| Abstract|| |
Aims: To evaluate the use of various gingival displacement techniques prior to impression making in fixed partial dentures by the Prosthodontists in Vadodara. Settings and Design: Questionnaire based survey among prosthodontists in Vadodara city. Methods and Material: All the prosthodontists practitioners and those prosthodontists in academic institutes in Vadodara City, Gujarat, were surveyed through a questionnaire regarding their usage of gingival displacement technique and their reasons and methods of using gingival displacement technique for fixed partial denture. The results were analysed through discriminant statistical analysis. Results: Among all the Prosthodontists in Vadodara city, 62% prefer the use of gingival displacement technique for successful clinical practice while 38 % of them do not follow the procedure believing it does not make major difference in clinical practice. Conclusions: Those Prosthodontists who preferred the use of gingival displacement technique were able to detect many advantages of using it in their daily fixed partial denture practice and the percentage of prosthodontists not following gingival displacement technique blamed it as a time consuming affair and was not feasible on economic grounds for the class of patient they treated.
Keywords: Gingival retraction, gingival retraction medicaments, impression making
|How to cite this article:|
Gadhavi MA, Nirmal N, Arora H. A survey on the use of various gingival displacement techniques in fixed partial denture by the prosthodontists in vadodara city. Indian J Dent Res 2018;29:176-80
|How to cite this URL:|
Gadhavi MA, Nirmal N, Arora H. A survey on the use of various gingival displacement techniques in fixed partial denture by the prosthodontists in vadodara city. Indian J Dent Res [serial online] 2018 [cited 2019 Nov 18];29:176-80. Available from: http://www.ijdr.in/text.asp?2018/29/2/176/229627
| Introduction|| |
Prosthodontics is an evolving specialty, with advancement in material and technological sciences. Gingival displacement techniques and impression materials have also advanced from earlier times till today for fixed partial denture. Over the past few decades, tremendous progress has been made in procedures for making fixed prosthodontic impressions. 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 [Figure 1].
The gingiva must be displaced to record an accurate impression and sometimes even to permit completion of the preparation and cementation of the restoration. Gingival displacement or dilation is an important procedure in the fabrication of fixed prostheses; quite often, the margins of these restorations are placed very close to the gingival margin or even subgingivally for esthetic and functional reasons. Therefore, the operating surgeon must correctly record the prepared cervical finish line to enable adequate marginal integrity for the restoration. This is accomplished by displacing the gingiva laterally and making the area clean and dry. Gingival displacement is usually performed using a displacement cord impregnated with a suitable medicament. Both nonsurgical and surgical techniques have also been established for gingival displacement.
This survey was undertaken to evaluate the use of gingival displacement technique and the methods of gingival displacement used by prosthodontists in Vadodara City, and results obtained were analyzed with knowledge available from previously published studies and compared different concepts of displacement that are popular nowadays.
| Subjects and Methods|| |
In this study, a survey was conducted among all the prosthodontists who have their private dental practice as well as those prosthodontists and postgraduate prosthodontist students who are attached with dental institutions in Vadodara city, Gujarat.
There were some criteria set for this survey.
Prosthodontists who are practicing and are attached to the academic institutions in Vadodara City, Gujarat, by filling the questionnaire form through E-mail, post, and handing it personally as well.
General dental practitioners and dental practitioners of other specialties other than prosthodontics were excluded from this study.
A total of 43 prosthodontists having their private dental practice and affiliated with academic institutions in Vadodara city, were selected to be part of this study [Questionnaire 1]. A questionnaire approved by Institutional Ethical Committee was used for the study. The questionnaire included questions concerned with the use of gingival displacement method, patient evaluation procedure, techniques preferred by various prosthodontists, and various materials preferred for the use of gingival displacement technique. All the participants were given a questionnaire to be filled through verbal meeting, posts, and E-mails. They were explained about the aim and methodology of the study. Forty-two participants without any bias and prejudice filled the form and replied. Overall 6–8 months time duration was taken to complete the survey.
The survey was performed by a single examiner and the data obtained were analyzed by using descriptive statistics such as frequency table and percentage.
| Results|| |
The data obtained from 42 prosthodontists from Vadodara city, Gujarat, may be representative of the procedures that the prosthodontists are using in their daily practice across the country before impression making for fixed partial denture procedure. The results showed that among all the prosthodontists in Vadodara city, 62% prefer the use of gingival displacement technique for successful clinical practice while 38% of them do not follow the procedure [Figure 2].
|Figure 2: Prosthodontists from Vadodara city who prefer the use of gingival displacement technique for successful clinical practice|
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It was observed that among those who practiced gingival displacement in their daily practice, 40.5% use it to achieve impressions with good margins while 31.0% of them follow the procedure for both subgingival finish line preparation and good margin replica in impression.
