See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/305794381

Gingival Displacements Options in Prosthodontics: A Critical Review on Recent

Advances Singh, DK, P Gupta, A Bhatnagar - J Adv Res Dent Oral Health 2016,
2016

Article · January 2016

CITATIONS READS
0 496

3 authors, including:

Atul Bhatnagar
Banaras Hindu University
23 PUBLICATIONS   22 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Atul Bhatnagar on 19 April 2017.

The user has requested enhancement of the downloaded file.

Review Article

DK Singh1, P Gupta2,
Gingival Displacements Options in
A Bhatnagar3 Prosthodontics: A Critical Review on
1,2
Senior Lect.,
Department of Recent Advances
Prosthodontics,
Azamgargh Dental Abstract
College, Azamgarh.
3
Assoc. Prof., Faculty of A plethora of innovations have taken place in impression-making for fixed prosthesis, all
Dental Sciences, IMS, with a singular objective to record the finish margins of tooth preparation and the
BHU, Varanasi. gingival tissues. The gingival displacement temporarily displaces the tissues laterally to
Correspondence to: adequately record the sub-gingival margins. The purpose of this review is to make an
Dr. Atul Bhatnagar, appraisal of the latest advancements in the field of tissue-displacement and analyze
Faculty of Dental their merits and demerits. A conscientious dentist is one with lucid comprehension of
Sciences, IMS, BHU,
concepts, a keen discerning eye on recent developments, well-informed choice of
Varanasi.
treatment plan, and impeccable execution of the chosen plan.
E-mail Id:
atuldent@hotmail.com Keywords: Gingiva, Margin, Retraction, Sub-gingival.

Introduction
Gingival displacement is reversible lateral and vertical deflection of the marginal gingiva
away from the tooth. Gingival displacement has been suggested to be an important and
mandatory procedure in fabricating indirect restorations, which may frequently have
cervical margins placed in the gingival sulcus (sub-gingival margins) for aesthetic and
functional reasons. This must be reproduced accurately in the impression made. A
failure will result in a compromised marginal integrity, recurrent caries and/ or gingival
inflammation and periodontal breakdown.1 Gingival displacement’s three-pronged
goals are to have adequate bulk flow of material into the sulcus, to accurately record
margin details, and to prevent impression material tear upon retrieval from the gingival
sulcus.2 The minimum lateral displacement so desired is about 0.2 mm. It is also
imperative that a small amount of impression material flows beyond the prepared
margin. This will permit accurate trimming of the recovered die.

Occasionally, gingival retraction is required in order to permit the completion of tooth

preparation or to allow cementation of laboratory-manufactured restorations.5

Gingival Displacement Techniques6

The techniques used for gingival displacement are broadly classified into mechanical,
chemico-mechanical, and surgical.7 According to Benson et al.,8 gingival displacement
measures fall into one of four major categories: (1) simple mechanical methods, (2)
How to cite this article: chemo-mechanical methods, (3) rotary gingival curettage, and (4) electrosurgical
Singh DK, Gupta P, methods. Of these four categories, the chemo-mechanical method of gingival
Bhatnagar A. Gingival displacement is the most widely used.9
Displacements Options in
Prosthodontics: A Critical
Review on Recent
Mechanical Technique
Advances. J Adv Res Dent
Oral Health 2016; 1(2): The most commonly used methods are:
13-21.
1. Copper band
ISSN: 2456-141X 2. Rubber dam
3. Displacement cords

© ADR Journals 2016. All Rights Reserved.

