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Figure 36: I prefer to use straight, non-serrated cord packers when
placing the #00 cord. In this shot, you can see that this cord is
braided and hollow. Its hollowness makes it easier to pack into the
sulcus; however, even #00 solid cords are fairly easy to pack. Because
it is braided, the #00 cord starts to expand once it is placed
in the sulcus, absorbing any crevicular fluids. Trying to pack a #00
cord when it is wet is frustrating, so we try to dry the sulcus as
much as possible first, especially at the gingival margin.
Figure 37: Now that the #00 cords are all in place, we can inspect
the margins and see if any of them need to be dropped subgingivally.
Our goal is to have slightly subgingival margins without taking
a bur subgingival. We are able to achieve this because the #00 cord
has vertically retracted the tissue approximately 0.5 mm. I typically
drop the margins with the 856-025 bur, and most times I turn the
water off and my electric handpiece down to 3,000 rpm. This way,
I can clearly see what I’m doing.
Figure 38: Even though I am a huge fan of the two-cord impression
technique, I continue to try every non-cord retraction technique
that comes on the market, hoping that one day I can stop packing
cord. So far I haven’t found anything that works as well as cord,
but the search continues. My common complaint about the paste
retraction systems has been the difficulty in getting retraction
material into the sulcus, so I ordered the 3M ESPE Retraction
Capsule after seeing an ad about its narrow tip that the company
claims fits directly in the sulcus. You can see us trying it out here.
Figure 39: The retraction paste is left in place for a minimum
of two minutes, but typically closer to eight minutes. Just
like we do with the two-cord technique, we place ROEKO
Comprecap Anatomic compression caps (Coltène/Whaledent;
Cuyahoga Falls, Ohio) over the preps to help keep the retraction
paste in place and the patient’s tongue away. The pressure
also drives blood out of the capillaries, providing us with additional
temporary hemostasis.
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