The results also revealed that the method which was most commonly preferable for displacement technique was mechanochemical method. Around 83.3% of prosthodontists preferred mechanochemical method followed by mechanical and surgical technique (7.1% each) and very few (2.4%) preferred all the methods depending on the clinical situation [Graph 1].
Among 83.3% who preferred mechanochemical method, all of the participants used one medicament at least and some used more than one to wet the cord before placement. Among 83.3% who used mechanochemical, 57% prosthodontists prefer nasal/eye drops which contain 0.1% xylometazoline or 0.1% oxymetazoline as a medicament along with displacement cord [Figure 3], and 81% of them preferred ultrapak displacement cord while following mechanochemical gingival displacement technique [Graph 2].
|Figure 3: Nasal/eye drops were used maximum as a medicament along with displacement cord|
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When the participants were asked whether they are aware of various cordless systems for gingival displacement, 95.2% of them were aware about the cordless displacement system and 38.1% of prosthodontists preferred Expasyl in cordless displacement system [Figure 4] while 11.9% did not use any of it.
|Figure 4: Expasyl preferred by 38.1% of prosthodontists followed by magic foam (23.8%)|
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| Discussion|| |
One of the most challenging aspects of crown and bridge is the management of the gingival tissues while making an impression. Tissue management includes placing the gingival tissues away from the preparation margins so that the margins can be recorded accurately.
Across the globe, researches have been conducted on different methods of gingival displacement, their effects on gingival and periodontal health as well as the marginal adaptation after gingival displacement technique, but none have evaluated the percentage of clinicians using this technique and also their preference of methods for gingival displacement.,, This study mainly focused on the methods of gingival displacement used by prosthodontists in Vadodara city and to determine the number of prosthodontists recommending the use of gingival displacement technique in their dental practice and also their reasons for using gingival displacement techniques. After asking twenty questions to these practitioners based on their experience, skill, knowledge, and success rate in fixed partial denture prosthesis, the following results were drawn.
Moldi et al. in 2013, evaluated from his study that 60.3% of dentists indicate the use of mechanochemical method and 24.8% dentists indicate the use of chemical method, 12.4% use of surgical method and 2.5% indicate the use of laser. That also indicated that most preferable was mechanochemical method of gingival displacement. These results support the present study which showed that among all the prosthodontists in Vadodara city, 62% prefer the use of gingival displacement technique for successful clinical practice while 38% of them do not follow the procedure believing it does not make major difference in clinical practice. Out of those who perform gingival displacement technique, 83% prosthodontists use mechanochemical method.
Katreva et al. in 2015, concluded that 76.10% of the polyvinyl siloxane impressions obtained better results after the displacement with Nasal decongestants. Their study supports the result of this survey which showed that 57% of prosthodontists used nasal/eyedrops as a medicament of choice while performing mechanochemical method. This is because these nasal decongestants consist of xylometazoline (0.05% xylometazoline hydrochloride) and visine (0.05% tetrahydrozoline hydrochloride) which have absence of cytotoxic effects on soft tissues and less hard tissue sensitivity, and many dentists also preferred its use as they are cheap and easily available.
Chaudhari et al. in 2015, suggested that sympathomimetic amines such as oxymetazoline and tetrahydrozoline can also be used as a gingival displacement agent as pH of tetrahydrozoline is alkaline, so it causes less damage to the gingival tissues and also to the tooth structure.
About 38% participants who do not prefer the gingival displacement technique in this study cited various response for their noncommital such as trauma to epithelial attachment, time consuming, risk of sulcus contamination, and painful procedure along with patient discomfort.
Through this study, it was quite clear that the rationale for prosthodontists not using gingival displacement technique is due to personal ease, patient discomfort, personal choice, and lack of empathy toward patient, ignorance even after knowing the advantages, and some do not use even after citing reasons [Figure 5].
|Figure 5: Rationale for prosthodontists not following gingival displacement technique|
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| Conclusion|| |
Through this study, it was clear that inspite of giving so much of importance to gingival displacement technique during our 3 years of masters in the field of prosthodontics including crown and bridge, we fail to replicate this into our clinical practice ignoring its advantages and benefits.
Out of 42 prosthodontists from Vadodara city, Gujarat, 38% of them do not prefer the gingival displacement technique in their daily practice which is quite a greater ratio.
The limitation of this study is that the results are subjective depending on the personal choice and ease of the clinician and also considering the clinical situation at that time.
For the successful fixed partial denture, a healthy coexistence between the restoration and their surrounding periodontal structure should be the goal of a prosthodontist. Several techniques have been proved effective and safe in the management of the soft tissues. The selection of one of them in soft tissue management depends on the clinical situation and the preferences of the operator.
Financial support and sponsorship
This study was funded by Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India.
Conflicts of interest
There are no conflicts of interest.
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Meghna Ashok Gadhavi
E-401, Shubham Vista Apartments, Opposite Nilamber Bellissimo Apartments, Vasna-Bhayli Road, Vadodara - 390 015, Gujarat
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]