Research Article

Gingival retraction in prosthodontics - A review

Ashish R. Jain*

ABSTRACT

A common objective for impressions and interim crowns or fixed dental prostheses is to register the prepared abutments and
finish lines accurately. For all impression procedures, the gingival tissue must be displaced to allow the subgingival finish
lines to be registered. Swift increase in research work in the recent past leaves no option for a clinician, but to be updated
and to possess the optimum knowledge to rationalize the use of materials and techniques that are employed for gingival
displacement in proximity to teeth. Numerous advancements have occurred in impression making for fixed prosthesis in the
present century. The purpose of this article is to review the latest advancements in the field of tissue retraction and analyze
their merits and demerits so that adequate amount of unprepared tooth structure can be recorded with least distortion of
impression material as well as minimal damage to attachment apparatus of the tooth.

KEY WORDS: Gingival displacement, Gingival retraction Paste, Gingival retraction, Retraction cord

INTRODUCTION width is commonly stated to be 2  mm, which

represents the sum of epithelial and connective
Gingival Retraction tissue measurements (Block 1987). Biologic width
Gingival retraction is defined as the deflection is also defined as the total of supracrestal fibers,
of marginal gingiva away from a tooth (GPT junctional epithelium, and gingival sulcus (Nevins
2005).[1] Accurate impressions for subgingival and Skurow).
crown margins require gingival tissue retraction.
Various materials, methods, and techniques exist Dimensions of Biologic Width[5]
for gingival retraction. This review presents various Gargiulo et al. reported in 1961 a certain uniformity
studies related to gingival architecture, materials, of the dimension of some components of biologic
techniques, and tissue reaction following gingival width: mean depth of the histologic sulcus is 0.69 mm,
retraction. mean junctional epithelium measures 0.97  mm
(0.71–1.35 mm), and mean supraalveolar connective
Ideal Requirements of Gingival Retraction Agent tissue attachment is 1.07  mm (1.06–1.08  mm).
A gingival retraction agent should be effective for The total of the attachment is, therefore, 2.04 mm
its intended use, safe both locally and systemically, (1.77–2.43  mm) and is called the biologic width,
and the effects should be spontaneously reversible, essential for the preservation of periodontal health,
wearing off in a short time, leaving no permanent and removal of irritation that might damage the
tissue displacement (Jokstad 1999).[2] periodontium (prosthetic restorations, for example). If
the biologic width is violated during the preparation
Importance of Biologic Width[3,4] of the tooth, some authors claim that there will be
Biologic width is defined as the dimension of soft no place left for the attachment and the result in the
tissue, which is attached to the portion of the tooth development of attachment loss and pocketing can
coronal to the crest of the alveolar bone. The biologic be observed. Violated biologic width can result in
uncontrolled bone resorption and might grow over
Access this article online the quantity of the bone necessary for the supralimbal
insertions of the connective tissue attachment on the
Website: [Link] ISSN: 0974-6943
tooth root. The result is advanced periodontitis.

Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha University, Chennai, Tamil Nadu, India

*Corresponding author: Dr.  Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospital,
Saveetha University, Ponamalle High Road, Chennai – 600  127, Tamil Nadu, India. Phone:+91-9884233423.
E-mail: dr.ashishjain_r@[Link]

Received on: 20-08-2017; Revised on: 19-09-2017; Accepted on: 28-10-2017

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 Ashish R. Jain

Margin Placement and Biologic Width[6,7] one tooth to ensure an accurate assessment (Michael
Two basic factors should be taken into account. First G Newman 2006).
is the shape and the method of preparation, which
depends on the therapist. The second factor is the VIOLATION OF BIOLOGIC
ultimate success of the restoration, which is influenced WIDTH[11]
by a number of items. It is desirable to place the
margin in a location that will facilitate the following: If the biologic width is violated, it is impossible
Preparation of the tooth and finishing of the margin to maintain periodontal health due to (a) bone
(easiest supragingivally): loss under the preparation margin that violated the
• Duplication of the margins with impressions that biologic width. Pocket and progressive periodontal
can be removed past the finish line without tearing tissue loss (periodontal ligament and bone) develop
or deformation (easiest supragingivally). and (b) gingival recession and localized bone
• Fit and finish of the restoration and removal of loss develop. This happens in cases where the
excess material (easiest supragingivally). labiobuccal bone is thin. (c) Localized gingival
• Verification of the marginal integrity of the hyperplasia with minimal bone loss (Michael G
restoration (easiest supragingivally). Newman 2006).

