ISOLATION

An operative procedure requires necessitates the need for adequate control over the operating field it is
imperative to that there should be proper moisture control, good accessibility and visibility as well as
adequate room for instrumentation around the working area. Such an environment is necessary for easy
manipulation and insertion of restorative materials. Isolating the working area includes isolation from
moisture like saliva, respiratory moisture and blood also soft tissues like tongue, cheek lips and gingival
tissue

Goal of isolation

 Moisture control
 Retraction of soft tissue
 Harm prevention

Following components of oral cavity needs to be controlled especially during endodontic and conservative
dentistry procedures:

 tongue
 Floor of the mouth
 Saliva
 Mandible
 Lips and cheeks
 Adjacent teeth and restoration
 Gingival tissue
 Buccal and lingual vestibule
 Respiratory moisture

Patient related advantages

 Provides comfort to patient

 Protects patient from aspiration of foreign bodies
 Protects patient’s soft tissues

Operator related advantages

 Provides dry clean field

 infection control
 Increases accessibility
 Prevents contamination of root canal preparation
 Improved property of the materials
 Improved visibility and less fogging

Methods Of
Isolation

Soft Tissue
Moisture Control
Retraction

Retraction of:
Indirect
Direct Methods lip, cheek tongue
Methods
and gingiva

ISOLATION FROM MOISTURE

A) Direct methods

1. Rubber dam

2. Cotton rolls and Absorbent wafers

3. Evacuator system & saliva ejector

4. Gingival retraction cord

5. Mouth props

B) Indirect methods

1. Comfortable position of the patient and relaxed surroundings

2. Local anaesthesia

3. Drugs:

• Anti-sialogogues

• Anti-anxiety drugs

• Muscle relaxants

Direct method

Rubber dam

It was introduced by Barnum a New York dentist in 1863.

It is defined as a flat thin sheet of latex/non latex that is held with clamp and a frame that is preferred to
allow the tooth/teeth to protrude through the perforation while all other teeth are covered.

Advantages

 Long term moisture control

 Maximum accessibility and visibility
 Clean dry field
 Protects soft tissue- lips, cheeks, tongue
 Prevents foreign body aspiration
 Improves the performance of material used

Disadvantage

 Takes time in application

 Communication with patient is difficult
 May cause damage to the crown and gingiva
 Insecure clamp can be swallowed or aspirated
Indication

 During root canal treatment/endodontic procedures

 Excavation of deep caries
 Subgingival restoration
 During adhesive restoration
 In high-risk patient: hepatitis B, HIV
 Bleaching of teeth

Contraindication

 Asthmatic patient
 Allergy to latex
 Mouth breathers
 Extremely malposition teeth
 Third molar

Rubber Dam Equipment

 Rubber dam sheet

 Rubber dam Clamp
 Rubber dam Forceps
 Rubber dam Frame
 Rubber dam Punch

Rubber dam accessories

 Lubricant/petroleum jelly
 Dental floss
 Rubber dam napkin

Rubber dam sheet

 Size: 6” *6” or 5” *5”

 Shape: square
 Colour: green, blue, black
 The sheet has shiny and dull side. Dull side faces the operator because it is less reflective.
 These sheets are autoclavable
 It is available in varied thickness: light, medium, heavy. Medium grade is preferred as light is thin
and is prone to tear whereas heavy grade is so thick that is difficult to apply.
 Although thicker dam is effective in retracting the tissues and is more resistant to tearing. It is
indicated for isolation of class V cavity.
 Thinner dam pass through the contacts easier. It is indicated in teeth with tight contacts
 Latex free dam sheet are mainly composed of following materials:
  Nitrile
 Vinyl
 Silicone

 Examples of latex free rubber dam sheets:

 Hygenic dental dam (Coltène/Whaledent, OH, USA) – It is a non-latex rubber dam for
patients with latex allergies. This powder-free, synthetic dam comes in one size (6 × 6 inches)
and in one thickness (medium gauge). It has a shelf life of 3 years and has the same tensile
strength of a latex dam.
 Derma dam (Ultradent Products. Inc, USA) - It is also a nonlatex and powder-free rubber dam
which removes the possibility of latex reactions. It has a low content of surface proteins and
has an advantage of having low dermatitis potential, reduced allergic reactions and greater tear
resistance
 Flexi dam (Coltène/Whaledent)- It is an elastic nonlatex dental dam made from an elastic
plastomer and can be elongated more than 1000 % before tearing. It is more tenacious than
latex dam and is simple to place. It needs to be stretched before use. Flexi dam is latex free
dam of standard thickness it has got following thickness:

