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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 76-81

Evaluation of knowledge and attitude about gingival displacement materials and techniques among dental practitioners


Department of Prosthodontics, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India

Date of Web Publication31-Dec-2018

Correspondence Address:
Dr. Rajlakshmi Banerjee
“Vrindavan,” Ground Floor, Sagar Palace Building, I/9, Lakshmi Nagar, Nagpur - 440 022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_27_18

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  Abstract 


Statement of Problem: Edentulism is a condition that critically affects the quality of life of patients by compromising function as well as esthetics. Fixed partial dentures have been a treatment of choice to replace missing teeth. Despite its various advantages, failures are not uncommon. Recording accurate impressions is a crucial prerequisite to ensure the success of prosthesis. Gingival displacement, especially in restorations with subgingival margins, is extremely important to record the accurate impressions of the finish line.
Aim and Objectives: The purpose of the study was to evaluate the knowledge and attitude about gingival displacement materials and techniques among dental practitioners in Nagpur region.
Materials and Methods: A survey consisting of 15 questions regarding gingival deflection method was distributed among 200 dental practitioners. The participants were approached personally with the printed questionnaire and through E-mail.
Results: The survey showed that approximately 86% of the dental practitioners practicing in Nagpur region did not perform gingival displacement before making impressions. Out of 16% of the dentists who perform gingival displacement, only 10% of them were prosthodontists. The most common method used for gingival displacement was retraction cord. Better techniques such as cordless gingival displacement were used by only 6% of the dentists because of lack of knowledge and technique sensitivity of these materials. Financial concerns may also be a deterrent for performing gingival displacement in such cases.
Conclusion: Hands-on experiences on gingival displacement need to be imparted at the undergraduate level and the importance of gingival displacement for the success of prosthesis needs to be conveyed to dental practitioners, so as to bring about a change which results in a better rehabilitation of patients with partial edentulism.

Keywords: Gingival displacement; gingival retraction; retraction cord


How to cite this article:
Gajbhiye V, Banerjee R, Radke U, Chandak A, Jaiswal P. Evaluation of knowledge and attitude about gingival displacement materials and techniques among dental practitioners. Indian J Multidiscip Dent 2018;8:76-81

How to cite this URL:
Gajbhiye V, Banerjee R, Radke U, Chandak A, Jaiswal P. Evaluation of knowledge and attitude about gingival displacement materials and techniques among dental practitioners. Indian J Multidiscip Dent [serial online] 2018 [cited 2019 Nov 21];8:76-81. Available from: http://www.ijmdent.com/text.asp?2018/8/2/76/249117




  Introduction Top


Displacement of the gingival tissue is essential for obtaining accurate impressions for the fabrication of fixed prostheses, particularly when the finish line is at or within the gingival sulcus.[1] Gingival displacement or gingival retraction is defined as the deflection of marginal gingiva away from the tooth to create sufficient lateral and vertical space between the preparation finish line and the gingival tissue to allow the injection of adequate bulk of the impression material into the expanded crevice.[2] Impression along the subgingival margin is critical to the marginal fit and emergence profile of the prosthesis. The critical sulcular width has been reported to be approximately 0.2 mm at the level of the finish line. Impressions with less sulcular width have higher incidences of voids, tearing of impression materials, and less marginal accuracy.[2] The techniques used to accomplish gingival deflection can be classified as mechanical, chemico-mechanical, and surgical.[3] The mechanical method of gingival displacement using plain retraction cord has been a standard for several years. It acts by physically pushing the gingiva away from the finish line, but its effectiveness is limited because of its inability to control the sulcular fluid seepage. The chemico-mechanical method using retraction cords impregnated with hemostatic agents and astringents is the most commonly used method. The chemicals used along with retraction cords can be broadly classified into vasoconstrictors and astringents.[4] Various newer materials and techniques have been introduced for gingival displacement in recent years, and therefore it was deemed necessary to conduct a study to evaluate and compare the preferred methods and materials for gingival displacement by dental professionals in Nagpur region.


  Materials and Methods Top


Ethical approval for the study was obtained from the Institutional Review Committee of VSPM Dental College and Research Centre, Nagpur. A descriptive cross-sectional study was undertaken that included 200 dental practitioners, chosen by convenient [Table 1] sampling method using an already validated questionnaire taken from an earlier study.[2] The participants were approached personally with the printed questionnaire which consists of 15 questions or through E-mail. Inclusion criteria included participants who were willing to participate in the survey. Participants who were not willing to participate in the survey were excluded from the study.


