Title Retraction Cord Causes Less Gingival Inflammation Than Retraction Paste
Clinical Question In a patient receiving a crown, does retraction paste reduce the amount of gingival inflammation/recession compared to retraction cord?
Clinical Bottom Line Retraction cord causes less gingival inflammation than retraction paste, such as Expasyl. This may lead to less gingival recession after crown preparation. Clinical judgment and proper technique are critical to evaluate in which scenarios retraction cord vs. retraction paste would cause less permanent recession.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
21972892Labban/2011Crown PatientsClinical Technique
Key resultsThree factors need to be considered when the modified single/double cord technique is selected to displace gingival tissue: 1) insertion time – cord packed for longer than 10 minutes is discouraged to avoid irreversible recession 2) cord packing instrument force 3) type of medicament - the use of aluminum chloride in low concentrations on packing cord showed the least inflammation The greatest inflammation was caused by the retraction paste Expasyl.
19040582Al Hamad/200860 patients; 180 premolarsComparative study
Key resultsAll cordless retraction techniques caused temporary inflammation. Gingival retraction paste Expasyl caused greater gingival inflammation and for a longer period of time than other methods.
Evidence Search "Gingival Recession"[Mesh] AND "Gingival Retraction Techniques"[Mesh]
Comments on
The Evidence
Validity: The first article by Labban presented no original experimentation or research. This paper used previous studies on inflammation in the gingival area to draw conclusions on what could be some best-practice techniques. The second article was a study with a sample of size of 60 patients. 60 dental students were recruited, and an expanding PVS material, Ultrapak packing cord, and Expasyl paste were applied. The results only showed significant findings for the Gingival Index (GI); the Expasyl group showed a significant change in GI from baseline at both 1 and 7 days. Expasyl caused sensitivity in 4 of the 60 subjects. However, this study was conducted on young healthy individuals and may not be applicable to the general population.
Applicability Clinical judgment and proper technique are critical to evaluating in which scenarios retraction cord or retraction paste would cause less permanent recession. Retraction cord causes less gingival inflammation than Expasyl, so this intervention is highly recommended for reducing the risk of gingival recession.
Specialty (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Gingival retraction cord, gingival retraction methods/techniques; gingival displacement
ID# 2866
Date of submission 04/10/2015
E-mail olivaresrm@livemail.uthscsa.edu
Author Roberto Olivares
Co-author(s) e-mail
Faculty mentor Niraj Patel, DDS
Faculty mentor e-mail PatelNK@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available