Singh DK et al.
Displacement cords are supplied in three basic designs,
namely, twisted cords, braided cords, and knitted cords.
Selection of the cord is determined by the operator
preference. The largest cord that can be atraumatically
placed in the sulcus should be used. Cords are usually
pressure-packed into the sulcus using special
instruments like the Fischer cord packing instrument or
plastic-filling instrument.
Chemico-Mechanical Technique
This probably is the most commonly used method of
gingival displacement. In this method, a cord soaked in a
Figure 1(a).Medicament Soaked displacement cord
The displacement cord soaked in the chemical agent of
choice is packed into the sulcus using a Fischer cord
packing instrument and left in place for a period of 4-8
min and then removed. This usually brings about the
desired gingival displacement. Harrison10 compared
plain cord, cord impregnated with two concentrations
of epinephrine plus zinc chloride, and cord impregnated
with 100% alum. Cords that contained zinc chloride at 8
and 40% concentrations caused severe tissue
destruction, while the other materials brought about
reversible injury. Both 8% epinephrine and 100% alum
were effective in the control of moderate bleeding.
Ramadan studied the length of time the sulcus
remained open and the width of the sulcus with plain
cord, 1/1000 epinephrine, 100% alum, and hemodent.
He concluded that the treated cords were effective as
compared to the plain cord.11 However, de Gennaro et
al.12 studied the histological responses among humans
to plain cord and cord impregnated with potassium
sulfate, hemodent, and 8% racemic epinephrine and
concluded that there was no practical difference
between the cords. Aluminum sulfate causes
hemostasis by a weak vasoconstrictor effect in addition
to precipitation of tissue proteins with tissue
contraction, inhibited trans-capillary movements of
plasma proteins, and subsequent arrest of capillary
bleeding. The medicament is regarded as safe and
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2016; 1(2)
medicament (reduces bleeding and sulcular fluid
seeping from the sulcus) is placed in the gingival sulcus
to bring about reversible gingival displacement (Fig.
1(a,b)).
Some of the commonly employed medicaments include:
1. 8% racemic epinephrine
2. Aluminum chloride
3. Alum (aluminum potassium sulfate)
4. Aluminum sulfate
5. 5. Ferric sulfate
Figure 1(b).Displacement cord placement into
gingival sulcus
devoid of systemic effects when used appropriately.12 A
material available for quite some time for clinical usage
is Expasyl (Kaolin incorporated into an organic binder
with aluminum chloride). It aids in soft-tissue control in
two ways. First, the consistency of the “putty-like
material” when injected into the sulcus aids to
mechanically displace the gingival tissues horizontally
and vertically to open the sulcular space, effectively
providing the space that mechanical cords provide. The
Expasyl paste is injected in the sulcus, exerting a stable,
non-damaging pressure of only 0.1N/mm. When Expasyl
is left in place for 1 min, the pressure is sufficient to
obtain sulcus opening of 0.5 mm for 2 min. Second,
aluminum chloride incorporated in the product is an
effective hemostatic agent (Fig. 2). It has been reported
to have advantages like effective hemostasis, little
pressure, i.e., atraumatic, less time-consuming, easy
removal, and easy to dispense with the gun. Prominent
disadvantages being expensive, thickness of the paste
makes it difficult to express into the sulcus and metal
tips too big for interproximal areas.13 Yet another
system on the docks is matrix impression system, which
is a new system that requires a series of three-
impression procedure, using three viscosities of
impression technique. It attempts to overcome the
deficiencies of the older systems and at the same time
incorporate their best features.14 A matrix of occlusal-
14
J. Adv. Res. Dent. Oral Health 2016; 1(2)
registration elastomeric material is made over the tooth
preparations. Depending on the distribution and
complexity of the preparations, the matrix may be made
in one piece or in two or more sections. The retraction
cord is removed and a definitive impression is made in
the matrix of the preparations with a high-viscosity
elastomeric-impression material. After the matrix
impression is seated, a stock tray filled with a medium-
viscosity elastomeric impression material is seated over
