Introduction of new materials and improved technologies has created new opportunities to attain these goals of prevention and aesthetics in dental practice. For a precision fit and long-term success with fixed prosthetic dental restorations, the quality of impressions taken is a key element of decisive importance. Taking an accurate impression requires appropriate tooth preparation and soft-tissue management followed by proper selection of impression material, system, tray and the impression technique. The purpose of this review is to demonstrate the high qualities of a new, preventive and improved, temporary retraction materials and techniques

Gulab Chand Baid

Rupali Kamath

Sarandha D.L

English

eDENT Journals

Advances in Gingival Retraction 
 
Rupali Kamath,1 Sarandha D.L,2 Gulab Chand Baid3 
 
Introduction   
  Marginal integrity is one of the important factors, which contribute to the success of 
cast restorations. The restoration can survive in the biological environment of the oral 
cavity, only if the margins are closely adapted to the finish line of the preparation 
  The gingiva must be displaced to make a complete impression and sometimes even 
to permit completion of the preparation and cementation of the restoration.  The 
procedure to expose the sub-gingival finish lines of preparation may be termed as 
gingival displacement, also referred as gingival retraction, gingival deflection and 
gingival tissue deflection.  
Need for the gingival retraction 
1. To widen the gingival sulcus in order to provide access for impression material to 
reach the subgingival margins and to record adequately the finish line. 
2. Helps in obtaining the perfect die with accurate margins, which helps in margin 
placement and contouring of the restoration. 
3. Helps in blending of the restoration with the unprepared tooth surface. 
4. Helps in placement and finishing of the margins on the prepared tooth. 
5. During cementation it helps in easy removal of cement without tissue damage.  
6. It helps the dentist in visually assessing the marginal fit and any caries if present. 
7. In situations when it is necessary to extend the restoration below the gingival 
margin to enhance retention. 
8. To enhance access and to prevent damage to the soft tissue during cavity 
preparation procedure, it may be desirable to carry out some degree of gingival 
retraction prior to commencement of preparation.  
 
 
 For the retraction of soft tissue, three principle methods are available for use today: 1) 
   IJCDS • FEBRUARY, 2011 • 2(1) © 2011  Int. Journal of Clinical Dental Science 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ABOUT THE AUTHORS 
 
1. 1.Dr. Rupali Kamath MDS,  
2. Professor, 
3. Dr. Syamala Reddy Dental 
College and Hospital, 
Bangalore, Karnataka, India, 
4.  rupalikamath@yahoo.com 
5.  
6. 2.Dr . Sarandha D.L MDS, 
7. Professor,   
8. Dr. Syamala Reddy Dental 
College and Hospital, 
Bangalore, Karnataka, India , 
9.  drsarandha@gmail.com 
10.  
11. 3.Dr. Gulab Chand Baid, 
12. Post Graduate student, 
13. Dr. Syamala Reddy Dental 
College and Hospital, 
Bangalore,Karnataka,India.  
drgulabbaid@gmail.com 
14.  
 
Corresponding Author:  
 
Dr. Gulab Chand Baid 
Post Graduate Student 
Dr. Syamala Reddy Dental 
College and Hospital ,  
SGR main road , Munnekolala, 
Marathahalli,  
Bangalore, Karnataka, India. 
 
Email: 
drgulabbaid@gmail.com 
Phone no - 9035761615 
 
 
Abstract      
                         
Introduction of new materials and improved technologies has created new opportunities to 
attain these goals of prevention and aesthetics in dental practice. For a precision fit and long-
term success with fixed prosthetic dental restorations, the quality of impressions taken is a key 
element of decisive importance. Taking an accurate impression requires appropriate tooth 
preparation and soft-tissue management followed by proper selection of impression material, 
system, tray and the impression technique. The purpose of this review is to demonstrate the 
high qualities of a new, preventive and improved, temporary retraction materials and 
techniques. 
 
