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THESIS – SYNOPSIS

Dr. ABHILASH.A

POST GRADUATE STUDENT

DEPARTMENT OF PROSTHODONTICS

K.V.G.DENTAL COLLEGE & HOSPITAL,

KURUNJIBAG-SULLIA (DK) KARNATAKA, INDIA

Rajiv Gandhi University of Health Sciences, Karnataka

Bangalore
ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the Candidate and Dr. ABHILASH. A

Address POST GRADUATE STUDENT,


(In block letters)
6. a. Brief resume of the intended work :
DEPARTMENT OF PROSTHODONTICS
6.1 Need for the study : K.V.G.DENTAL COLLEGE & HOSPITAL,
Impression of the teeth and the surrounding structures is of utmost important
KURUNJIBAG-SULLIA(DK)
because it is neither possible nor desirable to make patterns for fixed prosthesis
KARNATAKA,INDIA-574 327
directly in the mouth .1
The matrix impression uses custom matrix to control the sulcular environment

2. andName
to deliver impression
of the material to theK.V.G.DENTAL
Institution subgingival partsCOLLEGE
to be impressed .2 Also
& HOSPITAL,
Monophase [single mix technique] and Dual phase [Heavy body-light body combination]
KURUNJIBAG-SULLIA(DK)
impression techniques are routinely practiced techniques in fixed prosthodontics .3
KARNATAKA,INDIA-574
Polyvinyl siloxane impression materials 327 excellent
have been shown to have
properties as impression materials: however, they are sensitive to manipulative variables.4
3. Course
FPDofrequires
study and subject impression
an accurate MASTER OF DENTAL
that records locationSURGERY
of the finish line of
the prepared tooth and a portion of the apical tooth structure. Therefore,
PROSTHODONTICS ,CROWNit& is BRIDGE
necessary to effectively displace the free gingival margin.5

4. DateThe most common


of admission technique used31
of course with
st
ofgingival displacement is the use of
MAY 2007
gingival retraction cord with a haemostatic medicament .6
Relatively new products and techniques of gingival retraction have also been
5.
Title Of The Topic:
introduced to accommodate the clinician's struggle to obtain tissue control and
“The Comparative analysis of Gingival sulcus depth record with polyvinyl siloxane
achieve an ideal impression .Expasyl ,supplied in syringe and is designed to be injected
impression material using ‘Matrix impression system technique’, ‘Monophase’ &
into the unretracted sulcus . Once in the sulcus it theoretically expands and provides
‘Dual phase impression technique’ in conjunction with gingival retraction cord and
displacement and hemostasis .6
aluminium chloride paste retraction system [Expasyl] .”- an In-vivo study.
A wide spectrum of different gingival retraction cords are being used. Cords
containing epinephrine performed no better than aluminum sulfate cords .7

The aim of this in vivo study is to find out ,with which impression technique
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will we be able to better record the gingival sulcus depth when used along with use
of retraction cord and aluminium chloride paste retraction system[Expasyl] .

6.2 REVIEW OF LITERATURE

As impression materials, Polyvinyl siloxane have been shown to have excellent


properties: however, they are sensitive to manipulative variables. Several methods of
using very high viscosity (putty) materials to form ‘trays’ to obtain uniform bulk of
the wash impression are described, and the disadvantage of each of these techniques
is pointed out. It is recommended that for best results acrylic resin custom trays
should be used routinely. The interaction of polyvinyl siloxane materials with the
latex products is also discussed and the problems that this inhibition can cause are
stated. Suggestions to avoid this interaction are outlined. This material has a short
working time. Refrigerating the material will increase the working without affecting
the accuracy. 4

The authors investigated the length of time medicated displacement cord should
remain in the gingival crevice prior to impression making. A silk cord was placed into
the sulcus and was not removed during the study. Medicated cords were placed into
the gingival sulcus for 2,4,6 and 8 minutes. Following cord removal, closure of the
sulcus was recorded at intervals using a miniature video camera. Crevicular widths
were measured at the midbuccal and transitional line angle areas. At both the
midbuccal and transitional line angle areas, gingival crevices displaced for 2 minutes
were significantly smaller at 20 seconds than crevices following displacement for
4,6,and 8 minutes. No significant difference in crevicular width was found at any time
period after cord removal for crevices displaced for 4,6 and and 8 minutes. At the
transitional line angle, crevicular widths were significantly smaller than at the

