Advances in retraction
Editor’s Note: Please contact your state dental board or visit DANB's state-specific information page to verify allowable dental assisting functions and requirements in your state.
By Shannon Pace Brinker, CDA, CDD
The assistant’s help is important during the retraction procedure, whether it’s with placing the retraction material or helping at the dentist’s side. For this reason, assistants should familiarize themselves with the latest material options in order to offer the best possible clinical support and maximize their value in the operatory.
Pros and cons of retraction cord
Typically, state regulations specify course, exam and/or credential qualifications for dental assistants to place retraction cord. Assistants who place cord are familiar with the product's advantages and disadvantages. While a one- or two-cord technique can be very effective in retraction itself, there are sometimes unintended consequences to this procedure that can cause discomfort for a patient or damage the tissue. A study has shown that retraction cords can cause injury to the gingival sulcular epithelium, and that improper handling of cords can contribute to issues, including gingival recession and marginal exposure of the restoration.
Placing cord correctly requires significant practice and skill, and it is often recommended that the practitioner wear loupes in order to be as precise as possible. As we know, even when cord is placed correctly it can sometimes harm tissue, and in some cases it can cause a visible bruise. In other cases the damage may be very hard to detect visually, but as study data shows, physical manipulation of the tissue can cause abrasion and pain for the patient. Many periodontists prefer to avoid cord for these very reasons. A final drawback to cord is that the placement procedure can be time consuming.
Retraction paste: simple and effective
Retraction paste offers features that address many of the drawbacks of retraction cord. Aluminum chloride is typically used as the hemostatic agent in these materials, though ferric sulfate products also exist. However, it is important for the dental team to remember that ferric sulfate can sometimes cause discoloration and is therefore best suited only for cases where a PFM will be placed, as this type of restoration can conceal the underlying discoloration of the tooth. In instances where the doctor is undecided about the type of final restoration, it is safest to use an aluminum chloride material.
The convenience of retraction paste is that it can be applied around the prep and allowed to work chemically, then rinsed off with no damage to the tissue. The same study that showed gingival recession in cases where retraction cord was used also found that retraction paste caused no significant damage to gingival health.
One new retraction paste product, the 3M™ ESPE™ Retraction Capsule, is designed to make the retraction paste procedure easier than ever. The retraction capsule is a unit-dose capsule with an extra-fine dispenser tip that can be inserted directly into the sulcus, which gives the assistant better access and visibility. After application, the paste is left in place for two minutes, and then removed with an air/water spray. Many of us know it can be difficult to rinse retraction paste, but the consistency of this particular product allows it to stay put during retraction while still rinsing off easily.
Each retraction capsule contains 15% aluminum chloride. Because the capsules are single-use, there is less risk of cross-contamination, and fewer preparation and cleanup steps for the assistant. As most assistants have experienced, dentists want to work as efficiently as possible in the operatory, and I’ve seen how the retraction capsule can help with this. Data has shown that this procedure can cut up to half the time from the gingival retraction procedure as compared to retraction cords. It is also up to 30% faster than another popular retraction paste.
In addition to saving time, the retraction capsule addresses some of the chief drawbacks of retraction paste systems. For example, a retraction paste that many of us have experience with requires its own special dispenser gun and can be very difficult to extrude. In my practice, assistants often have to warm this material in hot water to soften it prior to use. Even with this preparation, sometimes the assistant’s hands visibly shake when trying to dispense the material. Additionally, the tip of the dispenser for this product does not offer the same easy placement as the new retraction capsule from 3M ESPE.
A Clinical Tip
One tip I’ve learned with retraction paste is to apply the material counterclockwise around the prep. As we know, dentists prep the tooth in a clockwise motion, and I have observed with other retraction pastes that it can be difficult to get the material to sit correctly in the sulcus when it is applied clockwise. However, material seems to lay in the sulcus better when it is applied counterclockwise.
With the right procedure and convenient material, assistants can have an easier time than ever in the retraction process. This new retraction capsule capitalizes on all the advantages of retraction paste and introduces new convenience in dispensing. Assistants who are interested in taking a more active and effective role in retraction should explore options like this and begin a discussion in their offices about improving this everyday procedure.
Editor's note: References available upon request.
Shannon L. Pace Brinker, CDA, CDD, a 1994 graduate of the dental assisting program at Bowman Gray School of Medicine, works with Dr. John Cranham in his private practice in Chesapeake, Va. She has been a dental assistant for more than 20 years. Shannon is the past president of the Metrolina Dental Assistants Society in Charlotte. She is also on the advisory board for the dental assistant program at Central Piedmont Community College. She is a member of the AACD and serves on its New Member Committee. She is also on The Journal of Cosmetic Dentistry’s editorial board. Shannon is the first auxiliary to sit on the AACD Executive Board. She is an evaluator for DENTAL ADVISOR and consultant for many dental manufacturers.