Establishing a Protocol for Gingival Retraction- A Review

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Varun Wadhwani
Vinay Sivaswamy
Vaishnavi Rajaraman
Khushali K. Shah


Impression making, gingival retraction, cordless retraction, and implant


To ensure the success of fixed dental prostheses, it is critical to obtain accurate impressions of the prepared finish line, whether it is a tooth-supported or implant-supported prosthesis. Gingival retraction techniques can be used to reduce any discrepancy between the restoration and the abutment if the prepared finish line is near the gingival sulcus. Accurate marginal positioning is crucial for optimal therapeutic, preventive, and aesthetic outcomes. Gingival retraction techniques can be classified into mechanical, chemical, or surgical methods. This article provides an overview of various conventional and modern methods of gingival retraction used in impression making of tooth-supported and implant-supported prostheses, and summarizes the conclusions extracted from studies on gingival tissue management.

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1. Bennani V, Schwass D, Chandler N. Gingival retraction techniques for implants versus teeth: current status. J Am Dent Assoc. 2008 Oct;139(10):1354–63.
2. Wöstmann B, Rehmann P, Trost D, Balkenhol M. Effect of different retraction and impression techniques on the marginal fit of crowns. J Dent. 2008 Jul;36(7):508–12.
3. Rajambigai MA, Raja SR, Soundar SIJ, Kandasamy M. Quick, painless, and atraumatic gingival retraction: An overview of advanced materials. J Pharm Bioallied Sci. 2016 Oct;8(Suppl 1):S5–7. 4. Merchant A, Ganapathy DM, Maiti S. Effectiveness of local and topical anesthesia during gingival retraction. Braz dent sci. 2022;1–8.
5. Murugan T, Inbasekaran D, Murthykumar K. Enhanced Gingival Recession Coverage by Er,Cr:YSGG Laser Root Biomodification. Contemp Clin Dent. 2021 Sep 21;12(3):328–31.
6. Rajasekar A. Comparative Evaluation Of Different Concentrations Of Povidone Iodine As Subgingival Irrigant In The Management Of Chronic Periodontitis. 2021 Sep 23 [cited 2023 May 5]; Available from:
7. Al Hamad KQ, Azar WZ, Alwaeli HA, Said KN. A clinical study on the effects of cordless and conventional retraction techniques on the gingival and periodontal health. J Clin Periodontol. 2008 Dec;35(12):1053–8.
8. Kannan A, Venugopalan S. A systematic review on the effect of use of impregnated retraction cords on gingiva. Research Journal of Pharmacy and Technology. 2018;11(5):2121–6.
9. International Journal of Dentistry, Oral Science (IJDOS). Prevalence And Distribution Of Drug-Induced Gingival Enlargement In Urban Population -A Retrospective Cohort Study Research Article. SciDoc Publishers [Internet]. 2021 Jan 1 [cited 2023 May 5]; Available from:
10. Maischberger C, Stawarczyk B, von Hajmasy A, Liebermann A. Hemostatic gingival retraction agents and their impact on prosthodontic treatment steps: A narrative review. Quintessence Int. 2018;49(9):719–32.
11. Kavita K, Sinha RI, Singh R, Singh R, Reddy KRP, Kulkarni G. Assessment of Aluminum Chloride Retraction Cords, Expasyl, and Tetrahydrozoline-Soaked Retraction Systems in Gingival Retraction. J Pharm Bioallied Sci. 2020 Aug;12(Suppl 1):S440–3.
12. Singh A, Rao B, Gujjari A. Evaluation of gingival displacement using foam cord and retraction cord: An in vivo study. J Int Oral Health. 2019;11(1):8.
13. Shillingburg HT, Hobo S. Fundamentals of Fixed Prosthodontics. 1981. 454 p.
14. Anand PS, Bansal A, Shenoi BR, Kamath KP, Kamath NP, Anil S. Width and thickness of the gingiva in periodontally healthy individuals in a central Indian population: a cross-sectional study. Clin Oral Investig. 2021 Nov 16;26(1):751–9.
15. Hong LG, Guo LP, Xue LL. [Gingival retraction paste versus gingival retraction cord for fixed prosthodontics: a systematic review]. Shanghai Kou Qiang Yi Xue. 2013 Aug;22(4):456–61.