A number of factors hold some importance for the Correcting Biologic Width Violations[12]
success of a prosthetic restoration: Biologic width violation can be corrected by either
• Brushing, flossing, and maintaining the restoration surgically removing bone away from proximity to the
on a daily basis (easiest supragingivally). restoration margin or orthodontically extruding the
• Removing plaque, calculus, and performing periodic tooth and thus moving the margin away from the bone.
inspection of the marginal integrity of the restoration Surgery is more rapid of the two treatment options;
without damaging the marginal fit or scratching the the bone should be moved away from the margin by
restorative material (easiest supragingivally). the measured distance of ideal biologic width for that
• Avoiding changes in gingival contour (easiest patient, with an additional 0.5 mm of bone removed
supragingivally). for a safety zone.
• Improving the esthetics.
• Root sensitivity. Subgingival margin placement is Critical Sulcular Width[6,9,11]
only a temporary solution if the gingival recession Critical sulcular width: 0.2 mm (SF Rosenstiel 2001)
progresses. Good oral hygiene and local fluoride
treatment resolve most root sensitivities. Impression with width <0.2mm:
• Subgingival extension of caries, restorations, or • ↑ Incidence of voids in the marginal area.
fractures. In the past, subgingival margin placement • ↑ Tearing of impression material
was advocated for teeth, in which insufficient • ↓ Marginal accuracy.
or questionable retention could be gained from
supragingival margins. This was to give greater Margin Placement Guidelines[5-7,9,12]
length and surface area, and sometimes more The first step in using sulcus depth as a guide in
parallelism, for increased retention. Today, the margin placement is to manage gingival health. Once
best way to achieve is preprosthetic surgical the tissue is healthy, the following three rules can be
crown lengthening procedure, which establishes an used to place intracrevicular margins
adequate biologic width and allows correct margin
placement (Ksenija JorgiÊ-Srdjak 2000). 1. Rule 1: If the sulcus probes 1.5 mm or less, place
the restoration margin 0.5 mm below the gingival
Evaluation of Biologic Width[8-11] tissue crest. This is especially important on the facial
Radiographic interpretation can identify interproximal aspect and will prevent a biologic width violation
violations of biologic width. A  more positive in a patient who is at high risk in that regard.
assessment can be made clinically by measuring the 2. Rule 2: If the sulcus probes more than 1.5  mm,
distance between the bone and the restoration margin place the margin half the depth of the sulcus below
using a sterile periodontal probe. If this distance the tissue crest. This places the margin far enough
is <2  mm at one or more locations, a diagnosis of below tissue so that it will still be covered if the
biologic width violation can be confirmed. The patient is at higher risk of recession.
biologic, or attachment, width can be identified for 3. Rule 3: if a sulcus >2  mm is found, especially
the individual patient by probing to the bone level on the facial aspect of the tooth, evaluate to
(referred to as sounding bone) and subtracting the see if a gingivectomy could be performed to
sulcus depth from the resulting measurement. This lengthen the teeth and create a 1.5  mm sulcus.
measurement must be done on teeth with healthy Then, the patient can be treated with rule 1
gingival tissues and should be repeated on more than (Michael G Newman 2006).

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Classification and Methods of Gingival Chemico-Mechanical