  Results Top


Out of the total dental practitioners practicing in Nagpur region, 66% were general dental practitioners, 15% were prosthodontists, 13% were endodontists, 3% were oral surgeons, 1% was periodontists, while the rest 2% were other dental practitioners. Descriptive statistics was done with the help of SPSS for Windows version 15.0 (SPSS Inc., Chicago, IL, USA). The survey showed that approximately 89% of the dental practitioners, practicing in Nagpur region, do not perform gingival displacement before making impressions. Only 12% of the dentists reported using gingival retraction cord [Figure 1], [Figure 2], [Figure 3], [Figure 4], while 88% of the dentists do not use retraction cord. Better techniques such as cordless gingival displacement were used by a very few dentists, i.e., 6%, because of the lack of knowledge and technique sensitivity of this material.
Figure 1: Percentage data of dental practitioners

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Figure 2: Percentage of dentists using gingival displacement techniques

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Figure 3: Percentage of dentists using gingival retraction cord

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Figure 4: Percentage of dentists using cordless retraction techniques

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  Discussion Top


Finish lines are frequently placed at or just below the crest of the gingival margin, meaning that gingival retraction is usually necessary when impressions are taken.[5],[6],[7],[8],[9],[10] Gingival retraction is the displacement of gingival tissue to gain access to the tooth surface below the finish line. There are a variety of techniques and materials available for gingival displacement and finish line exposure. The selection of any one of the various methods depends on the clinical situation and the preference of the operator. The mechanical method of gingival displacement using plain retraction cord has been a standard for several years.[11] It acts by physically pushing the gingiva away from the finish line, but its effectiveness is limited because of its inability to control the sulcular fluid seepage. The chemico-mechanical method using retraction cords impregnated with hemostatic agents and astringents is the most commonly used method.[11]

Enlargement of gingival sulcus as well as control of fluids seeping from the walls of gingival sulcus is readily accomplished by combining chemical action with pressure packing.[12] The chemicals used along with retraction cords can be broadly classified into vasoconstrictors and astringents. Vasoconstrictors are epinephrine. Astringents are aluminum potassium sulfate, aluminum chloride, ferric sulfate, etc., Surgical retraction methods are rapid but destructive and involve excision of tissue.[13],[14] Cordless technique claims of being more effective in displacing tissues and less injurious to gingival health. Gingival displacement paste (Expasyl™, Pierre Rolland, France), which contains kaolin and aluminum chloride, has been recently introduced.[12],[13]

In the present survey, chemico-mechanical method was preferred by a majority (4%) of the dentists. This could be due to the marketing and availability of various medicaments more than before. In the present study, 26.1% of the participating dentists used preimpregnated cords, of which 49% were impregnated with aluminum chloride, 27.6% with epinephrine, and 29.8% with aluminum potassium sulfate. In the study by Giridhar Reddy et al.,[3] 24% of the respondents preferred to use epinephrine-impregnated cord. On the other hand, Donovan et al. found that 79.39% used epinephrine-impregnated cords; 19.39% used cords with alum, aluminum sulfate, or aluminum chloride; and 16.97% used plain cord.[12],[16] Shaw and Krejci[17] reported that epinephrine-impregnated cord was used by 55% of the dentists. In the present study, majority of the respondents preferred to use aluminum chloride-impregnated retraction cord.[13] In the present study, 69.2% of the respondents wet the retraction cord before removal from the gingival sulcus. This could be due to an increased level of awareness that removing a dry cord from the gingival crevice can cause injury to the delicate epithelial lining.[18] The mechanical method of gingival displacement was preferred by 9% of the respondents. Donovan et al.[12] reported 16.97% of dentists using plain cords for mechanical method of gingival retraction. In the present study, 16% of respondents preferred to use surgical method of gingival displacement.

Al-Ani et al.[16] reported a relatively high number of participants using surgical method for gingival displacement. In the present study survey, chemico-mechanical method was preferred by a majority (69%) of the dentists. On the other hand, Donovan et al.[12] reported that only 19.39% of dentists were using aluminum chloride. In the present survey, majority of the respondents preferred to use aluminum chloride. This could be due to the increased level of awareness regarding the side effects of epinephrine. In the present survey, 24% of respondents preferred to use epinephrine. Donovan et al. reported that 79.3% of dentists were using epinephrine.

In this study, majority of the respondents check the medical condition of the patients only occasionally. Donovan et al.[12] reported a much higher percentage of dentists checking the medical condition of the patients and checking patients who experienced some systemic manifestations to gingival displacement procedures. In this study, only 2.8% of respondents reported systemic reactions in the form of increased pulse rate, increased blood pressure, palpitations, and syncope as a result of gingival displacement procedure. The results of the study were in accordance with that of previous reports[19],[20],[21] on the efficacy of gingival displacement on the clinical gingival and periodontal health.