16. Nallaswamy D. Textbook of Prosthodontics. JP Medical Ltd; 2017. 1417 p.
17. Ponnanna AA, Maiti S, Rai N, Jessy P. Three-dimensional-Printed Malo Bridge: Digital Fixed Prosthesis for the Partially Edentulous Maxilla. Contemp Clin Dent. 2021 Dec 21;12(4):451–3.
18. Merchant A, Ganapathy DM, Maiti S. Effectiveness of local and topical anesthesia during gingival retraction [Internet]. Vol. 25, Brazilian Dental Science. 2022. p. e2591. Available from:
19. Aparna J, Maiti S, Jessy P. Polyether ether ketone - As an alternative biomaterial for Metal Richmond crown-3-dimensional finite element analysis. J Conserv Dent. 2021 Nov-Dec;24(6):553–7.
20. Agarwal S, Ashok V, Maiti S. Open- or Closed-Tray Impression Technique in Implant Prosthesis: A Dentist’s Perspective. J Long Term Eff Med Implants. 2020;30(3):193–8.
21. Maiti S, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University Chennai, Nadu T, India. Correlation of soft tissue biotype with pink aesthetic score in single full veneer crown [Internet]. Vol. 16, Bioinformation. 2020. p. 1139–44. Available from:
22. Maiti S, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University Chennai, Nadu T, India. Data on dental bite materials with stability and displacement under load [Internet]. Vol. 16, Bioinformation. 2020. p. 1145–51. Available from:
23. Subhashree R. Gingival Retraction Methods Used In Different Gingival Biotypes As Classified By Anon Ross And Seibert And Lindhe Classification. 2020 Dec 18 [cited 2023 May 5]; Available from:
24. Jokstad A. Clinical trial of gingival retraction cords. J Prosthet Dent. 1999 Mar;81(3):258–61.
25. Raja Z, Nair C. A clinical study on gingival retraction. J Indian Prosthodont Soc [Internet]. 2003; Available from: 43d8ee99/A-Clinical-Study-on-Gingival-Retraction.pdf
26. Wang Y, Fan F, Li X, Zhou Q, He B, Huang X, et al. Influence of gingival retraction paste versus cord on periodontal health: a systematic review and meta-analysis. Quintessence Int. 2019;50(3):234–44.
27. Donovan TE, Chee WWL. Current concepts in gingival displacement. Dent Clin North Am. 2004 Apr;48(2):vi, 433–44.
28. Cloyd S, Puri S. Using the double-cord packing technique of tissue retraction for making crown impressions. Dent Today. 1999 Jan;18(1):54–9.
29. Abadzhiev M. Comparative research of the subgingival impression quality by fixed prosthesis using one and double cord retraction technique. J IMAB - Annu Proceeding (Sci Pap). 2010 Mar 26;15, book 2(2009):52–4.
30. Kumbuloglu O, User A, Toksavul S, Boyacioglu H. Clinical evaluation of different gingival retraction cords. Quintessence Int. 2007 Feb;38(2):e92–8.
31. Thimmappa M, Bhatia M, Somani P, Kumar DRV. Comparative evaluation of three noninvasive gingival displacement systems: An in vivo study. J Indian Prosthodont Soc. 2018 Apr-Jun;18(2):122–30.
32. Hansen PA, Tira DE, Barlow J. Current methods of finish-line exposure by practicing prosthodontists. J Prosthodont. 1999 Sep;8(3):163–70.
33. Mohan M. Pharmacological agents in dentistry: A review. J Pharm Health Serv Res. 2011 Jan 10;1(3):66–87.
34. Tarighi P, Khoroushi M. A review on common chemical hemostatic agents in restorative dentistry. Dent Res J . 2014 Jul;11(4):423–8.
35. Polat NT, Ozdemir AK, Turgut M. Effects of gingival retraction materials on gingival blood flow. Int J Prosthodont. 2007 Jan-Feb;20(1):57–62.
36. Liu J, Zhang XM, Hao PJ, Hui M, Yu HY. [Comparison of cytotoxicity between chemical retraction agents on human gingival fibroblasts in vitro]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2009 Apr;27(2):202–5.
37. Weir DJ, Williams BH. Clinical effectiveness of mechanical-chemical tissue displacement methods. J Prosthet Dent. 1984 Mar;51(3):326–9.
