This has to be one of the most important pieces we will write as an article for our “Diary of a Dental Lab”. It is the starting point of our journey to highlight to our customers how they can better understand our challenges in the dental laboratory when it comes to collaborating with us to achieve the best outcome for their cases and it all starts with an accurate impression!
As many of our customers are now opting to send us intraoral scans over the traditional physical method of taking an impression to capture the patient situation, we are able to better illustrate the benefits of using retraction cord techniques in our initial quality control stage in the lab. With the continuous advancement of digital technologies in our sector, the current capabilities for achieving sophistication and precision are unparalleled for us as a dental laboratory at the forefront of this evolution. Embracing the reliability offered by our Zirkonzahn® CAD/CAM manufacturing processes to create precise-fitting and aesthetically pleasing dental restorations starts with clinicians effectively managing gingival tissues before the final impression is taken and sent to us in the lab. We see the benefits and challenges of this daily in the cases we receive.
Various methods and materials exist to expose a crown preparation margin line, generally falling into subtractive or displacement categories, but we will focus only on gingival displacement techniques for the purpose of this article. The retraction technique refers to the process of creating adequate space between the tooth and the gingival tissue to obtain accurate impressions for the fabrication of dental restorations. (1) This technique is crucial in various dental procedures, especially when creating crowns, bridges, and other prosthetic solutions for our customers.
Purpose: Physical methods, like using retraction cords or devices, are employed to physically displace gingival tissues and create space around the tooth.
Benefits: Mechanical retraction provides a controlled and predictable way to manage tissue displacement, ensuring accurate impressions and minimising tissue trauma.
Managing gingival tissues effectively, particularly in crown and bridge procedures is a difficult task. (1) The application of gingival retraction cord aims to offer the dentist an unobstructed working view of a tooth and its prepared margins before proceeding with the impression. (2) When the finish line of a tooth preparation is just inside the gingival sulcus, precise displacement of gingival tissues becomes crucial for obtaining an accurate impression and fabricating a restoration that. (1) The appearance and durability of restorations are heavily influenced by gingival and periodontal factors. Given the close relationship between restorations and the surrounding soft tissues, it is crucial that all procedures prioritise the health of the gingiva and periodontium.(3) Retraction cords are still the most popular method used and more emphasis has been placed on cord material design. Choice of retraction technique is also influenced by the gingival biotype and finish line position. (2) The goal of tissue displacement is to temporarily shift the gingival tissues laterally, enabling the smooth flow of low-viscosity impression material into the expanded sulcus to capture the preparation margin. In today’s digital age this aids intraoral scanners in capturing the margin distinctly, avoiding the negative impact of tissue encroachment. (1)
Benefits for us as a Dental Laboratory
- Accuracy in Impressions:
Proper retraction ensures that the impression material captures precise details of the prepared tooth and surrounding tissues, leading to accurate and well-fitting dental restorations.
- Improved Marginal Integrity:
Adequate retraction contributes to achieving better marginal adaptation of crowns and other restorations, reducing the likelihood of gaps or discrepancies at the restoration margins.
- Enhanced Aesthetics:
Accurate retraction allows for the creation of restorations that mimic the natural contours of the teeth and gingiva, contributing to improved aesthetic outcomes.
- Efficient Workflow:
When we as a dental laboratory receive high-quality impressions, it streamlines the fabrication process, reducing the need for adjustments and remakes. This, in turn, improves efficiency and turnaround times.
- Patient Comfort:
Proper retraction techniques minimise trauma to the gingival tissues, promoting patient comfort during the impression-taking process and reducing postoperative sensitivity.
- Minimising the Risk of Errors:
By receiving impressions that have used effective retraction techniques, dental laboratories can minimise the risk of errors in the fabrication process, leading to increased patient satisfaction and fewer instances of restoration failures.
Employing suitable retraction techniques in dentistry is crucial for obtaining precise impressions and, consequently, ensuring the production of high-quality dental restorations with your dental laboratory. It gives us all a chance to make a great first impression when we start to work with a customer and to build on that to have a successful relationship long-term. This is very important in our mission as a ‘Guaranteed Irish’ member, where we want to showcase the value of working with an Irish dental laboratory like PD Ceramics Ltd, invested in getting things right from the start to bring high quality dental restorations to our customer base.
Achieving optimal gingival displacement is vital for ideal margin exposure, leading to improved outcomes in both direct and indirect restorative procedures. This not only enhances the efficiency of dental laboratories and reduces the need for remakes, but also plays a significant role in overall improvement of communication between the dentist and dental technician. The real win comes with patient satisfaction and the long-term success of the dental treatment goal that builds trust, reliability and loyalty for the dental practice and dental laboratories forging a future together.
- Mills DA, Fountain AC, Velazquez D. Cord Placement Model: An Instructional Guide for Preclinical Dental Students to Practice the Skill of Retraction Cord Placement. MedEdPORTAL. 2023 Feb 28;19:11303. doi: 10.15766/mep_2374-8265.11303. PMID: 36866189; PMCID: PMC9971216. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9971216/.
- Gingival Retraction: Carville R., Journal of the Irish Dental Association. Dec 2015/Jan 2016 : Vol 61 (6) Available at: https://www.dentist.ie/_fileupload/JIDA/pdfs%20of%20Journal/2015/2015%20No_%206%20-%20December%20January.pdf
- Adnan, S., Atif S Agwan. M.: Dental Update 2023 45:4, 707-709. Gingival retraction techniques: a review, Available at: https://www.dental-update.co.uk/content/restorative-dentistry/gingival-retraction-techniques-a-review/