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midbuccal at 20 seconds for all times and remained so up to 180 seconds. To achieve a
crevicular width of 0.2 mm, cord should remain in the gingival crevice for an optimum
time of 4 minutes prior to impression making when using the materials evaluated in
this study. 5

The matrix impression system significantly improves the gingival displacement


and sulcular cleansing phases. The Matrix has resolved the problems of gingival
bleeding and other sulcular contaminants and virtually eliminate the tearing of the
sulcular flange. The matrix impression system has reduced complex fixed
prosthodontic impressions into simpler component matrix impression.. 2

This study aimed to determine whether clinicians were able to identify


differences in clinical performances among 3 types of gingival retraction cords.
Dental students and faculty members ranked pairs or series of cords according to 6
criteria for clinical performance, with a blind experimental design. Cords differed in
consistency and impregnation. Results showed that cords containing epinephrine
performed no better than aluminum sulfate cords. Benefits and drawbacks of the cords
containing epinephrine should be considered in light of the potential risk of adverse
effects and apparent lack of significant improved clinical performance . 7

A review study was to enumerate the current concept in gingival


displacement. Gingival displacement is an important procedure with fabricating
indirect restorations. Gingival displacement is relatively simple and effective when
dealing with healthy gingival tissue and when margins are properly placed a short
distance into the sulcus. Several techniques have proven to be relatively
predictable, safe and efficacious. No scientific evidence has established the
superiority of one technique over the other, so the choice of the technique depends
on the presenting clinical situation and operator preference. 6

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A review of contemporary impression materials and techniques have been
described here. Impression materials vary considerably in properties like
accuracy, elastic recovery, dimensional stability, flow, flexibility, workability,
hydrophilicity, a long shelf life, patient comfort and economics. These differences
provide a basis for the selection of specific materials in specific clinical conditions.
Polyvinyl impression materials, its advantage and its interactions with latex gloves
have been highlightened. Brief note on different impression techniques in fixed
prosthodontics is also mentioned .1

Monophase [single mix technique] and Dual phase [Heavy body-light body
combination] impression techniques are routinely practiced techniques infixed
prosthodontics. The complete description of each step to be followed while making
the impression are described. 3

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6.3 OBJECTIVES OF THE STUDY :

 To Compare Gingival sulcus depth record with polyvinyl siloxane impression material
using ‘Matrix impression system technique’, ‘Monophase’ & ‘Dual phase impression
technique’ in conjunction with gingival retraction cord.

 To Compare Gingival sulcus depth record with polyvinyl siloxane impression material
using ‘Matrix impression system technique’, ‘Monophase’ & ‘Dual phase impression
technique’ in conjunction with aluminium chloride paste retraction system [ Expasyl ] .

b. MATERIALS AND METHODS :

7. 7.1 Source of data :


Eight patients with age group 14-30 years who reports to the Dept of Orthodontics ,
and who will diagnosed as Extraction cases for orthodontic treatment, and where
in either the first or the second premolar of both side of the maxillary quadrants is being
indicated for extraction and who will be willing to be subjects for the study will
be considered.

INCLUSION CRITERIA:
1. Patients aged 14 to 30 years.
2. Healthy periodontium.
3. Subject willingness.

EXCLUSION CRITERIA:
1. Patients below 14 & above 30 years.

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2. Patients with sulcus depth more than 2mm.
3. Inflamed and swollen gingiva.

7.2 METHODOLOGY :

Tooth Preparation will be done with equigingival finish line on both right and left
maxillary first or the second premolars.
Full arch maxillary Impressions will be made on these prepared premolars with three
different impression techniques MATRIX IMPRESSION SYSTEM TECHNIQUE,
MONOPHASE & DUAL PHASE IMPRESSION TECHNIQUE with gingival retraction
cord on the one prepared premolar of a quadrant and aluminium chloride paste retraction
system [EXPASYL] on the other prepared premolar of other quadrant. A gap of 7 days will
be kept between each impression. During this time interval, after making the impression the
tooth will be temporized to avoid patient discomfort.

