Gingival Retraction Methods: A Systematic Review

Sadia Tabassum, BDS, Samira Adnan, BDS, FCPS, & Farhan Raza Khan, BDS, MCPS, FCPS, MSc
Aga Khan University and Hospital, Karachi, Pakistan

Keywords Abstract
Gingiva; prosthodontics; patient outcomes;
clinical studies/trials; periodontium;
Purpose: The aim of this systematic review was to assess the gingival retraction
periodontal index. methods in terms of the amount of gingival retraction achieved and changes observed
in various clinical parameters: gingival index (GI), plaque index (PI), probing depth
Correspondence (PD), and attachment loss (AL).
Sadia Tabassum, Aga Khan University and Methods: Data sources included three major databases, PubMed, CINAHL plus
Hospital, 74800, Karachi, Pakistan. (Ebsco), and Cochrane, along with hand search. Search was made using the key terms
E-mail: sadya.tabassum@aku.edu in different permutations of gingival retraction* AND displacement method* OR
technique* OR agents OR material* OR medicament*.
Presented at 2015 FDI Annual World Dental Results: The initial search results yielded 145 articles which were narrowed down to
Congress held in Bangkok September 22–26, 10 articles using a strict eligibility criteria of including clinical trials or experimental
2015 (Abstract Title: 0855 Effectiveness of studies on gingival retraction methods with the amount of tooth structure gained and
Gingival Retraction Methods: A Systematic assessment of clinical parameters as the outcomes conducted on human permanent
Review, Publication Number: FC219). teeth only. Gingival retraction was measured in 6/10 studies whereas the clinical
The authors deny any conflicts of interest. parameters were assessed in 5/10 studies.
Conclusions: The total number of teeth assessed in the 10 included studies was
Accepted June 12, 2016 400. The most common method used for gingival retraction was chemomechanical.
The results were heterogeneous with regards to the outcome variables. No method
doi: 10.1111/jopr.12522 seemed to be significantly superior to the other in terms of gingival retraction achieved.
Clinical parameters were not significantly affected by the gingival retraction method.

Gingival retraction is the procedure whereby gingival tissues gingival recession, and changes in the epithelial attachment.6
are deflected away from the tooth to expose the crevicular part Astringents used with cords are usually based on aluminum
or the prepared tooth margins. Generally the need for retraction salts, for example, ferric sulfate or aluminum sulfate, and exert
arises when a tooth needs preparation for a fixed restoration a transient local effect.7
or specifically for restoration of a tooth in close proximity to Less invasive methods including cordless techniques have
the gingiva. It is of paramount importance that the gingival been introduced to minimize discomfort associated with the
tissues be managed properly for accurate impression making.1 cords. Expasyl (Kerr Corp., Orange, CA) is an aluminum chlo-
A proper impression should have adequate thickness so as to ride based, paste-like material that results in moderate gingival
reduce the incidence of tearing or distortion, which otherwise displacement.8 Magic Foam cord (Coltene Whaledent AG, Alt-
would lead to a poor marginal fit of the future prosthesis.2 An statten, Switzerland) is based on a poly(vinyl siloxane) material
improperly fitting restoration can pave the way for gingivitis and and was developed with the aim of easy and quick retraction of
periodontitis resulting from plaque accumulation.3 Capturing the gingiva.9 Merocel, (Merocel Co., Mystic, CT) is available
the complete details after gingival retraction yields a properly in the form of strips produced from a synthetic material. The
fitting fixed dental prosthesis. mechanism of action of this material relies on absorption of
The choice of several gingival retraction techniques is gingival fluids and thus mechanical displacement of gingiva.10
available in the contemporary dental practice. Mechanical, Diode lasers have been used in practice for periodontal and im-
chemical, and surgical methods (and their combinations) are plant surgeries. The principal advantage reported with the use
among the commonly used techniques.1 Retraction cord has of lasers is ease of application along with patient comfort and
been in use in dentistry since time immemorial and is fairly a good hemorrhage control.11
predictable in achieving the required retraction. Cords can be Gingival retraction methods can cause an inflammatory re-
used in combination with various hemostatic or vasoconstric- sponse mainly due to mechanical trauma or the chemical agents
tive agents to aid in controlling hemorrhage, but this comes at present in the astringents.12 According to Feng et al,6 the gingi-
the expense of increased patient discomfort.4,5 Apart from pain val retraction can result in increased levels of pro-inflammatory
and discomfort, incorporation of a cord can be time consuming cytokines, which can cause gingival recession. Researchers
and frustrating. Occasionally, cord packing can lead to trauma, have used indices such as gingival index (GI), plaque index
(PI), probing depth (PD), attachment loss (AL), and bleeding

