A 5-step process for better retraction

By David Rice, DDS, DrBicuspid.com clinical editor

December 6, 2019 -- Retraction comes in many forms ...

  • Cord
  • Laser
  • Pastes
  • Electrosurgery (which is the only option here of which I am not a fan)

With that, there are many instances where retraction makes our lives simple, including the following:

  • Veneers
  • Crowns
  • Bridges
  • Class 5 direct restorations

So we know about retraction, but there is a problem. After the daily clinic beatings we endured in dental school, many young dentists tend to cut the dental umbilical cord and shift to one of the other modalities. This may or may not be the best option, based on the case in hand.

Even worse, these doctors (and their team members) may be just scanning or taking an impression with no retraction at all.

Before you make that choice, if you have five minutes, I have a five-step process that will deliver retraction like the image below every time.

Image of retraction

Step 1

Prep the preverbal proximal slice so you have opened the contacts and have 360° access. You can use an interproximal diamond. I prefer a 330 bur as I move directly to using that same bur for my occlusal depth cuts. Fewer bur changes equals less time wasted.

Step 2

Based on the tissue thickness, select your cord. Thicker tissue archetypes and deeper sulci can handle larger cord. Thinner archetypes require you and I to be more careful and use thinner cords (makes sense, right?). My favorite cord system is Ultrapak by Ultradent.

Also, I like to presoak my cord in a hemostatic agent. If there is any tissue weeping, ViscoStat by Ultradent also is a winner.

Step 3

While that cord is packed in place, finish preparing your tooth or teeth. Pay attention to prep guidelines based on your restorative material of choice.

Step 4

Pull the cord and refine your prep. You're going to be blown away with the retraction you have.

Step 5

Rinse, dry, and scan or impression with your favorite polyvinyl siloxane (PVS). My favorites are Omnicam for scan and Honigum by DMG or Virtual by Ivoclar Vivadent for PVS impressions.

Give it a whirl. If you have any questions, thoughts or challenges, drop me a line at david.rice@ignitedds.com.


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