Gingival Retraction with a Paste

Wednesday, 06 February 2008 10:04

Sulcus opening and hemostasis are two essential prerequisites for good access. Classical gingival excision techniques by laser and primary rotary curettage, can sometimes be painful and lead to damage of the periodontium.

Gingival retraction techniques using cords are often laborious, painful in the absence of anesthesia,represent a risk of damage to the epithelial attachment,risk of epithelial detachment, risk of irreversible gingival retraction ,excessive bleeding or seeping.Level of the gingival margin is difficult to predict following periodontal healing and therefore may present aesthetic problems. Some existing products used for hemostasis have shown to be unstable, inhibit bonding, and often leave debris in the sulcus area.So what is the answer to all these problems? Here comes a product developed by Expasyl to save us from this ordeal.

It helps in saving considerable amount of time for the practitioner and enhances comfort for the patient.Expasyl utilizes a mechanical and chemical component for sulcus opening and hemostasis. It is comprised of three materials: kaolin, water, and aluminum chloride.Expasyl contains white clay (kaolin) to ensure the consistency of the paste and its mechanical action while aluminum chloride enhances the hemostatic action. Application of an air water spray will remove the material from the sulcus.

Indications for using Expasyl are essentially whenever hemostasis or sulcus opening (gingival deflection) is required. Procedures may include sulcus openingand hemostasis before taking an impression, restoration of cavities, or prior tobonding or cementing restorations. The Expasyl paste is injected into the sulcusexerting a stable, non-damaging pressure of 0.1N/nm.

It is important to note that the approximate measurement of biologic width is 3mm. When Expasyl is left in place for one minute, this pressure is sufficient to obtain a sulcus opening of 0.5mm for two minutes.

The product is supplied in reusable capsules. Depending on the clinical situation and number of teeth, four to 10 preparations can be performed with a single capsule. The reusable capsule can be decontaminated after each use. The disposable injection canula allows for bending and shaping for greater access.

Equipment
• Capsules
• Injection canulas
• Applicator

Care after use:
• Separate the applicator, capsule and canula.
• Discard the injection canula.
• Close and decontaminate the capsule.
• Clean applicator before disinfection and sterilization.
• Store the product separately from the canulas and applicator.

Storage
The paste is very viscous and dependant upon humidity andtemperature. Capsules must be kept around room temperature (20 degrees Celsius). If the contents of the capsule are left open to air,its viscosity will increase to where it becomes impossible to inject.To prevent the material from drying up, it is essential to close thecapsule immediately after use.Store the capsules separately from the canulas and applicator since the paste has aluminum chloride,which could corrode the metal found in canulas and applicator.

Insertion Protocol
At the start of injecting the Expasyl material, the canula tip must be braced onthe surface of the tooth with immediate proximity to the gingival edge anglinginto the sulcus. This creates an enclosed space which walls are compromised of thetooth surface, the cross section of the canula tip and the intrasulcular wall. In other words, the canula is pushed towards the tooth surface when expressing the material. It is important to see blanching (from pink to white) of the marginal gingiva to verify that the product has entered the sulcus. As the sulcus expands, the angle if the injection canula tip is increased to maintain contact with the sulcus lining of the gingival edge


Expasyl is injected into the sulcus physically displacing the tissue	Left for 1-2 minutes and then rinsed, aluminum chloride controls bleeding (and re-bleeding) and crevicular seepage
It leaves the sulcus open and dry Good marginal access and retraction	Easy-to-read impression Every detail rendered clearly & accurately

Comments (2)

Of course it will. Expasyl has hemostatic property and therefore will control bleeding.

As a prosthodontist, I often have to reprepare failed crowns, often in very bloody and subgingival fields.
Will Expasyl work in these conditions?
Dr. Zach