Retraction[13-39] Gingival retraction using chemically impregnated
(Barkmeier and Williams 1978) retraction cord is a mechanico-chemical method of
1. Surgical retraction (gingivectomy and gingivoplasty, displacement. Two forms:
periodontal flap procedures, electrosurgery, and (a) Chemical aspect
rotary gingival curettage). (b) Mechanical aspect.
2. Non-surgical retraction (rubber dam and clamps,
Chemical aspect: Chemicals used
retraction cord-impregnated/non-impregnated,
retraction rings, copper bands). • 0.1% epinephrine for 10 min
• 100% alum solution (potassium aluminum sulfate)
(Thompson M.J 1959) for 10 min
• 5% and 25% aluminum chloride solution for 10 min
1. Conventional.
• 13.3% ferric sulfate solution
2. Radical.
• 8% and 40% zinc chloride solution for 3 min
(Benson et al., 1986) • 20% and 100% tannic acid solution for 10 min
• Merocel
1. Mechanical method
• Ferric subsulfate (Monsel’s solution) for
2. Chemicomechanical method
3 min
3. Rotary gingival curettage
• Neosynephrine
4. Electrosurgical methods.
• 45% Negatol solution (45% condensation product
Methods of Retraction of meta-cresol sulfonic acid and formaldehyde)
• Caustic acid – sulfonic acid, trichloracetic acid.
Mechanical: Physically displacing the gingiva was • Nasal and ophthalmic decongestants.
one of the first methods used for insuring adequate • Oxymetazoline hydrochloride 0.05%.
reproduction of the preparation finish line. • Tetrahydrozoline hydrochloride 0.05%.
• Phenylphrine hydrochloride 0.25%.
• Rubber dam
• Combinations of chemicals.
• Copper rings (copper band and tube)
• Cocaine 10% with 0.1% epinephrine.
• Aluminum shell
• Zinc chloride with 8% epinephrine.
• Cotton twills with ZnO-E cement
• Plain cotton cords. The materials used in conservative gingival retraction
are (1) alum (saturated solution), (2) racemic
Copper band retraction method was found to be
epinephrine (8:100), (3) alum and racemic epinephrine
most satisfactory as it produced the least evidence in equal parts, (4) tannic acid (20% solution),
of trauma and less marked inflammatory reaction, and (5) zinc chloride (8% solution). The chemical
and after 8 days, the copper band retraction areas agents used are Monsel’s solution (ferric subsulfate)
were completely healed and least recession values and zinc chloride (40% solution). Injuries caused by
(0.1 ± 0.1 mm) followed by cord (0.2 ± 0.1 mm) and retraction agents (alum, zinc chloride, and epinephrine
electrosurgery (0.6 ± 0.2 mm) (Ruel, Schuessler et al. with the cord) on gingival sulcus epithelium were
1980). Various advantages of copper band gingival healed within 7–10  days (James 1961). Visine
retraction technique (rubber base material in copper (tetrahydrozoline HCl, 0.05%), afrin (oxymetazoline,
bands) are as follows: 0.05%) produced tissue displacement greater than any
• The gingival tissue retraction is maximal and of the other agents; neosynephrine (phenylephrine
superior to indirect retraction methods. HCl, 0.25%), epinephrine, and alum were more
• The margins may be established at maximum effective than the untreated mechanical control
subgingival depth. (Plain, untreated cord) (Bowles et al. 1991).
• The band impression made under pressure will have Tetrahydrozoline – sympathomimetic vasoconstrictor
no air bubbles or voids. (Visine) was found to have the lowest inflammatory
• The wax-lined tray has close border adaptation and potential. The ratio of the connective tissue area
ensures a bubble and void-free impression on the to that of the inflammatory infiltrate showed that
adjacent oral structures. 25% aluminum chloride (racestyptine) was the
• The technique can be used for sectional or complete most aggressive and tetrahydrozoline the least
arch impression, inlays, three-quarter crowns, or full aggressive retraction agent used (Kopac et al. 2002).
coverage crowns. Sympathomimetic vasoconstrictors have a pH of
• Only the tray type of impression material is required. 5.6 (0.05% tetrahydrozoline) and are free of systemic
• It is not necessary to pour the cast as soon as the side effects (most retraction agents have pH values
impression is made (Darby and Darby 1973). from 0.8 to 3.0) T 25% aluminum chloride was the

