This study compared gingival inflammation from different retraction cords using biochemical analysis of gingival crevicular fluid. Retraction cords with aluminum chloride and epinephrine showed similar inflammatory responses that were less than plain cords. Enzyme levels in fluid increased at 1 hour after retraction with all cords but returned to normal by 24 hours, indicating temporary inflammation. The study provided a quantitative measure of inflammation but could be improved with a larger sample size and histological analysis.

1. J Orofac Sci, 2(2)2010
Journal of
OROFACIAL SCIENCES
Original Research
A Comparison of Gingival Inflammation Related to Retraction Cords Using Biochemical
Analysis of Gingival Crevicular Fluid.
Krishna Kishore. Ka*, Sampath Anchea, Swetha Hima Bindu. Oa
a
Department of prosthodontics, SIBAR Institute of Dental sciences, Guntur, Andhrapradesh, India.
ARTICLE INFO ABSTRACT
Article History : AIM : This study was aimed to determine the clinical magnitude of the
Received : 11 June 2010 inflammatory response to gingival retraction procedures by using different types
Received in revised form : 14 July 2010 of retraction.
Accepted : 11 August 2010
MATERIALS AND METHOD : The study was performed on 10 dentulous
Key Words : patients with normal healthy gingival Condition and 3 gingival retraction cords
Gingival Retraction Cords, Plane retraction cord-ultrapack retraction cord impregnated with 10%
Healthy Gingiva, aluminium chloride-Novo retraction cord and retraction cord impregnated
Gingival Crevicular Fluid, with 0.197mg per cm racemic epinephrine -Racord and were comparatively
Filter Paper Strips, analyzed for gingival inflammation in all patients.
Inflammatory Response.
Preweighed filter paper strips were used to collect Crevicular fluid samples were
collected at ‘0’, 1, 24 hours after retraction.
RESULTS : Results showed Inflammatory response to plain retraction cord
when compared to the inflammatory response to impregnated retraction cords.
Both Aluminum chloride and epinephrine retraction cords showed similar
response.
©2010 SIDS.All Rights Reserved
INTRODUCTION :
One of the most important bio-mechanical But most of impression material used in the fixed partial
requirements of tooth preparation for the successful fixed prosthodontics do not flow in the gingival crevice or
restoration is the gingival finish line preparation. displaces the gingival tissue. Therefore gingival tissue
Construction of the fixed partial prosthesis needs exact displacement is required to get clean, dry, debris free field
duplication of the prepared tooth and finish lines by the for the impression and to evaluate depth and uniformity
appropriate impression procedures. For these purpose, at of the margins of the preparation.
least O.15mm to O.75mm of root surface beyond the MATERIALS AND METHOD :
gingival finish line should be recorded in the impression.
This Study was performed on 10 edentulous patients
* Corresponding author : with normal healthy gingiva in the age group 20-30 yrs
Dr. Krishna Kishore. K randomly selected. Oral prophylaxis was performed 3
Professor Department of Prosthodontics
weeks before retraction procedure and were given oral
SIBAR Institute of Dental Sceiences,
Guntur, Andhra Pradesh, India. hygiene instructions in order to ensure healthy gingival
obr.bindu@gmail.com condition during retraction procedure.
33

2. J Orofac Sci, 2(2)2010
Three Gingival Retraction Cords :
1. Plain retraction cord -Ultrapack
2. Retraction cord with O.197mg per cm racemic
epinephrine -Racord
3. Retraction cord with 10% Aluminium chloride-
Novo Retraction cord
Fig.3: electronic weighing machine
Fig.1: Retraction Procedure
were used, they were with the same diameter. retraction
was done in 11,21,24 respectively in all patients. Racord
in 21,novo in11 and plain retraction in 24 were
employed.(Fig- 1) Crevicular fluid samples were collected
using preweighed filter papers (Fig.2)–Whatman filter
paper no-3 of approximately equal size. Samples were
collected at the 0, before retraction 1 and 24 hrs after
retraction .The filter papers1 were weighed in an electronic
weighing machine (Fig.3) with accuracy of 0.0001 gm. Fig. 4: Biochemical Analysis Kits
Gingival crevicular fluid was diluted with 220µl of biochemical analysis kits by the sigma diagnostics, for
normal saline and shaked vigorously with the vortex mixer diagnosis of lactate dehtdrogenase and Ranbaxy
for 30 sec and then kept in VDRL rotator for 3,0 minutes diagnostics for diagnosis of Asparate amino Transferase.
and the sample was mixed again for 30 sec in vortex mixer
The procedure for the both enzymes was done by
for complete elution & centrifuges using a refrigerated
placing the reaction mixture ( sample with reagent) in a
centrifuge at 4 Úc with 5000 rpm for 5 minutes (Fig.4)
pipette and maintained at 30 and placed in cuvet
Specific enzyme test was analyzed for the samples using
chamber of simadzu UV 1601 scanning
spectrophotometer. (Fig.5).
Fig.2 : Collection of samples Fig.5: Scanning Spectrophotometer
34

