Tissue management for an exquisite impression depends on two factors. The first goal is to move the gingival tissues away from the margins and create a space for the impression material. The ideal space allows the technician the opportunity to create emergence profile and properly contour the restoration. The next goal of tissue management is to control moisture, as almost all of our impression materials are hydrophobic. As part of this process we often have to manage the tissue bleeding.
My preference for creating the appropriate space is to utilize a two cord technique. The primary cord which stays behind helps to control crevicular fluid and the top cord leaves a space behind for the impression material after it is pulled. If you are using cords that have been impregnated with epinephrine or other hemostatic agents they can also control hemorrhage when the tissue damage or inflammation is minor. In situations where the tissue is inflamed, edematous or damaged from the preparation we often need additional hemostasis. One of the most effective ways I have used to overcome this tissue hemorrhage is the use of Expasyl.
I place my primary and secondary cords as I do routinely. I find cord a much more effective way to create the space for impression material. Over the top of the second cord I inject the Expasyl, generously to cover all of the tissue. I allow the Expasyl to sit for 2-5 minutes. After rinsing the ,material is rinsed off the hemorrhage is completely controlled and I have the luxury of time to take my impression after pulling the top cord.
That does not look like a happy smile! Very informative. Thanks for sharing.
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What if there is insufficent sulcular depth to place two cords. Sometimes only one (and barely one) can go in.
I very rarely do not have enough room for cord. Sometimes I have to use a smaller cord ( size 00 or 000) instead of a size 0 as the primary cord for a shallow sulcus.
Many of my customers hate placing cord. Is it just lack of practice or is there some tips that would help them place cord for better tissue management.
Placing cord for me works best in a very dry field, so I work with isolation, most often an Isolite. I prefer a more rigid cord and use Unibraid from DUX dental. The last trick is to place a smaller cord first after prepping equigingival and allow it to move the tissue so you don’t prep it and causing bleeding, Then drop the margin subgingival and place the top larger diameter cord.