve the localised impression defect in
multiple preparation
Disadvantages
– Incisional injury
– Inaccuracy

Mechanochemical methodMechanochemical method
• Chemical action + pressure pack- enlargementChemical action + pressure pack- enlargement
of gingival sulcusof gingival sulcus
• Materials used-retraction cord &Materials used-retraction cord &
medicamentsmedicaments

• CriteriaCriteria
– Effectiveness of gingival displacement andEffectiveness of gingival displacement and
hemostasishemostasis
– Absence of irreversible damage to gingivaAbsence of irreversible damage to gingiva
– Paucity of untoward systemic effectsPaucity of untoward systemic effects

TechniquesTechniques
• Single string techniqueSingle string technique
• Deknatel technique / double stringDeknatel technique / double string
techniquetechnique
• Selective double stringSelective double string

ARMAMENTARIUMARMAMENTARIUM

Packing InstrumentsPacking Instruments

DOUBLE CORD TECHNIQUEDOUBLE CORD TECHNIQUE

Selective Double StringSelective Double String
• Indications:Indications:
– Spontaneous bleeding of gingival crevice isSpontaneous bleeding of gingival crevice is
presentpresent
• Techniques:Techniques:
– Pre packing of extra thin cord only into the areaPre packing of extra thin cord only into the area
of inflamed creviceof inflamed crevice
– Followed by packing with thin cord which isFollowed by packing with thin cord which is
removed during impressing making.removed during impressing making.

Epinephrine 0.1 & 8%Epinephrine 0.1 & 8%
• Recommended time & Mechanism of action
– 5-10 min Pronounced vasoconstriction
 Advantages
– Good displacement & haemostasis
• Tissue Recovery
– Fair
Disadvantages
– Systemic reactions
– Contraindications – Cardiovascular disease,
hyperthroidism, hypersensitivity to epinephrine
– Epinephrine syndrome – Increased heart rate, respiratory
rate and BP.

Alum (100%)PotassiumAlum (100%)Potassium
Aluminium SulphateAluminium Sulphate
– 10 – 20 min. Precipitation of protein and inhibiting
transcapillary movement of plasma protein
 Advantages
– Minimal tissue loss
– Extended working time
• Tissue Recovery
– Good
Disadvantages
– Less displacement and haemostasiswww.indiandentalacademy.com

Aluminium Chloride 5%-25%Aluminium Chloride 5%-25%
Aluminium sulphate 25%Aluminium sulphate 25%
– 10 mins. Weak Vasoconstrictor
 Advantages
– Minimal tissue loss
– Good haemostasis
• Tissue recovery
– Good
Disadvantages
– Local tissue destruction > 10%concentration

Ferric Sulphate 13.3%Ferric Sulphate 13.3%
– 1 – 3 minutes
 Advantages
– Good tissue response
– Compatible with Aluminium Chloride
• Tissue recovery
– Good
Disadvantages
– Not compatible with epinephrine
– Transient tissue discolorationwww.indiandentalacademy.com

Ferric sub SulphateFerric sub Sulphate
(Monsel’s Solution)(Monsel’s Solution)
Recommended time & Mechanism of action
3 mins
 Advantages
Good displacement
Tissue recovery
Good
Disadvantages
Highly acidic and messy to work

Zinc Chloride 8% & 40%Zinc Chloride 8% & 40%
 Advantages
– Good displacement
• Tissue recovery
– 8% - Fair
– 40% - Fair
Disadvantages
– Tissue necrosis and permanent tissue injury

Tissue diplacement/ dentistry orthodontics

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