Grade Thickness in mm
Thin 0.15
Medium 0.20
Heavy 0.25
Extra heavy 0.30
Special heavy 0.35
Rubber Dam Clamp/Retainer

To hold the rubber dam on to the tooth are available in different shape or size

The clamp should have 4-point contact with the tooth and the jaws should be confined within the mesial
and distal axial line angle. The bow would always be placed on distal side. If the jaws extend beyond the
distal line angle, it may result in:

 Gingival trauma
 Interference in matrix and wedge placement
 Difficulty in achieving complete seal anchor around anchor tooth

Both the jaws and the bow should be tied with the dental floss of 12” long to prevent accidental aspiration
of clamp

Clamps mainly serve two functions:

 Anchors the rubber dam to the tooth

 Help in retracting the gingival tissue

Components of retainer:

 Bow
 Jaw
 Prong
Types:

 Wing
 Wingless

Based on material it can be classified as:

 Metallic
 Non metallic

Based on jaw design it can be classified as:

 Retentive
 Bland

Wing clamp

It has 2 pair of wings:

 central wing
 anterior wing

Advantages:

 better stability and tissue retraction

 it leads to more rapidity of work and efficiency

Disadvantages:

 interfere with the matrix band and retainer placement.

 Interfere with the working length and master cone radiograph

Bland Clamp

They are usually identified by the jaws, which are flat and point directly towards each other. In these
clamps, flat jaws usually grasp the tooth at or above the gingival margin. They can be used in fully erupted
tooth where cervical constriction prevents clamp from slipping off the tooth.

Retentive Clamp
These clasps provide retention by providing four-point contact with the tooth. In these, jaws are usually
narrow, curved and slightly inverted which displace the gingivae and contact the tooth below the
maximum diameter of crown.

Metallic Clamp

Clamps were made from tempered carbon steel traditionally, they are now made from stainless steel

Non-Metallic Clamp

They are made from polycarbonate plastic and are radiolucent

Different rubber dam clamps are used for different tooth

S. No. Clamp Tooth Type

1 Ivory W212 Anterior teeth
2 Ivory W2 Small Premolars
3 Ivory W8 Maxillary molars
4 Ivory W7 Mandibular molars
5 Ivory W56 Most of the molars
6 Ivory W4 Most Premolars
7 Ivory W27 Terminal mandibular molar that require
tooth preparation on distal side
8 Ivory W14 Young permanent teeth
9 SS White#27 Primary teeth
10 SS White#212 Cervical retainer with 2 bows for class V
restoration

Newer Retainer

Tiger Clamp

It has serrated jaws and is used for broken down or inadequate tooth structure

Silker Glickman clamp(S-G clamp)

This is a clamp with anterior extension which allows for retraction of the dam around a severely broken-
down tooth, and the clamp itself is placed on a tooth proximal to the one being treated. It is made from
durable cast stainless steel, which is autoclavable, corrosion-resistant, flexible and long lasting. It is ideal
clamp for molar isolation. Its extended wings allow for rubber dam placement around the teeth with
minimal tooth structure.

Cushee clamp

It is a plastic clamp and is used for isolation of tooth with ceramic preventing fracture of thin ceramic
margins. These are soft thermoplastic cashew shaped nodules which are grooved on their inner surface and
act as rubber dam clamp cushions. It is slipped over the tooth attachment blade of clamp prior to clamp
application. It increases patient comfort through elimination of contact of steel clamp with gingiva or tooth
enamel, and thus helps to protect the natural tooth structure and costly restorations. It also enhances rubber
dam seal to limit leaking from above or below the dam and reduces clamp slippage. They are sterilizable
and reusable. It can be applied to one or both the jaws of rubber dam clamps. They are available in two
sizes: yellow for anterior and bicuspid clamps and blue for molar clamps.

Clamp with long guard extension

It helps in extension for simultaneous tongue and cheek retraction. Its not used with dam instead used with
cotton rolls. The larger wing of the clamp is used for the retraction of the tongue

Super Clamp (Dent Corp Research and Development, NY, USA)

This new product facilitates the isolation of an individual tooth without covering the patient ‘s whole
mouth and nose. It protects the tongue and cheeks while helping the patient and the dentist feel more
comfortable. The tongue need not be protected with the mouth mirror and hence it gives total security for
treatment with the rotary instrument. The device consists of a specially designed clamp with an added
―wing extension to retract the cheeks and the tongue.