KEYWORDS:  gingival management, impressions, prevention  
 
REVIEW 
64 
   IJCDS • FEBRUARY, 2011 • 2(1) © 2011  Int. Journal of Clinical Dental Science 
For the retraction of soft tissue, three principle methods 
are available for use today: 1) mechanical; 2) chemo-
mechanical; and 3) electrosurgical. The chemo-
mechanical technique is probably the most widely used 
but its limitations are time consuming, painful, need for 
local anesthesia and injury to epithelial tissue and 
gingival recession. 
To overcome these limitations, various newer retraction 
system are introduced - Expasyl, Magicfoam cord,  
Merocel strips, Gingitrac, lasers and stay put retraction 
cord 
Expasyl 
Expasyl was introduced by Satelac Pierre Rolland. It is a 
specially formulated consistency which exerts moderated 
calculated pressure on gingiva. 
According to Mahmoud Kazemi, gingival retraction with 
expasyl paste method caused less injury to gingival 
tissues than impregnated cord, while both provide 
gingival retraction (1). 
 Aluminium chloride – 15% which is an astringent 
and hemostatic agent. 
 Kaolin 
 Excipients  
 
Mechanism of action: 
It has both mechanical and chemical action. It creates 
and maintains space in the sulcus due to optimal 
characteristics of its viscosity which is mainly due to its 
kaolin component. It achieve hemostasis due to 
aluminium chloride. Time taken for retraction is 2 
minutes and sulcus widening achieved is  0.5mm  
Expasyl technique 
Applicator tip is placed in the cartridge and inserted into 
the gun. Paste is injected slowly in sulcus and left in 
place for 1-2 min. Blanching of tissues, indicates 
adequate displacement of the gingival tissue. The paste 
is removed by water and air spray. 
Expasyl power applicator: 
Ergonomic: Improves intraoral access. Delivers smooth, 
precise extrusion of gingival  paste with minimal effort. 
Convenient: The material dispenses evenly at a rate of 2 
to 5 mm/second with just step on the foot pedal and can 
be accommodates in most micromotors. 
Accurate: Gun or pen-style grip allows easy 
maneuverability and dispensing at the desired angle for 
even greater control. 
 
Expasyl can also be used prior to Placement of Crowns, 
veneers & provisionals, preparation of Class II & V 
Restorations, Rubber Dam Clamp Placement, and 
Placement of Orthodontic Brackets. 
 
Advantages: 
 
• Physically displaces tissue for good marginal 
access. 
• Safe minimal pressure required and no danger 
of rupturing epithelial attachment. 
• Minimal time and force needed compared with 
packing cord. 
• Controls bleeding and crevicular seepage  
 
Limitations: 
 
• Expensive.  
• Is effective only under specific, limited    
      conditions.  
• The paste's thickness made it difficult for some  
      evaluators to express it into the sulcus.  
• Disposable metal dispenser tips are too large,   
      making it difficult to express Expasyl into the  
      interproximal sulcus.  
 
Precaution: It is important to rinse thoroughly and verify 
that Expasyl is totally removed from the sulcus as residue 
of the ingredient, aluminum chloride, may inhibit set of 
polyether impression materials. 
 
Contraindications: 
 
• Presence of periodontal pocket and furcation 
involvement 
• Known allergy to aluminium  
 
Magic foam 
 
Magic foam had been developed in a free partnership 
with Prof. Dr. Dumfahrt and is the first expanding PVS 
material designed for easy and fast retraction of the 
sulcus without the potentially traumatic and time 
consuming packing of retraction cord. 
 
It is a non 
hemostatic cordless retraction system and consists of 
foam and cartridges, mixing and intraoral tips, 
comprecaps (3 sizes) 
 
Mode of action
 
Main mode of mechanism is by expansion of silicone 
foam. When comprecap is used to apply pressure the 
expansion of magic foam cord occurs in the sulcus.  
Magic foam technique: 
 
• Select and pre-fit one Comprecap for anatomic 
per preparation. 
• Apply Magic FoamCord around the preparation 
by syringing. An application in the sulcus is only 
necessary where there is a deep sub-gingival 
preparation margin. 
65 
   IJCDS • FEBRUARY, 2011 • 2(1) © 2011  Int. Journal of Clinical Dental Science 
• Material must not be forced into the sulcus 
under pressure and avoid sudden movements. 
• Place Comprecap over preparation. And the 
patient’s is ask to bite down for 3 -5 minutes.  
• This procedure makes optimal use of the 
formation of foam (i.e., the expansive effect of 
the silicone foam). Due to the counter pressure 
of the Comprecap, the expansion of the Magic 
FoamCord occurs in the sulcus.  
• After proper setting, remove the Comprecap 
Anatomic and Magic FoamCord in one piece. 
• Always check that the Magic FoamCord material 
has set in the mouth before removing it. 
 