the matrix and remaining teeth to create impression of
the entire arch. This system effectively controls the four
forces that are relapsing, retraction, displacement, and
collapsing that impact on the gingiva during the critical
phases of impression making. The design of the matrix
Figure 2.Expansyl
Gingitrac15 is a gingival-retraction paste system that uses
a preloaded syringe to apply the paste around the
margins. The paste contains aluminum sulfate as
astringent, and if necessary, a hemostatic agent can be
applied prior to its use. For single tooth use, a cap is
used to apply pressure for up to 5 min after application
of paste. The cap is first filled with the paste, and then
placed over the tooth and paste is syringed around the
Figure 4.Gingitrac Kit
Magic foam cord16 is a new non-hemostatic gingival-
retraction system. It is the first expanding vinyl
polysiloxane material designed for retraction of the
15
Singh DK et al.
also forces the high-viscosity impression material along
the preparations and into the sulcus where it cleanses
the sulcus of debris and fills it. The matrix facilitates the
formation of the optimum flange. Chances of tearing are
virtually eliminated because of improved configuration
of the sulcular flange, decreased amount of voids or
contaminant in the sulcus. The system eliminates
chances of tearing of the sulcular flange by developing
the optimal configuration, cleaning blood and debris
from the sulcus area at critical moments, delivering
impression material in the sulcus gently but with
increased accuracy and speed, and holding the sulcus
open for an increased time (Fig. 3).14
Figure 3.Matrix impression system
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 min. For both single
and multiple tooth preparations, gingival retraction is
achieved through the application of pressure. The paste
is removed prior to impression-taking.
gingival sulcus without the potential traumatic and
time-consuming packing of retraction cord. The material
is syringed around the crown preparation margins and a
ISSN: 2456-141X
Singh DK et al.
cap (Com-precap) is placed to maintain pressure. After 5
min, the cap and foam are removed and the tooth is
Figure 5.Magic Foam Cord
Mercocel17 is a new retraction material to displace
gingival tissues without tissue damage before
impression making. Mercocel retraction strips are
synthetic material that is specifically chemically
extracted from a polymer hydroxylate polyvinyl acetate
that creates a net-like strip without debris or free
fragments. Placement of Mercocel retraction technique
does not require use of local anesthesia, resulting in
careful management of the delicate gingival tissues with
improved management of the treatment. Also, mercocel
retraction device ensures sufficient gingival retraction to
Figure 6.Mercocel Strip Reveals Absence of Filaments and Spongy Microstructure
Racegel18 is a new hemostatic agent that controls
bleeding and absorbs crevicular fluid prior to and during
impression-taking and crown placement. Due to its
thermodynamic characteristics, the material’s viscosity
increases upon contact with the tissue, providing access
to the gingival margin. The gel contains 25% aluminum
chloride, oxyguinol and excipients. The aluminum
chloride is clinically proven for its astringent properties.
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2016; 1(2)
ready for final impression. The material claims to have
an expansion of 160% after 5 min.
permit measurement of the sub-gingival finish line and
gingival surfaces of unprepared teeth. The porous and
sponge-like microstructure of mercocel retraction strips
ensures a dry environment, allowing impression
material to record precise tooth preparations. Scanning
electron microscopy reveals absence of fibers thus,
decreasing the risk of post-operative complications. It is
chemically pure and can be easily shaped. It effectively
absorbs intraoral fluids such as saliva, blood and gingival
fluids. It is free of any fragments without presence of
any debris.
The bright orange color makes it easy to dispense, place
and rinse. The gel helps to prepare the sulcus prior to
impression-taking and can be used with or without
gingival retraction cords. It facilitates the opening of the
gingival crevice and reduces bleeding and oozing. Due to
its consistency, it rinses away quickly, leaving no
residual material, discoloration or irritation of the
surrounding tissue.
16