3. J Orofac Sci, 2(2)2010
Activity was calibrated as follows : TABLE : 2
∆ A per minute of G.C.F.x CHANGE IN GINGIVAL FLUID WITH TIME A
PAIRED t-TEST
control value x dilution factor
Retraction Cords Changes 0-1 hour
Enzyme activity = Wt of fluid in mg Mean S.D. t-value
A per minute of control Epinephrine Cord 0.17 0.11 5.07
***
The results were statistically analyzed by using student AI. Chloride Cord 0.16 0.08 6.00
***
“t” test analysis and ANOVA analysis and results were Plain Cord 0.14 0.05 8.57
condensed and described ***
Changes 0-24 hour Changes 1-24 hour
RESULTS :
Mean S.D. t-value Mean S.D. t-value
The ANOVA analysis revealed the following.
1.77 0.11 0.0 3.5
The mean fluid volume at 0 hour was statistically 0.06 0.11 9
N.S. *
insignificant. 0.09 0.07 2.16 0.16 0.08 6.00
A statistically significant difference in fluid volume N.S. ***
was noted at one hour with p value being 0.001 level. 2.23 0.06 0.1 1.96
0.08 0.11
N.S 0 N.S.
This can be readily explained by the fact that fluid
volume collected from the sulci retracted with plain cord DISCUSSION :
is more than the fluid collected from sulci retracted with
aluminium chloride and epinephrine. The use of gingival crevicular fluid flow measurements
for the evaluation of gingival health and the effects of
The gingival fluid volumes recorded at 24 hours various materials on gingival tissues has become widely
showed less statistical significance with p value of 0.008 accepted, that the gingival fluid is an objective and
level. This shows that the fluid volume have returned to quantitative measure of gingival inflammation.
near normal values or near 0 hour value.
IRA .B. Lamster et al (1985), Rutger person2 et al
TABLE : I
(1990) has stressed the reliability of these enzymes as
CHANGE IN GINGIVAL FLUID WITH TIME
markers of gingival inflammation, although most of their
O Hour 1 Hour 24 Hour studies were aimed at identifying progression of gingival
Retraction Cords Mean S.D. Mean S.D. Mean S.D. disease. These enzyme markers are reliable to identify
Epinephrine cord 0.92 0.155 0.75 0.127 0.86 0.155 inflammatory response to gingival retraction procedure.
AI. Chloride cord 0.87 0.142 0.71 0.120 0.78 0.103 T.E. Donovan AN3 et aI, (1985) in his review of
Plain cord 0.87 0.14 1.01 0.129 0.95 0.085 medicaments with gingival retraction cords, stressed the
F- Value 0.376 16.94 6.32 superiority of aluminium chloride retraction cord over
P- Value 0.69 0.0001 0.008 epinephrine impregnated cord.
Not Significant Significant Significant In this study 0.197mg per cm of racemic epinephrine4
ANOVA (Analysis of Variance) impregnated cord (Racord), 10% aluminium chloride5
A paired t -test performed to analyze gingival fluid impregnated cord (Nova), Plain cord (ultra pack) were
volume change between 0 hour, 1 hour and 24 hour shows compared in each of the ten healthy young patients 6,
there is highly significant change between 0 hour (i.e. where oral Prophylaxis was performed three weeks before
before retraction) and 1 hour after retraction with and oral Hygiene instructions were given. 11, 21 & 24
p<O.OO1 level. were selected for the retraction procedure.
The fluid volume change between 1 hour and 24 hour After the samples are collected according to the above
after retraction is of less significance with a p value of mentioned method spectrophotometric assay was
< 0.05 level and fluid volume change from 0 hour to 24 performed on each fluid sample for both Asparate amino
hours is also not significant. transferase7 and Lactate dehydrogenase after dilution with
35

4. J Orofac Sci, 2(2)2010
their respective reagents. Accurate quantification of CONCLUSION :
volume of Gingival crevicular fluid8 and quantification
of enzyme levels in these sample are recorded. These To conclude there is an increased inflammatory
values were statistically evaluated and the results are response to plain retraction cord when compared to the
conscientiously reported. inflammatory response to impregnated retraction cords.
Both aluminium chloride & epinephrine retraction cords
Retraction cords impregnated with aluminium showed similar inflammatory response suggesting that
chloride and epinephrine9, the gingival fluid volume any of these may be used for prosthetic impression
decreases after one hour when compared with volumes technique. The study has limitations in that, other enzyme
recorded prior to insertion of retraction cords and indicators of inflammation like ß-glucuronidase have not
returned to near normal levels when recorded after 24 been tested and histologic proof is not available. It is
hours. suggested that future studies done in larger sample group
The plain retraction cord causes increase in gingival will further throw light on this subject
crevicular fluid volume 1 hour after retraction when REFERENCES :
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response to gingival retraction procedures.
36