PDF Version - Glidewell Dental Labs
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Figure 35: The next step of the Reverse<br />
Preparation Technique is to place the top cord,<br />
the #2E Ultrapak cord (Ultradent). The “2” in the<br />
cord’s name refers to its size, while “E” refers<br />
to it being an epi cord. I know there may be<br />
some controversy with the use of epinephrine,<br />
but my experience has always been that if<br />
a patient can tolerate epinephrine in a local<br />
anesthetic injection, then they can tolerate it in<br />
the retraction cord. If a patient requires a nonepi<br />
vasoconstrictor in their anesthetic, epi cord<br />
would not be an option.<br />
35<br />
Figure 36: Packing this second cord, or top<br />
cord, is more difficult for a number of reasons.<br />
You can’t floss it into place interproximally like<br />
you can with the first cord because doing so<br />
would disrupt the bottom cord, which we want<br />
to stay firmly planted at the base of the sulcus.<br />
Also, even though this cord is hollow, it can be<br />
hard to pack in certain clinical situations where<br />
there is minimal attached gingiva. Because of<br />
this, on some maxillary bicuspids and lower<br />
anteriors, I will use a smaller #1E cord instead.<br />
In extreme cases, a cordless technique with<br />
Access ® Edge gingival retraction paste (Centrix;<br />
Shelton, Conn.) can be used in place of the<br />
top cord.<br />
36<br />
Figure 37: Once the top cord is in place, you<br />
get one last look at your margin. In this case, I<br />
am not entirely happy with what I see because<br />
the shape of my margin does not match the<br />
contour of the gingiva. The margin is not as<br />
smooth as it could be, but keep in mind that it<br />
was prepped with a super coarse 856-025 bur.<br />
This bur is fantastic for quick tooth reduction,<br />
but because of the size of the diamond particles,<br />
it leaves little chips in the margin. At this point,<br />
I switch to my fine grit 856-025 bur with the<br />
red stripe to get rid of that choppiness in the<br />
marginal surface.<br />
37<br />
Photo Essay: The Pursuit of BruxZir Anterior Esthetics27