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most aggressive agent that took only 1 min to damage et al. 1992; Pallasch 1998; Yagiela 1999). Fluid
all cell cultures. The proportion of cells damaged absorbency of retraction cords after soaking it in
after 10  min of exposure to tetrahydrozoline was aluminum chloride solution does not lessen the cords
60%, which was significantly less compared with ability to absorb fluid. Because aluminum chloride
other chemicals tested (Kopac et al. 2002). About solution does aid in hemorrhage control, soaking
25% aluminum chloride produced significantly cords before placement may be a useful adjunctive
greater amount of cellular damage more aggressive technique (Runyan et al. 1988). Potassium aluminum
than 0.05% tetrahydrozoline, which caused only sulfate produced fewer gingival inflammatory
mild changes in the cultured cells rat keratinocytes changes than aluminum chloride, and 8% racemic
(Kopac et al. 2002). Negatan solution (an aqueous epinephrine. Factors other than the chemical agent
solution containing in 100 g. approximately 45 g of (e.g., physiologic differences in patients) may play a
a condensation product obtained by reacting meta- role in the amount of gingival inflammation induced
cresol sulfonic acid with formaldehyde) was highly (de Gennaro et al. 1982). Use of cord impregnated
acidic and decalcified the teeth. When very high with aluminum chloride (5–10%) is referred to be the
concentrations or amounts of epinephrine were safest and most effective method of gingival retraction
applied locally to lacerated tissue, epinephrine could (Ramadan et al. 1972; Azzi et al. 1983). About 10%
be absorbed causing an increase in the heart rate and aluminum chloride solution acts as hemostatic agent
blood pressure. This could be risky for patients with and astringent. It has the ability to precipitate protein,
cardiovascular disease, hyperthyroidism, and to certain constrict blood vessels, and extract fluid from tissues.
hypersensitive individuals. Therefore, application It is highly soluble in water, freely soluble in alcohol,
of high concentration of epinephrine to large areas and soluble in glycerin. Aluminum chloride has no
of lacerated or abraded gingival tissues should be contraindications and minimal side effects and when
avoided (Felix 1964). Human blood pressure and pulse used in low concentrations have only a mild effect
rate response to racemic epinephrine retraction cord on the gingiva, whereas concentrated solutions cause
were (a) the pulse rate of patients after application of severe inflammation and necrosis (Shaw et al. 1980).
racemic epinephrine-impregnated retraction cords
Mechanical aspect
depends more on the level of anxiety and stress
Retraction cords
than on the level of epinephrine; (b) blood pressure
A gingival retraction cord resembles yarn. Pieces of
is elevated by placement of racemic epinephrine-
cotton or polyester are braided together to create a
impregnated retraction cords on an exposed vascular
specific diameter. Some brands of gingival retraction
bed or lacerated tissue; (c) 4% racemic epinephrine-
cord are pre-soaked in hemodent, a liquid used to
impregnated retraction cords cause less elevation of
stop minor bleeding of the gum tissue. Many dentists
blood pressure than 8% racemic epinephrine cords;
prefer to soak the gingival retraction cord in hemodent
(d) although the elevations in blood pressure from 8%
themselves, while others choose not to use hemodent
cord occur within a narrow range, this range may be
to stop any bleeding from the gingival tissue.
hazardous to cardiac patients. Therefore, 4% racemic
epinephrine cord should be used; (e) a desirable Classification of Retraction Cords
amount of tissue retraction is produced by 4% racemic
a. Depending on the configuration: Knitted, braided,
epinephrine cord; and (f) dry cords do not provide
twisted.
adequate retraction of tissue and are contraindicated
b. Depending on surface finish: Waxed and unwaxed.
for tissue-retraction purposes (Pelzner et al. 1978). c. Depending on the chemical treatment: Impregnated
The potential epinephrine reactions that can occur and plain.
following systemic absorption include increased d. Depending on number strands: Single and double-
anxiety after cord placement, limb tremor, diaphoresis, string.
headache, florid appearance, tachycardia, and elevated e. Depending on the thickness (color coded):
blood pressure (Malamed 1993). However, there Black-000, yellow-00 purple-0, blue-1, green-2,
are many variables that make it difficult to predict red-3
the physiological effect. These variables include f. Depending on surface texture: Wet and dry.
the concentration of epinephrine absorbed from the
cord; the length of time the cord is in the sulcus; To achieve a crevicular width of 0.2 mm cord should
the condition of the gingival tissue; the presence of remain in the gingival crevice for an optimum time
crevicular fluid or saliva; individual patient response; of 4 min before impression making (de Camargo
and drug interactions with tricyclic antidepressants, et al. 1993). Investigation of the length of time for
non-selective ß-adrenergic antagonists, certain general medicated displacement cord should remain in the
anesthetics, and cocaine. Therefore, recommendations gingival crevice before impression making. Initially,
have been made to either limit or avoid use of such a silk cord (deknatel) was placed into the sulcus over
epinephrine-impregnated retraction cords (Kellam which medicated cord was placed and not removed