Gold Coloured Clamps

These clamps have diamond grit on their jaw to improve the retention of the clamp
Rubber Dam Forceps

It is used to carry the clamp to the tooth. They are designed to spread the two working ends of the forceps
apart when the handles are squeezed together. Working ends have small projections that fit into two
corresponding holes on the rubber dam clamps. Area between the working end and the handle has a sliding
lock device, which locks the handles in positions while the clinician moves the clamp around the tooth. It
should be taken care that forceps do not have deep grooves at their tips or they become very difficult to
remove once the clamp is in place.

Rubber Dam Frame

It supports the edges of the dam. They are mainly designed with the pins that slope backwards. It has helps
in:

 Supporting the edges of the rubber dam

 Retracting the soft tissue
 Improving accessibility to the isolated teeth

They are available in following materials:

 Stainless steel
 Plastic

Metallic frame

These are the traditional frames and are made of stainless steel

Example:

Young’s Frame

U-shaped metal frame with small metal projections for securing the borders of the rubber dam

Plastic

It is radiolucent thereby it is not removed while taking a radiograph

Example:

Nygard Ostby frame

U- shaped frame made of plastic and it is designed in such a way that it exerts less tension on the dam it is
easier to use and requires no absorbent napkin, when taking radiograph. Shield is shaped to fit the face.

Star visi frame

It is a U-shaped plastic frame that exerts less tension on dam and is easy to use. As it is made from plastic
it is radiolucent so it need not be removed while taking the radiograph

Articulated Frame or Le Cadre Articule Rubber Dam Frame

The articulated rubber dam frame (IRED, France) was developed in France by Dr. G Saveur is made of
non-irritant plastic material (polysulfone) currently used in the agro alimentary industry and has the
following features:

 A double hinge situated in the vertical axis of the frame, which allows it to be folded in half in the
vertical direction.

 A brace situated at the bottom of the frame allows turning the dam sheet back on itself creating a
reservoir into which compresses or an aspiration device may be placed.

 Curved to fit the face

The articulated frame has an advantage in providing access to the buccal half of the cavity. This
accessibility facilitates proper positioning of the radiographic film, administration of additional local
anaesthetic, and evacuation of therapeutic liquids, which may have accidentally entered the buccal cavity.
In addition to this, it has a reservoir at the bottom of the frame that allows the placement of gauze to
compress and an aspiration canula to avoid leakage of fluids such as sodium hypochlorite onto the patient's
clothing.

Safe T- frame

The Safe-T-frame (Sigma Dental Systems) is composed of two hinged frame members whose snap-shut
locking mechanism securely clamps the rubber dam sheet in place. This concept also makes it possible to
retain the traditional U-formed frame geometry and dimensions and offers a secure fit without-stretching
the rubber dam sheet. It also has a further advantage of, raised edges of the frame which provide a barrier
around the sheet preventing fluids from escaping on to the patient. This contributes to greater patient
comfort.
Pre Framed Rubber Dam

Insti dam (Zirc)

It has an in-built flexible radiolucent nylon frame eliminating the need for a separate one. It is made of
translucent natural latex that is very stretchable, tear-resistant and provides easy visibility. There is an off-
centre pre-punched hole which customizes fit to any quadrant. More holes can be added if desired. Its
compact design is just the right size to fit outside the patient ‘s lips. It has the following advantages:

 Built-in flexible frame which eliminates the use of separate frame.

 Pre-punched hole helps eliminate tearing.
 Radiographs may be taken by bending the frame without removing the dam.
 Minimal pull-on clamp.
 Single-use and hence eliminates the need for sterilization.

Handi dam (Aseptico)

It is a pre-framed rubber dam which eliminates the need for traditional frames. It is quick and easy to
place. It allows easy access to oral cavity during the root canal procedure.

Dry dam

It is an alternative type of rubber dam which does not require a frame. It consists of a small rubber sheet
set in the center of an absorbent paper with light elastics on either side to pass over the ears. It fits like a
face mask with an absorbent lining to give patient comfort and reduced risk of allergic reaction. It is
available in medium and thin varieties. It is useful for quickly isolating anterior teeth but it is not useful for
isolation of posterior teeth. It has an added disadvantage of not being useful in a bleaching procedure due
to the absorbent nature of the paper surrounding it.