Advantages
 
• Non-traumatic, conservative method of 
temporary gingival retraction 
• Easy and fast application directly to the sulcus 
without pressure or packing 
• Comfortable to the patient 
• Extensive rising is not required due to absence 
of haemostatic chemicals that could 
contaminate impression site. 
• Outstanding retraction for perfect impressions. 
 
Limitations
 
•   Limited clinical indications. 
•   Hemostasis cannot be achieved. 
•   Relatively expensive compared to cord. 
•   No improvement in speed or quality of    
        retraction compared with cord. 
•   Less effective on subgingival margins. 
 
According to a clinical study of Magic FoamCord 
conducted in University of Innsbruck, Austria, 2006, by 
Prof. DDr. Dumfahrt H.; they concluded clinical proven 
performance of magic foam retraction material is  97 % 
usable retractions, which lead to a perfect impression. 
compared to 57 % usable retractions with Expa-syl™ 
SDS, Kerr Sybron Dental Specialties, Orange, CA, USA, 
(Clinical comparison of Expa-syl, University of Freiburg, 
Germany, Manolakis(2) 
 
Gingitrac 
It is a mild natural astringent in gel form. It utilizes 
patient’s bite pressure to push material into sulcus and 
retract gingiva. It consists of  Mixing Gun, Gingitrac 
Cartridge,  Gingitrac matrix Cartridge,   Mixing nozzles, 
Dispensing tips,  Regular Gingicaps, Large Gingicaps 
Method of application :
 
• For single tooth use, a cap (GingiCap) is used to 
apply pressure for up to 5 minutes after the 
paste has been applied. The cap is first filled with 
the paste, then placed over the tooth and paste 
syringed around the margins.  For multiple tooth 
preparations, a plastic tray is first used with a 
firm paste matrix over which the GingiTrac paste 
is syringed before the tray is placed over the 
arch and held in position for 3-5 minutes. For 
both single tooth and multiple tooth 
preparations, gingival retraction is achieved 
through the application of pressure prior. The 
paste is removed prior to impression-taking. 
Advantages 
• Works in less than 5 minutes, without hands in 
mouth 
• Gently retracts the gingival with no tissue 
trauma or ligament damage 
• Contains mild, natural astringent to control 
bleeding and oozing 
• Auto-mix gun system mixes and delivers 
GingiTrac  
• Works on single crowns or multiple crown 
preparations 
• No clean up 
 
Merocel strips 
Marco Ferrari et al in 1996 found Merocel, a synthetic 
material that is specifically chemically extracted by a 
biocompatible polymer (hydroxylate polyvinyl acetate) 
Mechanism of action 
• Merocel Strip expands by absorbtion of oral 
fluids and exerts pressure on surrounding 
tissue(3). 
Method of application: 
• Gingival retraction is carried out by inserting a 2 
mm thick Merocel retraction strip and 
provisional crown is inserted. Patient is asked to 
maintain the pressure on artificial crown and 
Merocel strip for 10-15 min. 
Advantages : 
• Easily shaped and adapted around tooth. 
• Highly effective in absorption of oral fluids. 
• Chemically pure and free from fragments and 
debris, hence no post surgical complications. 
• It is not abrasive and hence provides gentle 
displacement.  
 
