Gingival Retraction in Dentistry: When is it Necessary?

Gingival retraction is an important dental procedure used for manipulations in filling teeth, installing veneers, and even whitening. A liquid-free environment is important for working with restorative materials, impressions, and prosthetics. This is why retraction is important in dentistry.

What is a Gingival Retraction?

This is an auxiliary therapeutic manipulation, the purpose of which is to expand the sulcus. It is performed during therapeutic, surgical, or orthopedic treatment of the oral cavity, in particular, during manipulations near the gum tissues. Retraction is used when it’s necessary to reduce the height of the gums to open access to the neck of the tooth or partially to the roots. These measures are important for correct dental procedures. Retraction is necessary for the preparation of prosthetics and for the process of taking impressions for more accurate detailing. Also, this procedure is carried out for thorough cleansing of periodontal pockets in case of caries and inflammation. Recent advances in gingival retraction make it possible to choose the method that suits any patient.

Such an important dental procedure has the following goals:

• protection of the gingival margin from mechanical trauma;
• stop bleeding;
• protection of the working area from liquid leakage;
• providing access to the subgingival part of the tooth.

Types of Gingival Retraction

Currently, dentists may offer different methods of gingival retraction depending on the medical indication or patient preference.

Surgical. Gum retraction is performed under the action of a local anesthetic. Gingival tissues are opened with a scalpel or an electrical appliance. This technique is the most traumatic, so it’s used as a last resort. Mechanical. Manipulation is performed under local anesthesia. This is one of the most popular gingival retraction methods and involves the use of a special thread.

Chemical. In this case, special preparation is applied to the gum in the form of a gel, paste, or solution, which contains polymers, hemostatic, and kaolin. The gum hardens and solidifies within minutes, allowing the necessary treatment to be carried out. Laser. This is an effective but expensive method. The laser performs excellent retraction, moreover, the procedure itself is painless and has no negative consequences. Combined. This is a combination of chemical and mechanical retraction, using a cord impregnated with special preparations.

A gingival retraction cord is used in the treatment of various diseases of permanent teeth in surgical, orthopedic, and therapeutic dentistry.

The most popular types of retraction threads are:

Wicker. These are favorites among dentists, as they are highly durable. Used when taking impressions; Knitted. They protect the gum during preparation and have high absorbent characteristics; Twisted. It is preferred for the simplest and fastest procedures, as it quickly disintegrates into individual fibers.

The choice depends on the decision of the doctor, taking into account the individual clinical situation of the patient. In addition to the type of retraction cord, the composition of the impregnation is also taken into account. Commonly used epinephrine (promotes vasoconstriction), aluminum chloride (has antihydrogen properties), aluminum sulfate (cleansing coagulant), and zinc chloride (antiseptic). Dental cords with aluminum sulfate provide good hemostasis, including on cut gums.

What Causes Gingival Retraction?

It’s important to understand that the correction of the height of the gingiva in the tooth area due to retraction is a temporary intervention. At the end of the main dental procedures, the tissue again takes its place. Indications for the use of retraction are:

Treatment of various dental diseases that entail a risk of soft tissue damage. Especially a high probability of injury in the treatment of cervical caries and carious interdental cavities.

Dental cleaning. Dental plaque can form both above the gum and below it. Therefore, it’s important to improve access to problem areas. Prosthetics. In orthopedics, gum retraction is a common procedure. Thanks to it, the dentist can take impressions and fix prostheses as accurately as possible.

Whitening. During this procedure, dentists use a special gel containing highly active substances that can cause gum burns on contact. Retraction helps to avoid such injuries.

Tooth filling. This procedure is used if there is a high probability of bleeding of the mucosa. Because of this, the risk that blood gets under the filling increases, which reduces the quality of the restoration.

Even though the procedure is practically painless, side effects are possible in the form of exposure of the tooth necks, the formation of periodontal pockets, and inflammation in the tooth area. To avoid these manifestations, the patient needs to follow several recommendations: exclude irritating foods and drinks from the diet, use a soft brush, and regularly rinse the mouth with antiseptic and wound healing solutions. If severe pain continues after retraction, you have to contact the dental clinic in time to avoid negative consequences.