Framed Flexi Dam (Coltène/Whaledent)

The Hygenic non-latex flexi dam is also available with an convenient, built-in-frame. The flexible frame is
designed with a convenient working size of 100 mm x 105 mm to ensure easy placement without limiting
access. The dam has good tear resistance and is latex allergy free and odourless. The smooth surface of the
plastic frame helps to maximize patient comfort when positioned against their skin.

Opti Dam (Kerr)

Opti Dam is the first rubber dam with 3-dimensional shape and nipple design. The 3-dimensional shape of
Opti Dam and the anatomical frame shape match the contours of the mouth. This allows greater access and
improved visibility to the working area. This also allows reduced tension resulting in easier rubber dam
application and low risk of clamp displacement. Opti Dam is available in two versions: anterior and
posterior. Opti Dam involves much less preparatory work than for conventional rubber dams. i.e., no
marking of the tooth position because of outward oriented nipples and no hole-punching procedures as the
nipples are easily cut. It offers maximum patient comfort and allows them to breath with no pressure
around the nasal area.

Optra Dam (Ivoclar Vivadent, USA)

Optra dam represents the next generation of rubber dams, combining the benefits of a lip and cheek
retractor (Optra Gate), with the total isolation of a rubber dam. The anatomical shape, high flexibility and
patented inner-ring design allows it to be placed without the need for clamps. Additionally, there is no
need for a separate rubber dam frame making it even more time and cost efficient. It is available in both
regular and small sizes. The soft flexible material allows patients to maintain full mobility of their jaw
along with added comfort throughout the procedure. It provides optimum isolation as well as it is
comfortable for the patient. Due to the enhanced flexibility of the plastic rings, it can be placed more easily
in the patient's mouth. Its anatomical shape helps to create a considerably larger treatment field and
complete isolation of both arches can be achieved at the same time.

Rubber Dam Punch

This is used to punch the rubber dam for application om specific tooth. The rubber dam punch has a
moving table with holes of different diameters. The smallest one is for lower anterior teeth and the largest
is for posterior teeth
Rubber Dam Template

It is provided to the clinician to make an exact punch on the tooth in question for both upper and lower
teeth. The holes in the rubber dam should be punched approximately over the centre of the incisal or
occlusal surface of the teeth to be engaged using a rubber dam template below the rubber dam sheet.

Rubber Dam Napkin

It is placed between the dam and the patient’s skin in order to avoid any potential latex related allergic
reaction.

Application Of Rubber Dam

Determine Hole Positions

Hole positions can be easily marked using a template. The template provided in the kit is for the adult
dentition and is to be used with the 6" x 6" dental dam.

Marking Hole Positions

Place the dam on top of the template and mark the holes for teeth using a felt-tip pen.

Punching Holes

Punch the appropriate hole sizes for the teeth to be included in your isolation. When using Non-Latex
Dental Dam, it is advisable to punch one hole size smaller than recommended for latex dam.

Proper punching includes proper alignment of the punch table with the pin, alignment of the pin with the
hole mark on the dam, and punching; then, pulling the dam up over the point of the punch.

An improperly cut hole will result in a nick or tag that may cause the dam to rip while it is being placed
(consistent nicks or tags may be indicative of a dull punch). Water-Soluble Lubricant A water-soluble
lubricant is placed on the tissue side (non-powdered) of the dam. The lubricant facilitates placement of the
interseptal dental dam. Petroleum jelly is not recommended as it does not readily rinse off the surfaces of
the teeth.

Select a clamp that will maintain four-point contact with the tooth’s proximal surfaces. If a clamp is too
large, it will impinge on the soft tissues. If it is too small, it will not properly grasp the tooth’s surface, and
will be unstable.

SELECTING THE APPROPRIATE CLAMP

 Anterior Tooth: Use a double-bowed clamp (i.e. #9)

 Premolar: Use a small, flat-jawed clamp, (i.e. #00, #2) or curved-jawed clamp (#1) for maxillary
premolar.
 Mandibular Molar: Use a flat-jawed clamp, (i.e. #3, #7).
 Maxillary Molar: Use a clamp with curved jaws (i.e. #8, #56, #4).
 Partially-Erupted Tooth: Use a clamp with subgingivally designed jaws, suitable to the size of
anchor tooth (i.e. #2A, #8A, #14, #14A).
 Structurally Compromised Tooth: Use a clamp with serrated jaws (i.e. #12A, #13A).