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 Ashish R. Jain

during the study. Hemodent on Ultrapak #1 were controlled in 1  min  -  score 2. Hemorrhage control
placed into the gingival sulcus for 2, 4, 6, and 8 min. with a cord saturated in hemodent was more effective
Following cord removal, closure of the sulcus was than water-saturated or dry cords (Weir and Williams
recorded at intervals using a miniature video camera. 1984) Two layers of cord should be placed into the
Crevicular widths were measured at the midbuccal crevice wherever feasible, one below the finish line
and transitional line angle areas. At both the midbuccal of the preparation and one at the finish line. The
and transitional line angle areas, gingival crevices instrument should slide along the tooth surface, over
displaced for 2 min were significantly smaller at 20 s the chamfer or shoulder and into the crevice. The face
(P < 0.5) than crevices following displacement for 4, of the blade should have dimensions of approximately
6, and 8 min. No significant difference in crevicular 1.5  mm by 0.4 mm. The cord is left in place for
width was found at any period after cord removal approximately 5 min before making the impression.
for crevices displaced for 4, 6, and 8 min (Baharav This time is adequate for action of the drug in the cord
et al. 1997). Although the sulcular widths at the MB but short enough to avoid caustic injury (Fisher 1976).
and TLA points were similar immediately after the DL-adrenaline HCl-impregnated gingival retraction
cords were removed, the MB sulcus remained open cord was the most toxic (to human gingival
longer. Anatomic and microstructual differences at fibroblast) gingival retraction cord among aluminum
the TLA and MB gingiva may be responsible for the sulfate (GingiAid), and non-drug impregnated cord
different closure patterns of two areas. The gingiva (Gingi-Plain) (Liu et al. 2004). Chemically treated
at the interproximal area is not only thicker than the retraction cord used in conjunction with a modified
buccal area but also richer in collagen fibers. The acrylic resin temporary crown with a retraction collar
transitional line angle is an area of intersection of is applicable for all teeth and is used before making
the dentogingival and semicircular fibers, and the final impressions (Lawrence 1964). Impregnated
transgingival fibers originating from adjacent tooth. retraction cord showed poor results on gingival
In addition, the thick alveolar bone, in this area,
health when assessed histologically in respect to
gives rise to thicker alveologingival fibers than
periodontium as compared with retraction pastes
in the midbuccal area. Cords untreated with drugs
(Expasyl, Magic foam cord) (Phatale et al. 2010).
could be used safely for periods of 5–30  min and
that cords treated with 8% epinephrine or 100%
alum solution could be used safely for 5–10  min
TECHNIQUES OF GINGIVAL
(James 1961). Consistency of the cord whether it RETRACTION[40-48]
is twined or knitted is more important than the type
Gingival displacement can be accomplished using
of medicament used. Knitted cord showed better
several different techniques. No clinical study has
performance and there was no difference between
demonstrated the superiority of one technique over
alum-treated cord and epinephrine (Jokstad 1999).
another, so the choice of which procedure to use
Braided ULTRAPAC retraction cords (No.  00,
No.  0, and No.1) with identical lengths (35  mm) depends on the presenting clinical situation and
were soaked for various time intervals (2 s; 1, 5, operator preference.
and 60 min; and 24 h) in the medicament solutions
Single-Cord Technique
(epinephrine, aluminum chloride, and ferric sulfate)
at room temperature. 20  min of soaking time This technique is indicated when making impressions
was necessary for saturation of the cords before of one to three prepared teeth with healthy gingival
use, provided that air trapped within the cords tissues. It is the most commonly used method for
was removed. In addition to the soaking time, the gingival displacement.
saturation of the cords with the solutions largely
Double-Cord Technique
depended on the wetting of the cords (Csempesz et al.
2003). Cord induced the least clinical damage to the This technique is routinely used when making
periodontal tissues, both in terms of recession and impressions of multiple prepared teeth and when
attachment loss when compared with electrosurgery, making impressions when tissue health is compromised.
and rotary gingival curettage; however, all the
methods induced some kind of minor damage. Infusion Technique of Gingival Displacement
Apical migration of junctional epithelium was not The infusion technique for gingival displacement
seen in all the three techniques (Azzi et al. 1983). uses a significantly different approach from single- or
Retraction cords were placed with minimal overlap double-cord technique, it represents the action of the
around each tooth after 10  min; the cord was viscostat solution and the use of the dentoinfusor with
removed and evaluated for amount of bleeding; No a rub-scrub action that enables the hemostatic solution
bleeding - score 0, bleeding controlled with air and to penetrate the open small capillaries and form
water spray within 1 min - score 1, and bleeding not coagulum plugs.