J. Adv. Res. Dent. Oral Health 2016; 1(2)
Figure 7.Racegel Kit
Stay Put19 combines the advantages of an impregnated
braided retraction cord with the adaptability of a fine
metal filament. Both impregnated and unimpregnated
options are available for clinical use. Hemostatic agent,
aluminum Chloride is employed for impregnated Stay
Figure 8.Stay Put
Surgical Technique
1. Rotary curettage7 is performed on healthy tissue
wherein portion of sulcular epithelium is excised.
The criteria to be met are-no bleeding on probing,
less than 3 mm sulcular depth with presence of
appropriate keratinised gingival tissue. The choice
of bur is torpedo-shaped diamond point. Bleeding is
checked by utilizing a hemostatic agent-soaked
cord.
2. Electrosurgical method: With the assistance of an
electrode, surgical excision is affected. Sometimes,
it is also termed “surgical diathermy.” This method
is suggested in clinical situations having inflamed,
proliferated gingiva around finish margins of tooth
preparation, not indicated in patients on cardiac
pacemakers. Advantages offered by this technique
is minimal or no bleeding; the major disadvantage is
that it has a learning curve and is technique-
17
Singh DK et al.
Put. Non-impregnated stay put cord may be
impregnated with a suitable hemostatic agent as
desired. Main advantages are quick hemostasis, can be
pre-shaped, adaptable and pliable, good contrast to
gingiva, and no risk of cardiovascular problem.
sensitive. There are chances of damage to soft
tissue in the hands of a novice or careless user.
3. LASER: Lasers may also be employed as they cause
tissue-coagulation facilitating hemostasis tissue
removal via vaporization, and sulcular epithelium is
removed. Commonly used soft-tissue lasers for
gingival displacement include CO2 lasers, diode
lasers, Nd:YAG lasers, erbium lasers, etc.20(Fig. 9)
Recently, erbium lasers have been added to this list.
These minimally penetrate the soft tissues, so they
are fairly safe to use. Some of the advantages with
lasers include a dry bloodless field of surgery, sterile
working area, less mechanical trauma, minimal pain
and less postoperative swelling and scarring.
However, cost factor is a drawback and it is
technique-sensitive. Er: YAG laser is not good in
hemostasis as CO2 laser. However, CO2 laser
provides no tactile feedback, leading to risk of
damage to junctional epithelium.
ISSN: 2456-141X
Singh DK et al.
Figure 9.Laser
Azzi and colleagues21 studied the effect of retraction
cords, electrosurgery and rotary gingival curettage on
gingival recession and loss of attachment in dogs. They
Figure 10(a).Electro-surgical armamentarium
Gingival Displacement in Digital Impressions
A major restraint of direct optical impressions is their
limitation to line of sight. A clean sulcus is a
requirement of paramount importance while making
digital computer-aided design/ computer-added
manufacturing (CAD/ CAM) impressions. Retraction cord
fibers that remain in the sulcus may affect the accuracy
of gingival retraction and may result in artifact-
generated errors. Fifteen percent aluminum chloride in
an injectable matrix reduces these artifacts by leaving a
clean sulcus on removal. Indirect capture of digitalized
information is considered more accurate by clinicians.22
On the other hand, the method of data collection is
influenced by thickness of impression material in the
sulcus area. This can result in significant errors in cases
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2016; 1(2)
found that cords had the smallest effect on the gingival
and rotary curettage had the largest effect (Fig. 10(a,b)).
Figure 10(b).Rotary gingival curettage
of thin impression margins with radius less than the
contacting-probe tip.23
Gingival Displacementin Implants
The peri-implant tissue is different from that around the
teeth. The difference between the two is listed in the
chart (Fig. 11 and Table 1). Mechanical retraction
techniques are contraindicated around implants, except
in situations in which the patient’s gingival sulcus depths
are shallow, their mucosal health is impeccable and a
robust, thick gingival biotype is present.24 This is due to
the inherent potential of damaging the gingival
epithelial structures. Serrated packing instruments, if
not handled appropriately, may increase the probability
of damaging the implant collar and may create
microscopic scratches on the surface.
18
J. Adv. Res. Dent. Oral Health 2016; 1(2) Singh DK et al.