Using Wedjets or Dental Floss for Dental Dam Stabilization

Application Techniques
The Winged Technique: The advantage is that steps are eliminated because the dam, clamp, and frame
are simultaneously carried to the patient’s mouth for placement. Take the time now to prepare the dental
dam for placement using the winged technique.

The Wingless Technique: The clamp is placed on the tooth first, and the dam is stretched over the clamp
and tooth. Tie a safety ligation to the clamp to prevent swallowing should the clamp become dislodged.
Now place a safety ligation on a wingless clamp

The Modified Winged Technique: The dam is stretched over the bow of the clamp prior to its placement
in the mouth. The clamp is seated and the dam is stretched over the jaws and tooth. Take the time now to
prepare the dental dam using the modified winged technique.
INTERPROXIMAL PLACEMENT OF DENTAL DAM

Interproximal placement of the interseptal dental dam may be easily accomplished if a water-soluble
lubricant is applied to the dam and the following techniques are employed.

KNIFED-EDGE TECHNIQUE: A common mistake made is to bunch the dental dam while trying to
force it all through the contact at the same time. Instead, “knife” the edge through the contact area. If the
contact is not very tight, the dam should slip through it.

LOOP TECHNIQUE: For more difficult contacts, use waxed floss to carry an edge of the dam through
the contact area. The lingual end of the floss is looped over and inserted into the contact, while carrying
more dam with it. Remove floss by pulling both ends buccally without disturbing the dam.

CREATING A MOISTURE SEAL Inversion of the edges of the dental dam is essential in creating a
moisture seal around the necks of the teeth. A description of this technique follows.

INVERSION: Using a blunted instrument and a steady stream of air, tuck the edges of the dental dam into
the gingival sulcus.

Other Advances

Kool dam (Pulpdent Corporation)

It is a light cured material applied on the gingiva or tooth surfaces prior to power bleaching, sand
blasting or other procedures requiring intraoral protection or isolation. It is also used to block out
undercuts prior to taking impressions. Also called as liquid rubber dam Because of its low
exothermic reaction, it eliminates burning and pain, thus assuring patient comfort.

It remains flexible after curing and has good tear resistance. It stacks on itself smoothly and
evenly and is easy to remove. It is moisture friendly and works well in the oral environment and is
a rubber dam substitute. A similar resin product called as OpalDam is manufactured by Ultradent
Incorporation. It has two disadvantages. Firstly, being resin based, it produces heat when cured,
and can thus cause discomfort or pain to the patient. Secondly, some of these products tend to
displace and not stay where they are placed.
 Fast dam
Anatomically-shaped fast dam is designed to provide a superior means of maintaining a dry
quadrant field. It can be used in place of cotton rolls to retract the cheek and tongue while
maintaining a dry field. Continuous aspiration is achieved by means of 17 suction holes along the
perimeter, eliminating the need to change saturated cotton rolls while retracting the cheek and
tongue. Fast dam fits into the valve of all standard saliva ejectors. Fast dam is also suitable when
conventional rubber dam is too cumbersome.

SUCTION DEVICES

These devices prevent pooling of saliva. It can be classified on the basis of material used:

 Metallic
 Disposable

It can also be classified on the basis of volume of saliva ejected:

 High volume ejector

 Low volume ejector

Advantages of high volume ejectors

 Removes shavings of tooth and restorative material as well as other debris from the working site
 Toxic material is readily removed
 Decreases treatment time as intermittent rinsing and washing is avoided

Application of saliva ejector

Recent advances

Mirro-Vac Saliva Ejector Mirrors

Upper suction inlet relieves tissue grab and ensures anti fog acrylic mirror stays clear- even under direct
exhalation. It is ideal for sealants, air abrasion, bonding and other dry field procedures
Hygoformic saliva ejector

It is comfortable and less traumatic

Isolite

The Isolite is a new dental device that simultaneously delivers continuous throat protection, illumination,
retraction and isolation. It has a unique soft, flexible mouthpiece which isolates maxillary and mandibular
quadrants simultaneously, retracts and protects the soft tissues from accidental damage from high speed
turbines, delivers shadow less illumination and continuously aspirates fluids and prevents the aspiration of
foreign objects. It can be particularly useful in young people with incompletely erupted teeth. Using
Isolite, a core buildup during endodontic treatment can be done immediately by placing a matrix or core-
former, and thus completing the process in one step. This reduces the amount of time and number of steps
needed as compared to conventional rubber dam.

