Abstract
This study aimed to ascertain whether the Merocel strips (MS) can achieve adequate hemostasis and effectively retract the gingiva compared to the aluminum chloride-impregnated knitted retraction cord (ACIKRC) utilizing a digital gypsum model. It was a randomized, double-blinded, split-mouth, active-controlled clinical trial. The sample consisted of 122 abutments that were randomly divided into two groups. Group A: Gingival retraction was evaluated in 44 abutments. A single gypsum model was created by matching models before (t0) and after (t1) gingival retraction utilizing exocad software to record gingival horizontal displacement angles. Group B: Hemostatic efficacy was assessed in 78 abutments at t0 and t1. Each group was further divided into two equal sub-groups. Sub-group I: ACIKRC Size 000. Sub-group II: MS. The mean value of gingival horizontal displacement angles in the MS (25.09 ± 15.53) group was higher than the ACIKRC (19.93 ± 10.95) group (p = 0.158). The mean value of gingival bleeding scores in the MS (0.02 ± 0.22) group was significantly lower than the ACIKRC (0.77 ± 0.71) group (p < 0.05) at t1. MS in 0.75 mm thickness without a temporary crown and ACIKC provided similar horizontal gingival retraction abilities. However, MS showed better bleeding control.
Introduction
Establishing a favorable impression is a golden key for a highly fitted final restoration and fixed dental prostheses, including crowns, veneers, and onlay restorations1. Recording the gingival finish line in the impression is necessary to produce appropriate marginal fit and esthetics2. While supra-gingival finish lines are generally preferred, it is common for finish lines to be subgingival due to factors such as caries extending cervically, tooth fractures, existing restorations, esthetic requirements, additional retention needs, hypersensitivity, and abrasion3. However, proper gingival displacement is necessary before making the impression because most final impression materials cannot adequately displace soft tissue, fluid, or debris4. There are two types of gingival tissue displacement techniques: non-surgical and surgical. Non-surgical procedures include mechanical and chemicomechanical methods, whereas surgical methods include lasers, electrosurgery, and rotary curettage5. Different clinical settings require the use of a variety of techniques. The conventional approach for gingival retraction involves using retraction cords in various sizes. These cords can be plain or soaked with astringent-hemostatic agents such as ferric sulfate, aluminum potassium sulfate, aluminum chloride, racemic epinephrine, or aluminum sulfate6. When inserted into the gingival sulcus, these cords retract the gingiva, revealing the finish line of the prepared tooth6. The procedure is sensitive and cannot be standardized because the force applied to the gingival cord varies among dentists and differs from case to case, depending on the sulcus width and anatomy6. Additionally, chemically impregnated retraction cords have several side effects and require careful precautions7.
Recently, a novel retraction material called Merocel has been introduced in dentistry. It aims to displace gingival tissue without causing damage before taking impressions5. Merocel retraction strips are made from a synthetic material derived from a biocompatible polymer called hydroxylate polyvinyl acetate8. These strips create a net-like structure without any debris or free fragments. It is chemically pure, easily shaped, remarkably effective for absorption of intraoral fluids such as blood, saliva, and crevicular fluid, soft and adaptable to the surrounding tissues, free of fragments, without debris, and not abrasive8,9. The strips showed promising results without any damage to the gingival tissues in addition to absorbing oral fluids, making the area clean5. This study aimed to ascertain whether the Merocel strips (MS) can achieve adequate hemostasis and effectively retract the gingiva compared to the aluminum chloride-impregnated knitted retraction cord (ACIKRC) utilizing a digital gypsum model. The null hypothesis is that the MS will not outperform the ACIKRC in retracting the gingiva and achieving adequate hemostasis.
Materials and methods
Study design and ethics
It was a randomized, double-blinded, split-mouth, active-controlled clinical trial. It occurred between May 2024 and July 2024 at the Department of Fixed Prosthodontics, Faculty of Dentistry, Damascus University. It was conducted per the Consolidated Standards of Reporting Trials (CONSORT) statement10 and the Declaration of Helsinki, as revised in 201311. Ethical approval was provided by the Biomedical Research Ethics Committee of Damascus University (N1493), and the trial was retrospectively registered at the ISRCTN registry (ISRCTN25412523) on 08/10/2024. Signed written informed consent was obtained from each participant after explaining the treatment plan in detail.
Eligibility criteria
The inclusion criteria were as follows:
Healthy participants.
Participants older than 18 years.
Teeth indicated for full coverage crowns.
The gingival sulcus depth is 1–2 mm.
The gingival biotype is thick4,5,12.
The exclusion criteria were as follows:
Participants with systemic diseases that impact oral health, including cardiovascular and hematologic disorders, diabetes, and hyperthyroidism.
Pregnant participants.
Participants with periodontal diseases.
Participants are allergic to the materials used.
Abutments with abnormal size and position4,5,12.
Out of 29 participants, 23 participants were included according to the eligibility criteria. The sample consisted of 122 abutments out of 134, including incisors, canines, and premolars in 23 participants, which was randomly divided into two groups:
Group A: Gingival retraction was evaluated in 44 abutments of 8 participants.
Group B: Hemostatic efficacy was assessed in 78 abutments of 15 patients.
Each group was further divided into two equal sub-groups using the split-mouth technique:
Sub-group I: Size 000 ACIKRC (SURE-CORD, Sure-endo, Gyeonggi-do, South Korea) was applied for 4 min13.