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Gingival Retraction Methods Tabassum et al

on probing (BOP) to assess the gingival health affected by tissue Figure 1. The time frame used for the study is described in
manipulation in gingival retraction.6 Except for AL, almost all Figure 2.
of these periodontal indices either measure the dental hygiene
or the gingival inflammation. Regardless of the method used Study selection
for retraction, it is imperative to get a proper fitting restoration The first search hits were reviewed by one of the investigators
with minimal damage to the gingiva. to exclude any duplications or studies not relevant to the re-
search question. The reviews of the titles of all the remaining
Aims potential studies were performed by two reviewers indepen-
The aim of this review is to determine the gingival retraction dently and any disagreement was resolved through discussion
methods with respect to the amount of gingival retraction with the third author. The reasons for exclusion of papers were
achieved and changes in various clinical parameters such as also noted. Study quality was rated using a customized data
gingival index, plaque index, bleeding on probing, probing collection form. Finally, selected studies were the ones that
depth, and attachment loss. answered our review questions (i.e., amount of gingival retrac-
tion achieved or changes in various periodontal parameters such
as PD, AL, BOP, etc.).
Materials and methods
Selection criteria Data analysis

The following PICO model was adopted: The data analysis in this systematic review was confined to
reporting the simple descriptive measures of gingival retraction
Population: Gingival tissues around vital and nonvital human achieved with various methods and the descriptive measures of
teeth (incisors, canines, premolars, and molars) in both dental the periodontal parameters (such as GI, PI, PD, AL, BOP) as
arches of adult subjects. reported in the primary studies.
Intervention: Gingival retraction achieved with retraction
cords, pastes, surgery, cautery, or lasers. Results
Comparison: The above-mentioned methods served as their
own comparators. Only eleven studies satisfied the inclusion criteria for this sys-
Outcome: Amount of tooth structure gained (mm), changes in tematic review. One study13 was later excluded on the basis
parameters such probing depth, gingival index, and clinical of its quality, as the results were inappropriately reported. The
attachment loss. authors of that study were consulted for clarification of the
results, but no response was received. The total number of teeth
assessed in the ten finally selected studies was 400. Of these,
Data sources
there were 252 posterior teeth (i.e., premolars and molars) and
For selection of studies, all experimental studies done from 46 anterior teeth. For the remaining 58 teeth, it was not men-
1955 until December 2014 on human gingival tissues were tioned whether they were located anteriorly or posteriorly. The
explored on three major health science databases (PubMed, most common method reported in the included studies was
CINAHL Plus, Cochrane), using the search strategy of various the chemomechanical method. All of these studies were either
key terms in different permutations of: gingival retraction*AND clinical trials or single-arm longitudinal studies. The principal
displacement method* OR technique*or agents OR material* outcomes examined in these studies were either the amount of
OR medicament* OR apparatus OR cord* OR chemical OR gingival retraction achieved or the changes in various periodon-
coagulation OR aluminium sulphate OR past. An additional tal parameters (Table 2).
hand search was carried out; however, no attempt was made to Laufer et al14 demonstrated that at least 0.2 to 0.4 mm
search the grey literature. displacement of the marginal gingiva in the horizontal direc-
Table 1 summarizes the inclusion and exclusion criteria tion is necessary to avoid distortion of the impression. The
and the parameters assessed, along with the commonly used values of gingival retraction measurement in the selected stud-
retraction methods. The study selection flow chart is shown in ies are shown in Table 3. The method of retraction and the tool

Table 1 Criteria for inclusion, exclusion, parameters assessed, and retraction methods

! ! !
Inclusion criteria Exclusion criteria Parameters interest Retraction methods
!
! ! !
In vivo studies Publications in languages other Age Mechanical (i.e., cords)

! ! !
Clinical experimental studies than English Gender Chemomechanical (i.e., Expasyl

! ! ! !
Randomized clinical trials Animal studies Demographics paste)

! !
Clinical trials In vitro studies Tooth location Surgical (i.e., rotary curettage)

!
Histological studies Periodontal status of teeth
Case reports, reviews, and
technique-based reports

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Figure 1 Study flow diagram.

