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