38. Nowakowska D, Saczko J, Kulbacka J, Wicckiewicz W. Chemical Retraction Agents - in vivo and in vitro Studies into their Physico-Chemical Properties, Biocompatibility with Gingival Margin Tissues and Compatibility with Elastomer Impression Materials. Mini Rev Med Chem. 2017;17(5):435–44.
39. Bader JD, Bonito AJ, Shugars DA. A systematic review of cardiovascular effects of epinephrine on hypertensive dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Jun;93(6):647–53.
40. Kellam SA, Smith JR, Scheffel SJ. Epinephrine absorption from commercial gingival retraction cords in clinical patients. J Prosthet Dent. 1992 Nov;68(5):761–5.
41. Website [Internet]. Available from:
42. Csillag M, Nyiri G, Vag J, Fazekas A. Dose-related effects of epinephrine on human gingival blood flow and crevicular fluid production used as a soaking solution for chemo-mechanical tissue retraction. J Prosthet Dent. 2007 Jan;97(1):6–11.
43. Bowles WH, Tardy SJ, Vahadi A. Evaluation of new gingival retraction agents. J Dent Res. 1991 Nov;70(11):1447–9.
44. Feng J, Aboyoussef H, Weiner S, Singh S, Jandinski J. The effect of gingival retraction procedures on periodontal indices and crevicular fluid cytokine levels: a pilot study. J Prosthodont. 2006 Mar-Apr;15(2):108–12.
45. Laufer BZ, Baharav H, Langer Y, Cardash HS. The closure of the gingival crevice following gingival retraction for impression making. J Oral Rehabil. 1997 Sep;24(9):629–35.
46. Gupta G, Mv SK, Rao H, Garg P, Kumar R, Sharma A, et al. Astringents in Dentistry: A Review. Asian Journal of Pharmaceutical and Health Sciences [Internet]. 2012 [cited 2023 May 3];2(3). Available from:
47. Guntupalli Y, Ganesh SB, Jayalakshmi S. Effect of disinfectants on the tear strength of addition silicone impression material - An study. J Adv Pharm Technol Res. 2022 Dec;13(Suppl 2):S458–61.
48. Sarmento HR, Leite FRM, Dantas RVF, Ogliari FA, Demarco FF, Faot F. A double-blind randomised clinical trial of two techniques for gingival displacement. J Oral Rehabil. 2014 Apr;41(4):306–13.
49. Conrad HJ, Holtan JR. Internalized discoloration of dentin under porcelain crowns: a clinical report. J Prosthet Dent. 2009 Mar;101(3):153–7.
50. Thomas MS, Joseph RM, Parolia A. Nonsurgical gingival displacement in restorative dentistry. Compend Contin Educ Dent. 2011 Jun;32(5):26–34; quiz 36, 38.
51. Schuessler PJ, Ruel JA. The Effect of Various Retraction Procedures in Humans Upon the Periodontium: a Correlation of Clinical and Histologic Observations. 1976. 121 p.
52. Prasad KD, Hegde C, Agrawal G, Shetty M. Gingival displacement in prosthodontics: A critical review of existing methods. Journal of Interdisciplinary Dentistry. 2011 Jul 1;1(2):80.
53. Madaan R, Paliwal J, Sharma V, Meena KK, Dadarwal A, Kumar R. Comparative Evaluation of the Clinical Efficacy of Four Different Gingival Retraction Systems: An In Vivo Study. Cureus [Internet]. 2022 Apr 7 [cited 2023 May 3];14(4). Available from:
54. S S, Ma VS, Mi VS, F HG, M H. Gingival Retraction Methods for Fabrication of Fixed Partial Denture: Literature Review. J Dent Biomater. 2016 Jun;3(2):205–13.
55. Rathod A, Jacob SS, MAlqahtani A, Valsan I, Majeed R, Premnath A. Efficacy of Different Gingival Displacement Materials in the Management of Gingival Sulcus Width: A Comparative Study. J Contemp Dent Pract. 2021 Jun 1;22(6):703–6.
56. Burke FJT, Crisp RJ. Evaluation of a novel compule-based gingival retraction system in UK general dental practices. Dent Update. 2014 Jun;41(5):432–4, 437–8.