 Lasers 
Soft tissue reduction with lasers in the field of dentistry 
has been subjected to intense scrutiny in recent years. 
Their application on the gingival tissue was made 
possible particularly by the use of flexible optical fibers 
(the most commonly used diameter range from 320 to 
400 microns for prosthetic applications), ensuring 
precision of laser action at the cervicular sulcus level.  
66 
   IJCDS • FEBRUARY, 2011 • 2(1) © 2011  Int. Journal of Clinical Dental Science 
Types of Lasers used in dentistry are Co2 lasers, Nd–
YAG(Neodymium-Yittrium-Aluminium-Garnet)lasers,  
Argon lasers etc. 
Principle 
     Lasers work through Photo-ablation and produce 
completely blood – free incisions followed by rapid, 
Pain–free healing with no underlying inflammation.  ND 
– YAG laser is preferred for resection of the oral soft 
tissues and can be used successfully without local 
anesthesia for gingival retraction prior to impression 
making, particularly in the presence of hypertrophied 
tissue.  The pulsed Nd – YAG laser beam is directed to 
the operative site through a flexible quartz optical fiber. 
As this beam is invisible at the correct operative 
wavelength, red Helium – Neon laser is used to provide a 
visible aiming beam coaxial with the YAG laser. The tip of 
the fiber extends approximately 1mm from the hand 
piece and provides accuracy for positioning and 
directing the beam. The tip of the fiber is kept in touch 
with the soft tissue and is moved in the same way as a 
conventional scalpel. The laser technique is a little slower 
than using a scalpel but produces a very controlled 
tissue removal free of hemorrhage and pain. Healing is 
rapid and uneventful.  
Overuse of laser energy causes shrinkage of the tissue 
and unwanted exposure of the crown margins. The 
operator always should follow laser safety guidelines. 
The postoperative instructions should include warm 
saltwater rinses morning and night for 5 to 7 days and 
the use of an ultra-soft tooth brush to the affected area, 
using the modified bass technique for sulcular 
burshing(4).
 
Enrico F. Gherlone and colleagues conducted a study (5)
 
 
to evaluate the tissue retraction and gingival healing 
using pulsed laser gingival retraction in comparison with 
the conventional mechanical or surgical techniques 
This study showed that the laser technique was less 
aggressive to the periodontal tissues compared to the 
conventional ones i.e., less gingival recession and less 
amount of bleeding from the sulcus. Also, laser 
technique showed hemostasis during impression 
making. 
Stay put retraction cord
 
It is a Fine Metal Filament reinforced displacement cord 
and can be Impregnated/ Non-impregnated. When the 
stay – put cord is shaped, it remains in shape and does 
not deform. It is a unique combination of softly braided 
retraction cord and ultra fine copper filaments.  
Advantages of Stay – put retraction cord  
1.      Can be easily adapted.  
2.      Can be preformed  
3.      Does not lift in the sulcus.  
4.      Does not unravel.  
5.      No overlapping required.  
6.      Non-impregnated, but can be impregnated with an  
        astringent or haemostatic solution as required.  
 
Conclusion 
Atraumatic gingival tissue management for impression 
making provides greater patient comfort during and 
after impression making.  
During restorative procedures, it is incumbent upon 
clinicians to consider the advantages and limitations of 
each method in individual case and patient, and to strive 
for minimally invasive methods that optimize the 
procedural site for impression making and restoration 
placement.   
References : 
1. Mahmoud Kazemi, Maryam Memarian, Venus 
Loran; comparing the effectiveness of two 
gingival retraction procedures on gingival 
recession and tissue displacement: clinical study; 
Res. J. Biol. Sci, 2009; 4(3); 335-339 
 
2. Manolakis A., Bartsch N., Hahn P., Clinical 
Comparison of a Gingiva Retraction Paste and 
Impregnated Cords, IADR/AADR/CADR 82
nd
 
General Session (March 10-13, 2004) 
 
3. Marco Ferrari, Maria C. Cagidiaco, Carlo Ercoli -
Tissue management with a new gingival 
retraction material: a preliminary clinical report. J 
Prosthet Dent 1996; 75: 242-247. 
 
4. Coluzzi Dj: An overview of laser used in dentistry. 
Dent Clin N Am. 2004:751-770  
 
5. Gherione EF et al. The use of 980nm diode and 
1064 nm Nd;YAG lasers for gingival retraction in 
fixed prosthesis. J Oral Laser Applications 2004; 
4; 183-190 
 
 
 
 
 
 
 
 
67 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


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