Table 2 List of studies included in the review

Formulation of a review question

August 2014 Author Method(s) used

Al Hamad et al, 20081 Mechanical (Magic FoamCord and Ultrapak

cord), Chemomechanical (Expasyl)
Registration with Prospero (CRD42014013335) Feng et al, 20066 Mechanical (Ultrapak cord)
August 2014 Ferrari et al, 199610 Mechanical (Merocel)
Gupta et al, 201315 Mechanical (StayPut & Magic FoamCord),
Chemomechanical (Expasyl)
Literature research completed Kamansky et al, 198417 Surgical (Rotary curettage),
Chemomechanical (Hemodent cord)
December 2014 Krishna et al, 201311 Surgical (lasers)
Kazemi et al, 200918 Chemomechanical (Ultrapak cord with
astringent, Expasyl)
Data Extraction form Prasanna et al, 201316 Chemomechanical (Ultradent cord with
February 2015 astringent, Expasyl),
Sarmento et al, 201412 Chemomechanical (Ultrapak cord with
astringent, Expasyl)
Yang et al, 200519 Chemomechanical (Ultrapak cord with
Selection of relevant studies and compilation of data
vasoconstrictor, Expasyl, Korlex)
July 2015

Figure 2 Systematic review timeline.

a diode laser for gingival retraction and reported values for
midbuccal, mesiobuccal, and distobuccal regions. Prasanna
used to assess the resulting retraction is also mentioned there. et al16 employed chemomechanical methods. Expasyl paste
Gupta et al15 evaluated the effectiveness of two mechanical performed significantly better (p < 0.01) in their study than the
(Stayput and Magic FoamCord) and one chemomechanical cord with astringent. Gingival response to rotary curettage was
method (Expasyl). They reported a significantly higher amount assessed by Kamansky et al17 They subjected one abutment to
of vertical retraction gained with the mechanical methods as the rotary curettage and the other abutment to the hemodent
compared to Expasyl. Krishna et al11 resorted to the use of cord and observed that rotary curettage resulted in a greater

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Gingival Retraction Methods Tabassum et al

Table 3 Amount of gingival retraction achieved

Method used & No. of teeth

Author measurement tool assessed Retraction achieved (mm)

Horizontal
Gupta et al15 Mechanical (Stayput & 60 Stayput 0.233 ± 0.082
Magic FoamCord) and Magic Foam Cord 0.199 ± 0.069
chemomechanical (Expasyl) Expasyl 0.151 ± 0.085
Stereomicroscope Vertical
Stayput 1.065 ± 0.385
Magic Foam Cord 0.864 ± 0.302
Expasyl 0.484 ±0.195
Krishna et al11 Surgical 20 Mid buccal 0.399
(PICASSO diode laser, Dentsply) Mesiobuccal 0.445
Toolmaker microscope Distobuccal 0.422
Prasanna et al16 Chemomechanical 32 Ultradent cord 0.21 ± 0.01
(Ultradent cord with astringent, Expasyl paste 0.26 ± 0.02
Expasyl)
Stereomicroscope
Kamansky et al17 Surgical (Rotary curettage) 20 Rotary 0.15 (facial)
and chemomechanical 0.03 (palatal)
(Hemodent cord) Hemodent Cord 0.035 (facial)
Modified Boley gauge 0.02 (palatal)
Kazemi et al18 Chemomechanical 20 Cord 0.46 ± 0.03
(Ultrapak cord with astringent, Expasyl 0.34 ± 0.04
Expasyl)
Traveling microscope
Yang et al19 Chemomechanical Cord 0.28
(Ultrapak cord with 24 Expasyl 0.29
vasoconstrictor, Expasyl, Korlex) Korlex 0.25
3D laser scan

