Using Expasyl for Other Clinical Uses
Gingival retraction agent can be employed several other ways beyond its original intended use.
Expasyl, distributed by Kerr Corporation, has long been one of dentistry’s best-kept secrets for tissue management. Originally marketed as “a replacement for traditional retraction cord,” Expasyl has many other clinical uses beyond the scope of its originally intended use. As an overall tool for soft-tissue management during restorative procedures, the author has found Expasyl to be a very efficient material and an important component of his armamentarium (Figure 1, Figure 2, Figure 3). In his experience when using Expasyl as a combination tissue deflection and hemostatic agent, in many cases it has performed better than liquid hemostatic agents. Some of the many clinical uses of Expasyl are described below.
Depending on the position of margin placement relative to the free gingival margin, Expasyl can be used alone or in conjunction with retraction cord to gain absolute access to the intracrevicular area. The hemostatic component of Expasyl creates a dry environment, and controls bleeding and sulcular exudates, so that impression materials can capture the entire restorative margin and the emergence profile of the tooth apical to the restorative margin. This is critical information for the dental ceramist to be able to create a biologically acceptable ceramic restoration.
Gingival Tissue Control
This is one area often not discussed where Expasyl—and if retraction is not necessary, Kerr’s hemostatic agent, Hemostasyl — can be very effective. Using 37% phosphoric acid to condition teeth before placing dentin adhesives during a resin cementation procedure or a direct composite restoration placement can cause bleeding from the gingival sulcus even when the gingival tissue is healthy. Using iron-containing astringents to control bleeding when using resin cements is not advised, as iron may cause a darkening of the cement color over time if it is not sufficiently removed from the tooth surface before cementation. Many hemostatic solutions applied directly to the bleeding site are difficult to control in this situation. Both Expasyl and Hemostasyl have higher viscosity, so they will not run or drip and, because no agitation is required, the possibility of irritating the tissue during application is minimized. When bleeding does occur after etching, Expasyl is placed in the affected area and compressed lightly with a cotton pellet. It is rinsed away after about 1 minute with an air-water spray combination. The gingival tissues are deflected and the bleeding is controlled. If tissue deflection is not required, Hemostasyl can be placed precisely via syringe-tip delivery in the affected area, allowed to set for 1 to 2 minutes, then rinsed away with a combination of air and water spray. If the area was previously etched, wiping the tooth surface with a cleansing agent allows the adhesive process to continue without having to re-etch the area.
Today, many dentists use lasers or electrosurgery to trough or resect excess gingival tissues before making master impressions or placing Class V direct composite restorations. Although these technologies report excellent hemorrhage control in many instances, neither is 100% effective, especially in inflamed tissue. Using Expasyl after these respective procedures, however, helps to ensure a bloodless field.
Interproximal Hemorrhage Control
The clinical success of a Class II direct composite restoration depends on isolation from moisture and liquid contaminants in the preparation when performing bonding and placement procedures. Rubber dam and other isolation devices cannot always adequately keep contaminants out of the gingival proximal area. And, the need to replace old, poorly contoured restorations often means this tissue will be inflamed. It can be extremely difficult to ensure that the preparation will remain contaminant-free during the many steps involved in bonding and composite placement. If the tissue is bleeding prior to matrix placement, Expasyl can be used to deflect the tissue away and control moisture and blood contamination. Using the same technique outlined previously, Expasyl will allow placement of the matrix and wedging without contamination, and will prevent further contamination during the bonding and placement procedure.
Just a few of the creative uses for Expasyl have been described here, including the intended use of tissue retraction for master impressions. Expasyl is a unique dental material by virtue of its ability to deflect tissue and control hemorrhage and moisture in the gingival sulcus, and, in this author’s clinical opinion, it should be on every dentist’s bracket table.
About the Author
This article was written by Robert A. Lowe, DDS.
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