  Conclusion Top


It can be concluded that gingival displacement is a very important step in the fabrication of fixed partial denture, which is being overlooked by the dental practitioners in Nagpur region. The effect of not performing gingival displacement procedure before impression making should be reiterated, hands-on experience on gingival displacement needs to be imparted at the undergraduate level, and the importance of gingival displacement for the success of prosthesis needs to be conveyed to dental practitioners, so as to bring about a change which results in a better rehabilitation of patients with partial edentulism.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[Additional file 1]

 
  References Top

1.
Prasad DK, Hegde C, Agrawal G, Shetty M. Gingival displacement in prosthodontics: A critical review of existing methods: J Intdiscip Dent 2011;1:1-7.  Back to cited text no. 1
    
2.
Shetty K. Gingival tissue management: A necessity or a liability? Triv Dent J 2011;2:112-9.  Back to cited text no. 2
    
3.
Giridhar Reddy SV, Bharathi M, Vinod B, Reddy KV. Gingival displacement methods used by dental professionals: A survey. J Orofac Sci 2016;8:120-2.  Back to cited text no. 3
    
4.
Ashri NY, Ai Rifaiy MQ, EI-Metwally A. The effect of gingival retraction cord on periodontal health compared to other gingival retraction procedures: A systematic review. Periodon Prosthodon 2016;2:1-10.  Back to cited text no. 4
    
5.
Moldi A, Gala V, Puranik S, Karan S, Deshpande S, Neela N, et al. Survey of impression materials and techniques in fixed partial dentures among the practitioners in India. ISRN Dent 2013;2013:430214.  Back to cited text no. 5
    
6.
Ahmed SN, Donovan TE. Gingival displacement: Survey results of dentists' practice procedures. J Prosthet Dent 2015;114:81-5.  Back to cited text no. 6
    
7.
Shrestha L, Pradhan D, Mehta VV, Dixit S. Gingival retraction methods: A descriptive survey among dentists in Nepal. Int J Contemp Med Res 2017;4:1836-9.  Back to cited text no. 7
    
8.
Rosenstiel SF, Land MF, Fujimoto J. Management of Soft Tissues and Impression Making. Contemporary Fixed Prosthodontics. 4th ed. St. Louis: Mosby; 2001. p. 431.  Back to cited text no. 8
    
9.
Thompson MJ. Exposing the cavity margin for hydrocolloid impressions. J Southern Calif Dent Assoc 1951;19:17-22.  Back to cited text no. 9
    
10.
Nemetz H, Donovan T, Landesman H. Exposing the gingival margin: A systematic approach for the control of hemorrhage. J Prosthet Dent 1984;51:647-51.  Back to cited text no. 10
    
11.
Harrison J. Effect of retraction materials on the gingival sulcus epithelium. J Prosthet Dent 1961;11:515-21.  Back to cited text no. 11
    
12.
Donovan TE, Gandara BK, Nemetz H. Review and survey of medicaments used with gingival retraction cords. J Prosthet Dent 1985;53:525-31.  Back to cited text no. 12
    
13.
Woycheshin FF. An evaluation of drugs used for gingival retraction. J Prosthet Dent 1964;14:769-76.  Back to cited text no. 13
    
14.
Goldberg PV, Higginbottom FL, Wilson TG. Periodontal considerations in restorative and implant therapy. Periodontol 2000 2001;25:100-9.  Back to cited text no. 14
    
15.
Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: Length of service and reasons for replacement. J Prosthet Dent 1986;56:416-21.  Back to cited text no. 15
    
16.
Al-Ani A, Bennani V, Chandler NP, Lyons KM, Thomson WM. New Zealand dentists' use of gingival retraction techniques for fixed prosthodontics and implants. N Z Dent J 2010;106:92-6.  Back to cited text no. 16
    
17.
Shaw DH, Krejci RF. Gingival retraction preference of dentists in general practice. Quintessence Int 1986;17:277-80.  Back to cited text no. 17
    
18.
Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of Fixed Prosthodontics. 3rd ed. Chicago: Quintessence Publishers; 1997. p. 262-4.  Back to cited text no. 18
    
19.
Al Hamad KQ, Azar WZ, Alwaeli HA, Said KN. A clinical study on the effects of cordless and conventional retraction techniques on the gingival and periodontal health. J Clin Periodontol 2008;35:1053-8.  Back to cited text no. 19
    
20.
Laufer BZ, Baharav H, Langer Y, Cardash HS. The closure of the gingival crevice following gingival retraction for impression making. J Oral Rehabil 1997;24:629-35.  Back to cited text no. 20
    
21.
Benson BW, Bomberg TJ, Hatch RA, Hoffman W Jr. Tissue displacement methods in fixed prosthodontics. J Prosthet Dent 1986;55:175-81.  Back to cited text no. 21
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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