increase in sulcus depth. Kazemi et al18 assessed chemome- significant difference in the gingival recession, PI, BOP, and
chanical methods of displacement; however; their results were AL from the baseline to 12 months of Merocel placement. A
contradictory to other studies. In their study, cord resulted in double-blind randomized clinical trial of two techniques was
significantly greater (p > 0.001) gain in the width of the gingival undertaken by Sarmento et al.12 Cord with astringent and Expa-
sulcus compared to Expasyl paste. The three chemomechani- syl paste were incorporated, and neither of the two techniques
cal materials used in Yang et al’s study19 showed significant resulted in any significant change in the periodontal indices.
increase in width of the sulcus; however, the materials did Kazemi et al18 observed a significant increase in GI at the 7th
not differ significantly from one another in terms of retraction and 14th day in the cord group as compared to Expasyl, which
achieved. The demographic details of the studies addressing returned to baseline on the 28th day. The details of author, pa-
amount of gingival retraction are shown in Table 4. For amount tients, and other demographics of the studies that addressed the
of tooth structure gained, only two studies mentioned the gender periodontal parameters are given in Table 6. None of these stud-
of the study participants,17,19 whereas only one study mentioned ies mentioned the gender of the participants. Most of the studies
the arch location of the studied teeth.19 included abutment teeth belonging to the maxillary arch.
Various periodontal parameters assessed in different studies
are summarized in Table 5. Al Hamad et al1 concluded that Discussion
all gingival retraction methods result in an acute tissue injury;
however, in Expasyl group a higher change in GI was seen The authors could not find any systematic review or meta-
as compared to the other two methods (i.e., Ultrapak cord and analysis on the effectiveness of gingival retraction methods. So
Magic Foam group). Feng et al6 showed significant increases of to the best of our knowledge, the present report may be the
GI only at 1, 3, and 7 days after gingival retraction, whereas the first systematic review done of gingival retraction. The review
other indices (i.e., PI, BOP, AL) remained mostly unchanged. was registered at Prospero registry to enhance the transparency
Ferrari et al10 evaluated Merocel, and patients were called for of the work. The Prospero database also ensures that un-
a follow-up after 1 year. The results exhibited no statistically planned duplication of the reviews is prevented. The inclusion

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Table 4 Author, demographics, and tooth details of studies addressing amount of tooth structure gained with retraction

Study Participants’ Arch Tooth Teeth Periodontal or

Author location age (years) Gender location location status gingival status

Gupta et al15 India >18 Not mentioned Not mentioned Not mentioned Not mentioned Healthy
Krishna et al11 India Not mentioned Not mentioned Not mentioned Ant and post Root canal treated Not mentioned
Prasanna et al16 India Not mentioned Not mentioned Not mentioned Posterior Not mentioned Healthy
Kamansky et al17 USA 25.7 (mean age) Males Maxillary Anterior Not mentioned Healthy
Kazemi et al18 Iran 21-48 Not mentioned Not mentioned Posterior Not mentioned Healthy
Yang et al19 China 25 (mean age) Males, females Maxillary Anterior Not mentioned Healthy

Table 5 Periodontal parameters assessed with gingival retraction

Parameters
Author assessed Post-retraction follow-up Remarks

Al Hamad et al1 PD, AL, GI, PI 1st and 7th day Significant change in GI with all techniques
Feng et al6 PI, GI, PD, AL, BOP 1st, 3rd, 7th, 14th, 28th day Significant change in GI (1st day)
Ferrari et al10 PI, BOP, PI At 52 weeks No significant change
Sarmento et al12 GBI, PD, PI, AL 1st and 10th day No significant change
Kazemi et al18 GI 7th, 14th, 28th day Significant changes till 14th day

PD = probing depth, AL = attachment loss, GI = gingival index, PI = plaque index, BOP = bleeding on probing, GBI = gingival bleeding index.

Table 6 Author, demographic, and tooth details on studies addressing gingival retraction using periodontal indices

Periodontal
Study Age Arch Tooth or gingival
Author location (years) Gender location location Teeth status status

Al Hamad et al1 Jordan Not mentioned Not mentioned Maxillary/ Posterior Non root canal Healthy
Mandibular treated
Feng et al6 USA 31-65 Not mentioned Not mentioned Ant and Not mentioned Healthy
post
Ferrari et al10 USA 20-38 Not mentioned Maxillary Anterior Not mentioned Healthy
Sarmento et al12 Brazil Not mentioned Not mentioned Maxillary Anterior Not mentioned Healthy
Kazemi et al18 Iran 21-48 Not mentioned Not mentioned Posterior Not mentioned Healthy