Instruments and materials used during the course of the study


Instruments:
1. Pressure sensitive probe
2. B.P. blade
3. Carborandum cutting disc
4. Glass slab
5. Perforated Impression trays
6. Scissors

Materials:
1. Polyvinyl siloxane impression material
2. Medicated Gingival retraction cord.
3. Aluminum chloride paste retraction system [EXPASYL].
4. Tray adhesive
5. Tray acrylic
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Equipments:
1. Traveling Microscope.

METHOD OF COLLECTION OF DATA:


 The maxillary premolar [tooth which is indicated for extraction] either the first or the
second premolar will be prepared both on the right and the left maxillary quadrants
with equigingival finish line to receive a crown.
 The depth of the gingival sulcus will be measured using a pressure sensitive probe at
mesio-buccal, mid buccal & disto-buccal on the buccal side, mesio-palatal, mid-palatal
& disto-palatal on the palatal side. The equigingival shoulder finish line will be taken
as a standard reference point for all measurements.
 Full arch maxillary impression will be made using three different impression
techniques i.e. MATRIX IMPRESSION SYSTEM TECHNIQUE, MONOPHASE &
DUAL PHASE IMPRESSION TECHNIQUE. Impression will be made with gingival
retraction cord on one prepared premolar of a quadrant and aluminium chloride paste
retraction system [EXPASYL] on the other prepared premolar of other quadrant with a
gap of 7 days between each impression technique. The tooth will be temporized after
making the impression.

Preparation of the Specimen


Specimens will be prepared by sectioning the tray along with the elastomeric
impression with the help of the carborandum cutting disc/Impression cutter, using the
previously formed bucco-lingual grooves as guide. The obtained portion of the tray will be
further sectioned along the mesio-distal groove, to divide the specimens in to two
halves. The impression will be sectioned with the help of B.P Blade. The buccal
half/section and the palatal half/ section will be used for measurements.

Measurement of the penetration of elastomeric impression material in gingival sulcus


This will be done with the help of a Traveling Microscope. This equipment is capable
of measuring the specimen up to two decimal points of millimeter.

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The Traveling Microscope consists of eye piece through which the specimen can be
viewed on vertical and horizontal scales, through which the specimens can be measured.
These scales are divided in two parts, one main scale and other vernier scale reading.
The main scale readings has divisions at a distance of 0.5mm and the vernier scale has
50 divisions for each division of the main scale.

The specimen will be kept on the stand in front of the eye piece and the eye piece
will be adjusted for the proper view of the concerned area. The Eye piece has got a ‘+’
mark in the centre. This mark will be overlapped with the finish line on the specimen.
Doing this the inclination of each specimen in both the planes will be made constant. The
reading at this point will be noted on the vertical scale. After noting this reading, the eye
piece will be moved straight down towards the penetration of elastomer in the gingival
sulcus. After reaching the deepest extension in the straight, reading will be noted from
the vertical scale. The difference between these two readings will give the exact distance
of the extension of elastomer in gingival sulcus from the finish line which served as a
reference point.

Statistical Analysis
The study will be analyzed through Two Way ANOVA test and Post hoe test.

7.3 Does the study require any investigations or interventions to be conducted on

patients or other humans or animals?

Yes

7.4 Has the ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance certificate from our institution is enclosed.

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c. List of references

1. Terry E. Donovan , Winston W. L.Chee. A review of contemporary impression

8 materials and techniques. Dent Clin N Am 48 (2004) 445-470.

2. Gus J. Livaditis, The matrix impression system for fixed prosthodontics:


J Prosthet Dent 1998; Feb:79(2):208-16

3. Rosenstiel, Land, Fujimoto: Contemporary Fixed Prosthodontics: -4th Edition


2006.431-65

4. Chee WW, Donovon TE. Polyvinyl siloxane impression materials: a review


of properties and techniques. J Prosthet Dent 1992 Nov;68(5):728-32

5. Haim Baharav,Ben-Zion Laufer The effect of displacement time on gingival

crevice width. Int J Prosthodont 1997 May-Jun;10 (3):248-53.

6. Terry E. Donovan , Winston W. L.Chee. Current concepts of gingival


displacement. Dent Clin North Am.2004 Apr;48(2)vi,433-44

7. Asbjorn Jokstad. Clinical trial of gingival retraction cords.

J Prosthet Dent. 1999 Mar;81(3):258-61.

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