57. Martins FV, Santana RB, Fonseca EM. Efficacy of conventional cord versus cordless techniques for gingival displacement: A systematic review and meta-analysis. J Prosthet Dent. 2021 Jan;125(1):46–55.
58. Huang C, Somar M, Li K, Mohadeb JVN. Efficiency of Cordless Versus Cord Techniques of Gingival Retraction: A Systematic Review. J Prosthodont. 2017 Apr;26(3):177–85.
59. Tabassum S, Adnan S, Khan FR. Gingival Retraction Methods: A Systematic Review. J Prosthodont. 2017 Dec;26(8):637–43.
60. Gupta A, Prithviraj DR, Gupta D, Shruti DP. Clinical evaluation of three new gingival retraction systems: a research report. J Indian Prosthodont Soc. 2013 Mar;13(1):36–42.
61. Manuscript S a. Comparing the Effectiveness of Two Gingival Retraction Procedures on Gingival Recession and Tissue Displacement: Clinical Study [Internet]. [cited 2023 May 3]. Available from:
62. Beier US, Kranewitter R, Dumfahrt H. Quality of impressions after use of the Magic FoamCord gingival retraction system--a clinical study of 269 abutment teeth. Int J Prosthodont [Internet]. 2009 Mar [cited 2023 May 3];22(2). Available from:
63. Prasanna GSR, Reddy K, Kumar RKN, Shivaprakash S. Evaluation of efficacy of different gingival displacement materials on gingival sulcus width. J Contemp Dent Pract. 2013 Mar 1;14(2):217–21.
64. Yang JC, Tsai CM, Chen MS, Wei JY, Lee SY, Lin CT. Clinical Study of a Newly Developed injection-type Gingival Retraction Material. Journal of Dental Sciences. 2005;24(3):147–51.
65. Brady WF. Periodontal and restorative considerations in rotary gingival curettage. J Am Dent Assoc. 1982 Aug;105(2):231–6.
66. Kamansky FW, Tempel TR, Post AC. Gingival tissue response to rotary curettage. J Prosthet Dent. 1984 Sep;52(3):380–3.
67. Louca C, Davies B. Electrosurgery in restorative dentistry: 1. Theory. Dent Update. 1992 Oct;19(8):319–20, 322–3.
68. Kelly WJ Jr, Harrison JD. Electrosurgery in restorative dentistry. N Y State Dent J. 1984 Jun-Jul;50(6):345–7.
69. Louca C, Davies B. Electrosurgery in restorative Dentistry: 2. Clinical applications. Dent Update. 1992 Nov;19(9):364–6, 368.
70. Kamal R, Dahiya P, Saini HR. Dental treatment in patients with cardiac pacemakers: Is it a risky affair? Journal of Dental Research and Review. 2016 Apr 1;3(2):76.
71. Shillingburg HT, Sather DA. Fundamentals of Fixed Prosthodontics. Quintessence Publishing (IL); 2012.
72. DeVitre R, Galburt RB, Maness WJ. Biometric comparison of bur and electrosurgical retraction methods. J Prosthet Dent. 1985 Feb;53(2):179–82.
73. Parker S. The use of lasers in fixed prosthodontics. Dent Clin North Am [Internet]. 2004 Oct [cited 2023 May 4];48(4). Available from:
74. Selvaganesh S, Gajendran PL, Nesappan T, Prabhu AR. Comparison of clinical efficacy of diode laser and erbium, chromium: Yttrium, scandium, gallium, and garnet for implant stage 2 recovery procedure - A randomized control clinical study. J Indian Soc Periodontol. 2021 Jul 1;25(4):335–40.
75. Tao X, Yao JW, Wang HL, Huang C. Comparison of Gingival Troughing by Laser and Retraction Cord. Int J Periodontics Restorative Dent. 2018 Jul/Aug;38(4):527–32.
76. Krishna Ch V, Gupta N, Reddy KM, Sekhar NC, Aditya V, Reddy GVKM. Laser gingival retraction: a quantitative assessment. J Clin Diagn Res. 2013 Aug;7(8):1787–8.
77. Scott A. Use of an erbium laser in lieu of retraction cord: a modern technique. Gen Dent. 2005 Mar-Apr;53(2):116–9.

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