criteria of the present systematic review were made stringent Sarmento et al,12 Yang et al19 ) for the measurement of gingi-
by including randomized controlled trials (RCTs) or single- val retraction. The retraction with this paste varied from 0.15
arm experimental studies only; however, among the selected to 0.48 mm. Surgical method was the least popular; only two
studies, only Sarmento et al12 conducted a double-blind RCT studies used lasers or rotary curettage (Kamansky et al,17 Kr-
with a low risk of bias. Prasanna et al16 mentioned random- ishna et al11 ). The resultant retraction achieved with the lasers
ization, but the study had an unclear risk of bias, because the fell in the range of 0.23 to 0.67 mm, whereas with rotary
method of randomization was not made explicit. None of the curettage, 0.15 mm retraction was seen on the facial side. The
authors reported any conflict of interest or sponsoring in any amount of gingival retraction achieved for mechanical methods
of the studies selected. A lack of homogeneity was observed fell in the range of 0.19 to 0.23 mm, whereas for chemome-
in reporting the outcomes. Tools and methodology adopted for chanical methods a very variable range of 0.02 to 0.46 mm
gingival retraction measurement were variable among stud- was seen due to different measurement techniques. For surgi-
ies. Eight studies (Al Hamad et al,1 Feng et al,6 Ferrari cal methods the amount of retraction came out to be between
et al,10 Gupta et al,15 Kazemi et al,18 Prasanna et al,16 Sarmento 0.03 and 0.45 mm.
et al,12 and Yang et al19 ) reported the use of cords, mostly with Likewise, the periodontal parameters were only assessed
the astringents. The range of gingival retraction achieved with by 5 of the 10 studies (Table 3). The indices at the baseline
the cord varied from 0.02 to 0.46 mm. After the cord, Expasyl were evaluated in four studies.1,6,10,12 Ferrari et al10 conducted
paste was the most popular method, used by six studies (Al the longest follow-up: for 1 year. Only two studies evalu-
Hamad et al,1 Gupta et al,15 Kazemi et al,18 Prasanna et al,16 ated the change in the periodontal parameters to the 28th day

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Table 7 Quality assessment of the included studies

Type of Allocation Incomplete Risk of

Author study Randomization concealment Blinding outcome data bias

Al Hamad et al1 Clinical trial No No Yes No High

(quasi-experimental study)
Feng et al6 Pre-post single-arm study NA NA NA No High
Ferrari et al10 Pre-post single-arm study NA NA NA No High
Gupta et al15 Clinical trial No No No No High
Kamansky et al17 Clinical trial No No No Yes High
Krishna et al11 Single-arm experiment NA NA NA Yes High
Kazemi et al18 Clinical trial No No No No High
Prasanna et al16 Randomized crossover trial Unclear Unclear No No Unclear
Sarmento et al12 Randomized double-blind Yes Yes Yes No Low
crossover clinical trial
Yang et al19 Clinical trial Yes No No No High

(Feng et al,6 Kazemi et al18 ). Most indices were measured by 1. Only 10 studies, assessing 400 teeth, met the inclusion
all the studies, except Kazemi et al,18 who only assessed GI, criteria.
but did not make any mention of GI at the baseline. Al Hamad 2. Most studies failed to mention the arch location of the
et al1 and Kazemi et al18 reported significant changes in GI abutment teeth as well as gender differences of the pa-
through the 7th and 14th day, respectively. tients participating in the study.
EPOC criteria20 were used for determining the risk of bias. 3. The most commonly used method was chemomechanical
These criteria are proposed by the Cochrane Handbook for (cords with astringents and Expasyl paste).
Systematic Reviews of Interventions. The included studies were 4. Trials on surgical methods were limited; only one study11
subjected to quality assessment, and the scores are summarized reported the use of lasers, and only one study17 reported
in Table 7. the use of rotary curettage.
With the exception of one study (Sarmento et al12 ),the rest 5. Amount of gingival retraction achieved for mechanical
of the studies either had high or unclear risk of bias. Lack methods was in the range of 0.19 to 0.23 mm, whereas for
of methodological quality was observed in these studies, so chemomechanical methods a range of 0.02 to 0.46 mm
this systematic review is not a portrayal of best practices ob- was observed. For surgical methods the recorded range
served in dentistry. This demands high quality trials to explore was 0.03 to 0.45 mm.
the research question further. The present systematic review 6. Periodontal indices were not significantly affected with
has limitations, because many other factors like ease of ap- different retraction methods; however, only Al Hamad et
plication, time for retraction, cost of intervention, trauma to al1 and Kazemi et al18 reported significant changes in GI
tissues, gingival recession, and other clinically relevant factors on the 7th and 14th day, respectively.
were not considered. These factors are equally important when
it comes to the selection of the most appropriate gingival re- Future considerations can be given to work being attempted
traction material or technique. Moreover, as inclusion criteria to produce more high quality randomized controlled trials to
were restricted to only two main parameters (i.e., amount of generate sufficient data to answer the review question.
gingival retraction gained and changes in various periodontal
indices), this could have introduced an unintentional selection
bias. Since the results of the studies included in this system-
Acknowledgments
atic review showed significant variability in study design and We gratefully acknowledge Mr. Khawaja Mustafa and Mr. Musa
methodology, it was not possible to pool data and derive a mean Khan at Aga Khan University Health Sciences Library for help-
estimate of the amount of tooth structure gained with gingival ing us with the literature research.
retraction, therefore, the results are confined to the systematic
review format instead of a meta-analysis approach.
References
Conclusions 1. Al Hamad KQ, Azar, W, Alwaeli HA, et al: A clinical study on
the effects of cordless and conventional retraction techniques on
In this systematic review, two major outcomes (amount of gin- the gingival and periodontal health. J Clin Perio
gival retraction and changes in various periodontal indices) 2008;35:1053-1058
were assessed, and it was observed that results were not ho- 2. Donovan TE, Gandara, BK, Nemetz H: Review and survey of
mogenous, because different tools were used for measurement medicaments used with gingival retraction cords. J Prosthet Dent
of gingival retraction. 1985;53:525-531