Figure 11.Difference between peridental and peri-implant tissues

Increase in surface free energy and surface roughness
will further facilitate biofilm formation on dental
implant and abutment surfaces.25 The atraumatic
application of an injectable matrix certainly faces a few
limitations. Injectable matrix provides limited success
with peri-implant tissue retraction. Rotary curettage,
electrosurgery and all types oflasers except CO2 laser are
not advisable for use with peri-implant soft tissues.
Their use in anterior applications, where esthetics plays
Table 1.Difference between perdental and peri-implant tissues
Peridental Tissue
Free gingival margin with buccal keratinized epithelium Free gingival margin with buccal keratinized epithelium
Gingival sulcus apically limited by the junctional
epithelium
Keratinized epithelium at the base of gingival sulcus
Junctional epithelium adherent, less permeable, high
regenerative capacity
Cementum
Gingival fibers inserting perpendicularly in the
cementum
Biological width of at least 2.04 millimeters
Periodontal ligament
No direct contact between tooth and bone
Peridental Tissue
Free gingival margin with buccal keratinized epithelium Free gingival margin with buccal keratinized epithelium
Gingival sulcus apically limited by the junctional
epithelium
Keratinized epithelium at the base of gingival sulcus
Junctional epithelium adherent, less permeable, high
regenerative capacity
Cementum
Gingival fibers inserting perpendicularly in the
cementum
Biological width of at least 2.04 millimeters
Periodontal ligament
No direct contact between tooth and bone
a critical role, is also questionable.26 Although injectable
matrix technique sounds promising for implant
situations, further development is needed. As compared
to the research linked to implant fixture designs, there is
relatively little research to guide clinicians about the
appropriate use of various gingival retraction techniques
around implant abutments.27 As implants become
mainstream treatments for tooth loss, this topic
certainly deserves further research.
Peri-implant Tissue
Gingival sulcus apically limited by the junctional
epithelium
No keratinized epithelium at the base of gingival sulcus
Junctional epithelium poorly adherent, more
permeable, low regenerative capacity
No cementum
Gingival fibers running parallel to the implant collar
Biological width of 2.5 mm±0.5 mm
No periodontal ligament
Direct contact of implant to bone
Peri-implant Tissue
Gingival sulcus apically limited by the junctional
epithelium
No keratinized epithelium at the base of gingival sulcus
Junctional epithelium poorly adherent, more
permeable, low regenerative capacity
No cementum
Gingival fibers running parallel to the implant collar
Biological width of 2.5 mm±0.5 mm
No periodontal ligament
Direct contact of implant to bone