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Every Other Tooth Technique crown, (2) create a subgingival sulcus, and (3)
The undesirable outcome of unesthetic black triangles reduce excessive height of hypertrophic tissue from
in the gingival embrasures can be prevented with this edentulous areas. A U-shaped loop electrode is used
technique. This can be used with the single- or double- as the working electrode with the active (cutting),
cord technique. Retraction cord is placed around the current. The loop is held approximately at a 15°
most distal prepared tooth. No cord is placed around angle to the surface of the tooth and is pointed
the prepared tooth mesial to this tooth. Retraction rootward. An acute angle in the tissue results, and
procedures are completed on alternate teeth. very little of the marginal gingiva is removed. For
a wider sulcus, a less acute angle is necessary,
Merocel Retraction Strips but more of the marginal gingiva will be removed
Merocel retraction strips were a predictable retraction (Anthony 1964). Combination of electrosurgery of
material in conjunction with impressions procedures. marginal gingival tissues and retraction by placing
Merocel reaction strips are a synthetic materials the cord in the gingival sulcus allows making of
that are specifically chemically extracted from a accurate impressions of multiple prepared teeth with
biocompatible polymer (hydroxylate polyvinyl advantages of ample working time, ease of operation
acetate) that creates a netlike strip without debris or and impression free from capillary seepage (Lampert
free fragments. The material possesses beneficial 1970). Electrosurgery (0.6 ± 0.2 mm) showed more
physical properties such as effective absorption of recession values than copper band (0.1 ± 0.1  mm)
intraoral fluids, free of fragments, chemically pure, and cord (0.2 ± 0.1  mm) (Ruel et al. 1980). The
and executing moderate pressure on gingival tissue electrosurgical method showed more tissue loss at
without requiring local anesthesia, which ensures a each time interval, more subject variability, clinically
gingival tissue displacement atraumatically (Ferrari indiscernable tissue appearance at the time intervals
et al. 1996). tested, and provided for a greater bulk of impression
material at the margin than when compared with our
SURGICAL method (DeVitre et al. 1985). Regrowth of gingival
tissue around abutment teeth after electrosurgical
Rotary Curettage–Gingitage, Denttage, Troughing procedures showed an average reduction of gingival
Technique crest height of 0.23 mm after 6 months. Almost 70%
The purpose of which is to produce limited removal of regrowth occurred 1 month after insertion of the
of epithelial tissue in the sulcus while a chamfer finish final restoration. Pain was often associated with
line is being created in tooth structure. Concept of the electrosurgical procedure in third molar regions
using rotary curettage was described by Amsterdam in and in the palatal areas of maxillary anterior teeth.
1954 and further developed by Hansing and Ingraham. Periodontal packs were not helpful in controlling
Gingitage involves simultaneous subgingival post-electrosurgical discomfort and do not aid
tooth preparation and intentional rotary diamond healing (Coelho et al. 1975).
instrument curettage of the inner lining of the gingival
sulcus. The definitive tissue removal allows room RETRACTION PASTES[43-50]
for the placement of retraction cord and insertion
of impression materials. There was no significant Expasyl Retraction Paste
difference between the cord displacement technique Expasyl, an alternative to dental retraction cord, is
and the gingitage technique (Tupac and Neacy 1981). a viscous paste used for all procedures requiring
Recession of clinical magnitude was induced only gingival retraction including impressions, seating of
by rotary gingival curettage when compared with restorations, fitting rubber dams, and restoring Class
retraction cord and electrosurgery. Apical migration 2, 3, and 5 cavities. Unlike cord, little or no pressure
of junctional epithelium was not seen in all the three to apply expasyl, which greatly minimizes the risk
techniques (Azzi et al. 1983). Rotary curettage was of rupturing the epithelial attachment and enhances
efficient and predictable technique for retraction, patient comfort. Expasyl is extruded directly into
but it created recession on thin tissues than on thick the sulcus where it holds its rigidity to create space
(maxillary anterior fixed partial denture) palatal between the tooth and the tissue, much like retraction
tissues (Kamansky et al. 1984). cord. Bleeding and crevicular seepage are controlled
through the presence of aluminum chloride, which
Electrosurgery or Surgical Diathermy also shrinks epithelial tissue further expanding the
Electrosurgery unit is a high frequency oscillator sulcus. Expasyl utilizes a mechanical and chemical
or radiotransmitter that uses either vacuum tube or component for sulcus opening and hemostasis. It
a transistor to deliver a high-frequency electrical is comprised of three materials: Kaolin, water, and
current at least 1.0MHz. Electrosurgery is used aluminum chloride. Expasyl contains white clay
in restorative dentistry to (1) elongate the clinical (kaolin) to ensure the consistency of the paste and

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 Ashish R. Jain

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