6 Journal of Prosthodontics 00 (2016) 1–7 !

C 2016 by the American College of Prosthodontists
Tabassum et al Gingival Retraction Methods

3. Sorensen SE, Larsen IB, Jorgensen KD: Gingival and alveolar 12. Sarmento HR, Leite FR, Dantas RV, et al: A double-blind
bone reaction to marginal fit of subgingival crown margins. randomised clinical trial of two techniques for gingival
Scand J Dent Res 1986;94:109-114 displacement. J Oral Rehabil 2014;41:306-313
4. Bennani V, Schwass D, Chandler N: Gingival retraction 13. Shivasakthy M, Asharaf AS: Comparative study on the efficacy
techniques for implants versus teeth: current status. J Am Dent of gingival retraction using polyvinyl acetate strips and
Assoc 2008;139:1354-1363 conventional retraction cord—an in vivo study. J Clin Diagn Res
5. Csillag M, Nyiri G, Vag J, et al: Dose-related effects of 2013;7:2368-2371
epinephrine on human gingival blood flow and crevicular fluid 14. Laufer BZ, Baharav H, Ganor Y, et al: The effect of marginal
production used as a soaking solution for chemo-mechanical thickness on the distortion of different impression materials. J
tissue retraction. J Prosthet Dent 2007;97:6-11 Prosthet Dent 1996;76:466-471
6. Feng, J, Aboyoussef H, Weiner S, et al: The effect of gingival 15. Gupta A, Prithviraj DR, Gupta D, et al: Clinical evaluation of
retraction procedures on periodontal indices and crevicular fluid three new gingival retraction systems: a research report. J Indian
cytokine levels: a pilot study. J Prosthet Dent 2006;15:108- Prosthodont Soc 2013;13:36-42
112 16. Prasanna GS, Reddy K, Kumar RK, et al: Evaluation of efficacy
7. Nowakowska D, Saczko J, Kulbacka J, et al: Dynamic of different gingival displacement materials on gingival sulcus
oxidoreductive potential of astringent retraction agents. Folia width. J Contemp Dent Pract 2013;14:217-221
Biol (Praha) 2010;56:263-268 17. Kamansky FW, Tempel TR, Post AC: Gingival tissue response to
8. Lesage P. Expasyl: protocol for use with fixed prosthodontics. rotary curettage. J Prosthet Dent 1984;52:380-383
Clinic 2002;23:97-103 18. Kazemi MMM, Loran V: Comparing the effectiveness of two
9. Rupali K, Sarandha DL, Chand BD: Advances in gingival gingival retraction procedures on gingival recession and tissue
retraction. Int J Clin Dent Sci 2011;2:64-67 displacement: clinical study. J Biol Sci 2009;4:335-339
10. Ferrari M, Cagidiaco MC, Ercoli C: Tissue management with a 19. Yang JC, Tsai CM, Chen MS, et al: Clinical study of a newly
new gingival retraction material: a preliminary clinical report. J developed injection-type gingival retraction material. Chin Dent
Prosthet Dent 1996;75:242-247 J 2005;24:147
11. Krishna CV, Gupt N, Reddy KM, et al: Laser gingival retraction: 20. Cochrane: EPOC-specific resources for review authors.
a quantitative assessment. J Clin Diagn Res 2013;7:1787- http://epoc.cochrane.org/epoc-specific-resources-review-authors.
1788 Accessed April 26, 2016

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