19 ISSN: 2456-141X
Singh DK et al.
Discussion
While using chemico-mechanical means of gingival
retraction, absorption of chemicals, like epinephrine, at
the sulcus interface is dependent on patient’s gingival
health.28 Healthy gingiva acts, to some extent, as a
barrier to the absorption of epinephrine. This may be a
reason why the theoretical overdose levels are not
observed clinically.29
Absorption varies with the degree of vascular-bed
exposure, the length of cord used, the concentration of
cord impregnation and the length of application time.
Clinicians should avoid applying high concentrations of
epinephrine to large areas of lacerated or abraded
gingival tissues as its absorption increases substantially
due to large vascular-bed exposure.30 Surgical retraction
procedures are rapid but at the same time destructive
and involve excision of tissue. On the other hand, few
authors advocate the use of electrosurgery, rotary
curettage and lasers around natural teeth.29 Clinicians
can make a good use of an injectable matrix for gingival
retraction as it offers the opportunity to perform an
atraumatic procedure. The materials such as 15%
aluminum chloride in a Kaolin matrix can be introduced
into the sulcus surrounding natural teeth with no risk of
laceration. With no damage to the junctional epithelium
at the base of the sulcus or to the sulcus walls, the risk
of inflammation caused by chemicals delivered in the
matrix is reduced significantly. In addition to this, it is as
effective as epinephrine-soaked cord in reducing the
flow of sulcular exudate. Inflammation results from the
use of chemical agents, but the aluminum chloride in
the injectable matrix offers the best outcome of the
chemical choices to date.31
Conclusion
Gingival retraction holds the merit of being an
indispensable clinical procedure for predictable soft-
tissue management and impression-making. The myriad
clinical complications arising out of inadequate marginal
adaptation can be clearly avoided, provided apt
attention is paid to impression-making after due
exposure of finish margins with any of the mentioned
methods of gingival retraction. The choice of technique
and material employed for gingival retraction rests upon
considerations of cost-efficacy and availability. With
rapid-paced development in materials available for
gingival retraction for tooth or dental implant situation,
an alert and conscientious clinician will choose
judiciously and remain abreast with the new knowledge.
Conflict of Interest: Nil
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2016; 1(2)
References
1. Rosentiel SF, Land MF, Fujimoto J. Contemporary
Fixed Prosthodontics. 4th Edn. Mosby Elsevier, 2007:
431-65.
2. Donovan TE, Chee WWL. Current Concepts in
Gingival Displacement. Dent Clin N Am 2004; 48:
433-44.
3. Hansen PA, Tira DE, Barlow J. Current methods of
finish-line exposure by practicing prosthodontists. J
Prosthodont 1999; 8(3): 163-70.
4. Donovan TE, Chee WW. Current concepts in gingival
displacement. Dent Clin North Am 2004; 48(2): 6,
433-44.
5. Ayo-Yusuf OA, Driessen CH, Botha AJ. SEM-EDX
study of prepared human dentine surfaces exposed
to gingival retraction fluids. J Dent 2005; 33(9): 731-
39.
6. Hansen PA, Tira DE, Barlow J. Current methods of
finish-line exposure by practicing prosthodontists. J
Prosthodont 1999; 8(3): 163-70.
7. Shillingburg HT Jr, Hobo S, Whitsett LD et al.
Fundamentals of Fixed Prosthodontics. 3rd Edn.
Quintessence Publishing Co, Inc, 1997: 257-79.
8. Benson BW, Bomberg TJ, Hatch RA et al. Tissue
displacement methods in fixed prosthodontics. J
Prosthet Dent 1986; 55(2): 175-81.
9. Donovan TE, Gandara BK, Nemetz H. Review and
survey of medicaments used with gingival
retraction cords. J Prosthet Dent 1985; 53(4): 525-
31.
10. Harrison JD. Effect of retraction materials on the
ginigival sulcus epithelium. J Prosthet Dent 1961;
11: 514.
11. Ramadan FA, el-Sadeek M, Hassanein el S.
Histopathologic response of gingival tissues to
hemodent and aluminum chloride solutions as
tissue displacement materials. Egypt Dent J 1972;
18(4): 337-52.
12. de Gennaro GG, Landesman HM, Calhoun JE et al. A
comparison of gingival inflammation related to
retraction cords. J Prosthet Dent 1982; 47(4): 384-
86.
13. Radz GM. The next generation of soft tissue control.
Available from: www.kerrdental.com.
14. Livaditis GJ. The matrix impression system for fixed
prosthodontics. J Prosthet Dent 1998; 79(2): 208-16.
15. Poss S. Minimal Invasive tissue management for
restorative procedures. Available from: www.
ineedce.com.
16. Beier US, Kranewitter R, Dumfarht H. Quality of
impressions after use of Magic foam cord gingival
retraction system- A clinical study of 269 abutment
teeth. Int J Prosthodont 2009; 22(2): 143-47.
20
 J. Adv. Res. Dent. Oral Health 2016; 1(2)
17. Ferrari M, Cagidiaco MC, Ercoli C. Tissue
management with a new gingival retraction
material. A preliminary case report. J Prosthet Dent
1996; 75(3): 242-47.
18. Hess LA. Hemostasis just got easier: New Racegel.
Canada: Septodent. Gingiva management system.
Available from: www.coltenewhaledent.com.
19. Weir DJ, Williams BH. Clinical effectiveness of
mechanical-chemical tissue displacement methods.
J Prosthet Dent 1984; 51: 326-29.
20. Scott A. Use of an erbium laser in lieu of retraction
cord: a modern technique. Gen Dent Mar-Apr 2005;
53(2): 116-19.
21. Azzi R, Tsao TF, Carranza FA Jr et al. Comparative
study of gingival retraction methods. J Prosthet
Dent 1983; 50(4): 561-65.
22. Masek R. Margin isolation for optical impressions
and adhesion. Int J Comput Dent 2005; 8: 69-76.
23. Quaas S, Rudolph H, Luthardt RG. Direct mechanical
data acquisition of dental impressions for the
manufacturing of CAD/ CAM restorations. J Dent
2007; 35: 903-908.
24. Bennani V, Schwass D, Chandler N. Gingival
retraction techniques for implants versus teeth:
21
View publication stats
Singh DK et al.
Current status. J Am Dent Assoc 2008; 139: 1354-
63.
25. Subramani K, Jung RE, Molenberg A et al. Biofilm on
dental implants: a review of the literature. Int J Oral
Maxillofac Implants 2009; 24: 616-26.
26. Martin E. Lasers in dental implantology. Dent Clin
North Am 2004; 48: 999-1015.
27. Weir DJ, Williams BH. Clinical effectiveness of
mechanical-chemical tissue displacement methods.
J Prosthet Dent 1984; 51: 326-29.
28. Kellam SA, Smith JR, Scheffel SJ. Epinephrine
absorption from commercial gingival retraction
cords in clinical patients. J Prosthet Dent 1992; 68:
761-65.
29. Polat NT, Ozdemir AK, Turgut M. Effects of gingival
retraction materials on gingival blood flow. Int J
Prosthodont 2007; 20: 57-62.
30. Donovan TE, Chee WW. Current concepts in gingival
displacement. Dent Clin North Am 2004; 48: 433-44.
31. Brady WF. Periodontal and restorative
considerations in rotary gingival curettage. J Am
Dent Assoc 1982; 105: 231-36.
Date of Submission: 11th Feb. 2016
Date of Acceptance: 26th Feb. 2016
ISSN: 2456-141X