Parts

Mouth piece

Application

Sweflex Saliva Ejector

It is curved, flexible, efficient, comfortable, reduces aerosols with superior suction capability.
COTTON ROLLS AND CELLULOSE WAFERS

They are moisture absorbents that aid in minimally retracting soft tissues and can be used as an alternative
when rubber dam application is not practical or possible

Cotton rolls are of two types:

 Manually rolled
 Pre-fabricated

When used in association of profound anaesthesia, cotton rolls provide acceptable dryness for procedures
like:

 Examination
 Impression taking
 Cementation
 Sealant placement
 Topical fluoride application

Application of cotton rolls

For maxillary teeth

For isolation in maxillary anterior area; small sized rolls are placed on either side of labial frenum

For Mandibular Teeth

For isolation in mandibular anterior area; small sized rolls are placed on either side of labial frenum along
with lingual sulcus

Silver Dri- Aid

The laminated side prevents soak through and reflects light for improved visibility

Gauze pieces

It serves the same function as cotton rolls and is better tolerated by the delicate tissues and has a lesser
chance of adhesion to dry tissues

LIP RETRACTOR

Simple lip retractor is of the dimension 11cm 4 ½ “ and for a plastic lip retractor is 12cm 4 ¾” it is of
following types:

 Simple lip retractor

 Plastic lip retractor
 Wire lip retractor
 Oringer lip retractor

CHEEK AND TONGUE RETRACTOR

It pulls cheeks and lip backwards and outwards and is used for photographic purpose while working on
anterior teeth

Disposable Spand – Ezz Expander

It is available in following sizes:

 Small
 Medium
 Large
GINGIVA RETRACTION

PHYSICAL RETRACTION

GINGIVAL RETRACTION CORD

It provides improved access visibility and protects gingiva from abrasion during cavity preparation also it
restricts restorative material from entering the sulcus

Retraction Cord Designs

• Twisted
• Knitted
• Braided
Advantages
– does not separate when inserted into the sulcus and much easy to use.
– larger sizes should be avoided as they tend to double up and leads to traumatic placement
Retraction Cord Diameter
The cord that can be atraumatically placed into the sulcus should be used.
• SMALL- to be used in anterior teeth, where thin firmly tissue is present
• MEDIUM- indicated where greater bulk is encountered e.g. posterior teeth
• LARGE- should be used with caution as can produce soft tissue trauma
Chemically Impregnated Cords
• The cords are used to keep the chemicals in contact with the tissue and confine them to the
application site.
• By combining chemical action with pressure packing, enlargement of the gingival sulcus as well as
fluid control is more readily accomplished.
Gingival retraction cord collars

It helps in physical retraction and has a better tissue control with fully visible subgingival margins and
reduces the chances of recession

SURGICAL METHODS
1. Rotary Gingival Curettage
• Also called as ‘Gingettage’ and ‘Troughing’
• A technique of using rotary diamond instruments to enlarge the sulcus. It involves
preparation of the tooth sub-gingivally while simultaneously curetting the inner lining of
the gingival sulcus.
 • The goal is to eliminate the trauma from pressure packing and the need for electrosurgical
procedures
 suitability of the gingiva for gingettage
• Absence of bleeding from probing.
• Sulcus depth less than 3 mm.
• Presence of adequate keratinized gingiva

2. Electrosurgery
• Also called ‘Troughing’ and ‘Gingival dilation’
• A trough is created that extends from the crestal height of the gingiva to a point 0.3-
0.4mm apical to the finish line using a fully rectified current.
• Indications
1. Areas of inflammation and granulation tissue around tooth.
2. In cases where it is impossible to retract the gingiva.
3. To enlarge the sulcus and also to control hemorrhage.
4. To remove irritated tissue that has proliferated over the finish line.
5. Removal of edentulous cuff.
6. Crown lengthening.
 Contraindications
1. Patients with cardiac pace makers, TENS, Insulin pump.
2. Very fine marginal gingiva with little or no attached gingiva.
3. Presence of inflammable anesthetics or agents.
4. Delayed healing due to debilitating disease, radiation therapy.
CHEMICAL METHODS
It is the most popular technique for gingival retraction:
 Vasoconstrictor
 Astringint
 Styptics
Vasoconstrictor: Epinephrine is used most commonly
Astringent: zinc chloride(8%), silver nitrate(2%)
Styptics: alum, aluminium chloride, tannic acid, ferric chloride
The chemicals can be carried to the operating site by means of:
 Cords
 Cotton rolls
 Cotton pellet