Pastes and Lasers Offer New Options to Clinicians Who Are Ready to “Cut the Cord”
Stephan D. Poss, DDS
For many decades, retraction cord has been the "gold standard" for gingival displacement. This is largely due to its low cost, ease of use, and predictable results. It comes in many sizes, with or without an impregnated hemostatic agent, and can be combined with other medicaments extraorally before use. Unfortunately, improper use of retraction cord can cause postoperative sensitivity and pain as well as gingival recession. It is also time-consuming for the clinician to place.
Many have adopted newer materials and techniques in an effort to make tissue retraction procedures easier. One approach is to start by considering a more conservative preparation. Instead of a crown, could the tooth be restored with an inlay or an onlay? Some clinicians were trained to place all margins subgingivally, regardless of the specifics of the situation. I have seen this approach used too many times when retraction cord was not necessary. Because the use of porcelain-fused-to-metal crowns has declined dramatically, there is not as much need to bury the margins of a crown below the gingival height. This is especially true with adhesive dentistry. If a treatment or a procedure requires retraction, depending on the specific needs of the case, clinicians can consider the use of retraction paste in place of retraction cord. It is a little more expensive, but much less traumatic to the patient and can save the clinician time. In situations requiring double cord packing, clinicians can elect to place a single cord in a smaller size, then use retraction paste in place of the second cord. This can be beneficial in cases requiring greater hemostatic control.
Today, a discussion about retraction materials and methods would not be complete without mentioning lasers. Diode lasers have dropped dramatically in cost. A fair number of my colleagues do not use retraction cord at all; they clean out any excessive tissue with a diode laser and if necessary, use a small amount of retraction paste.
Because gingival retraction will always present challenges, clinicians may want to think "outside of the box of retraction cord" and consider other newer methods that can be just as effective, reduce trauma, and save time for the dentist as well as the patient.
Stephan D. Poss, DDS, a diplomate of the American Board of Craniofacial Dental Sleep Medicine and the Academy of Clinical Sleep Disorders Disciplines and a fellow of the American Academy of Craniofacial Pain, has directed numerous live patient continuums on esthetic anterior and posterior restorations at various teaching institutes. In addition to consulting for several dental manufacturers in the area of new product development, he has published numerous articles in the leading dental journals; lectures internationally on esthetic dentistry, sleep apnea, and temporomandibular joint disorder (TMD); and maintains a restorative and TMD practice in Brentwood, Tennessee.