Gingival retraction: cord or cordless systems?

Gingival retraction is necessary for the identification of finish lines for fixed prosthodontics, and the management of cervical abrasion, root caries, and root sensitivity. A range of techniques is available to achieve this, mechanical, mechano-chemical and surgical. The aim of this review was to assess the efficacy of cordless versus cord techniques in achieving hemostasis control and gingival displacement and their influence on gingival/periodontal health.

Methods

Searches were conducted in the Medline/ PubMed, Web of Science, Science Direct, Embase, Cochrane Library, Open Grey and the Pro-quest Dissertation Abstracts and Thesis databases. Two reviewers independently selected studies and abstracted data with study quality being assessed using the Cochrane risk of bias tool. Randomised and quasi-randomised trials were considered.

Results

7 studies (4 RCTs, 3 quasi-RCTs) were included.
2 studies were considered to be at low risk of bias, 3 at unclear risk and 2 high risk.
Sample size ranged from 8 to 252 patients.
Haemostasis control (4 studies)– 3 studies found cord techniques were less efficient in controlling bleeding and to lesser extent, when non-impregnated cords were used. 1 study found no difference between cord and cordless gingival retraction.
Gingival displacement (5 studies) – 2 studies found no difference, 1 noted a more effective gingival displacement when a paste system was used while 2 showed greater gingival displacement when cords were used.
Gingival/periodontal health (4 studies) – 3 studies reported less traumatic injury to soft tissues when gingival paste was used.
A paste system, in general, was documented to be more comfortable to patients and user-friendly to the operator.

Conclusions

The authors concluded:

…this article supports the observation that gingival retraction paste can more effectively help to achieve a dry field and at the same time be less injurious to soft tissues; however, its ability to displace gingival tissues, compared to retraction cords, was compromising

Comments

A good database search had been conducted along with a standard methodological approach to this review. A small number of RCTs have been identified addressing the main question but heterogeneity in the included studies has precluded meta-analysis. The findings suggest that both corded and cordless systems have a role in gingival retraction with the authors pragmatically suggesting that when there is greater need for gingival displacement corded systems are used.