October 2012, Volume 8, Issue 10
Published by AEGIS Communications
Gingival Retraction Made Easier
New retraction capsule offers improved patient comfort and saves time, compared to traditional retraction cords and pastes.
Although the gingival retraction procedure is a daily task in most practices, many dentists do not devote much thought to it beyond noting that it can be time-consuming. After more examination, however, it may be apparent that there is significant room for improvement and time-savings in retraction materials and procedures. Dentists who prefer to use cords for their retraction technique are well aware that proper cord placement takes time and care to avoid damaging tissue. Among the complaints about available products by dentists who use paste materials for retraction is their difficulty in application and rinsing.
A New Alternative
The recently introduced 3M™ ESPE™ Retraction Capsule (3M ESPE, www.3MESPE.com) is poised to address many of the complaints about current retraction products. This 15% aluminum chloride retraction paste is packaged in unit-dose capsules that are designed with an extra-fine tip that fits directly into the sulcus. When compared with retraction cords, the retraction procedure with this material can be up to 50% faster. Additionally, while patient comfort is not typically a factor associated with retraction, this product offers dentists an option that is easier on patients.
An important advantage of the retraction capsule is that it reduces the risk of bleeding and/or hemorrhage after it is removed, and it is gentler on gingival tissue. This is especially helpful in the anterior region, where margin placement is critical for the esthetic outcome of a case. The last thing any clinician wants to see when the permanent restoration is being placed is recession, so careful treatment of the gingiva is critical during retraction.
The retraction capsule also offers advantages when compared with other retraction pastes. The fine tip of the capsule—which is significantly smaller than competitive products—provides better access into the sulcus and interproximal areas. Additionally, because the tip of the capsule is plastic with round, soft edges, dentists can use it with less worry about damaging the tissue and causing patient discomfort. The flexible tip and orientation ring are similar to those found on a periodontal probe, enabling precise control and easy intraoral handling.
The retraction capsule also fits into most common composite dispensers, eliminating the need for a dedicated dispensing gun and the time-consuming steps involved in assembling it. Its unit-dose size prevents issues with cross-contamination and makes cleanup after procedures as simple as possible. The material also extrudes very easily and evenly, while other retraction pastes can be difficult to dispense from the gun. Finally, while some retraction pastes can require a strong air and water spray to remove, the paste from the retraction capsule rinses away very easily and is simple to clean off the preparation. This benefit has been experienced by the author firsthand, and was confirmed by a clinical study that highlighted the advantage of this quality in regard to its potential for reducing contamination, which could negatively influence steps later in the procedure.1 This is a benefit not only for dentists, but for assistants as well, as they are often charged with removal of the retraction material.
Of course, dentists must select materials appropriate for specific clinical situations. The retraction capsule is indicated for procedures including material-based or digital impression-taking, cementation of temporary and permanent restorations, and preparation of Class 2 and Class 5 fillings. However, it is not indicated in cases where patients exhibit a diseased periodontium, open furcations, or exposed bone. In determining whether it is appropriate to use retraction paste, clinicians should examine the anatomy of the sulcus for the tooth in question. In cases where the sulcus is very tight, the practitioner may prefer to place a small retraction cord first and use it in combination with the retraction paste. This offers the advantages associated with the paste in hemostasis, with extra help from the cord in the physical retraction, and together still offers increased patient comfort.
The patient, a 69-year-old woman, presented with a large cervical lesion on tooth No. 21 (Figure 1). The tooth was prepared for a Class 5 composite restoration. The retraction capsule was placed into a composite dispenser, and a small amount of paste was extruded onto a mixing pad. The tip of the retraction capsule was then inserted into the sulcus and the paste was slowly injected. The retraction capsule was used to fill the sulcus area completely (Figure 2). A small cotton roll was then placed on top of the preparation, and the patient was instructed to gently bite down on the roll. The material was left in place for 2 minutes, after which it was rinsed with a combination air/water spray and suction (Figure 3). The cleanup took only a few seconds (Figure 4). After this procedure, the tooth was restored with a composite—A3 Body shade of Filtek™ Supreme Ultra Universal Restorative (3M ESPE) (Figure 5). The bonding agent used was Scotchbond™ Universal Adhesive (3M ESPE).
In a typical 40-minute appointment, the retraction capsule can save up to 5 minutes. This is obviously significant in a busy practice, and enables clinicians to devote valuable extra time to patient care and questions. The retraction capsule offers dentists a new alternative to time-consuming retraction cords and pastes, and, as the case above demonstrates, provides highly effective retraction and hemostasis while improving patient comfort.
1. Decoteau C, Ogledzki M, Soroushian S, Perry RD. Rinse time of hemostatic retraction pastes. 2011. IADR Abstract #1025.
About the Authors
Brent Fredrickson, DDS
Chalet Dental Care
St. Paul, Minnesota