Sub-group II: MS (Epistaxis Nasal Dressings, Eon Meditech, Gujarat, India) was applied for 4 min.
Randomization and blinding
It was a double-blinded trial, with participants and outcome assessors masked to group allocation. Randomization was performed by flipping a coin, a simple method.
Patient preparation
Scaling was conducted alongside the recommendation of using 0.12% chlorhexidine mouthwash twice daily for two weeks. The patient was educated on the significance of maintaining oral health and instructed on brushing techniques14. Two weeks after the periodontal treatment, along with the previous protocol, the periodontal tissues were assessed using several indexes: gingival index15, bleeding on probing16, probing depth17, and plaque index15. In addition, the width and biotype of the gingiva were examined18. Participants with healthy gingival tissues, free from gingivitis and exhibiting a thick biotype, were selected.
Efficacy of gingival Retraction
The finish line was initially prepared above the gingival margin and then placed 0.5 mm below the gingival margin. A conical bur with a non-cutting tip (Dentsply, Maillefer, Ballaigues, Switzerland) was utilized. The two-stage impression technique was considered utilizing condensation silicone (Zetaplus, Zhermack, Badia Polesine, Italy) before the gingival retraction. After achieving adequate isolation, retraction cords were applied using a single-cord technique. MS was administered within the sulcus utilizing a cord packer (GCPG7NS, Hu-Friedy Mfg. Co., LLC., Chicago, United States). The proper length of the cord was prepared according to the diameter of the abutment. The cord was applied firmly with moderate pressure and minimal trauma within the gingival sulcus, starting from the area adjacent to secure the cord and proceeding to the buccal area until the entire neck of the tooth was encircled. The ACIKC was applied similarly. Impressions were created using high-viscosity impression material, as it aids in compressing the retraction materials within the sulcus. After the retraction materials were removed, the second stage was conducted using low-viscosity impression material. The final impression was taken utilizing condensation silicone in two stages. A virtual model of recorded impressions was created using a scanner (AutoScan-DS-EX Pro, SHINING 3D Tech Co., Ltd., Hong Kong, China). Virtual gypsum models were designed utilizing the exocad software (DentalCAD 3.1 Rijeka, exocad, Hesse, Germany), and then a single gypsum model was created by matching models before and after gingival retraction (Fig. 1). A longitudinal section was determined of the prepared abutment from the incisal edge or the occlusal surface to the gingival margin parallel to the longitudinal axis (Fig. 2). The following measurements were considered at the following points for each abutment: midbuccal, mesiobuccal, distobuccal, midpalatal, mesiopalatal, and distopalatal. The angle of the gingival sulcus opening, which formed between the abutment surface and the inner surface of the gingival sulcus, was measured before (t0) and after (t1) gingival retraction (Fig. 3) by two blinded outcome assessors (ICC > 0.8). The difference between the two angles was calculated to determine the horizontal retraction.
Fig. 1
figure 1
Virtual gypsum models were designed utilizing the exocad software, and then a single gypsum model was created by matching models before and after gingival retraction.
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Fig. 2
figure 2
A longitudinal section was determined of the prepared abutment from the incisal edge or the occlusal surface to the gingival margin parallel to the longitudinal axis.
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Fig. 3
figure 3
The angle of the gingival sulcus opening, which formed between the abutment surface and the inner surface of the gingival sulcus, was measured (A) before and (B) after gingival retraction.
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Hemostatic efficacy
The finish line was initially prepared above the gingival margin and then placed 0.5 mm below the gingival margin utilizing a conical bur (Dentsply, Maillefer, Ballaigues, Switzerland). The bleeding was assessed before (t0) and after (t1) gingival retraction according to Gupta et al.19 study by two blinded outcome assessors (ICC > 0.8) as follows:
Score 0 = No bleeding.
Score 1 = Bleeding controlled within one minute.
Score 2 = Bleeding not controlled within one minute.
After achieving adequate isolation, retraction cords were applied using a single-cord technique, and then the two-step impression technique utilizing condensation silicone was considered. In the first step, a heavy-body impression was made. The gingival retractor cords were removed after moistening the gingival sulcus with water to avoid damaging the sulcular epithelium, dislodging the blood clot, and causing bleeding. The hemostatic efficacy was evaluated according to Weir and Williams’s abovementioned study. In the second step, a light-body impression was made.
Sample size calculation and data analysis
The sample size was calculated using the G*Power version 3.1.9.4 (Heinrich Hein Universität Düsseldorf, Germany). For group A, a sample size of 44 abutments achieved the following parameters: effect size of 0.86 (effect size d = 0.86), two-tailed 5% significance level (α = 0.05), 95% confidence interval, 80% statistical power (1-β err prob = 0.80), and 2 experimental sub-groups. For group B, a sample size of 78 abutments achieved the following parameters: effect size of 0.64 (effect size d = 0.64), two-tailed 5% significance level (α = 0.05), 95% confidence interval, 80% statistical power (1-β err prob = 0.80), and 2 experimental sub-groups. Data analysis was done utilizing IBM SPSS software version 24 (IBM SPSS Statistics version 24, IBM Corp., New York, USA). Descriptive statistics of participants’ characteristics were presented as frequency, percentage, mean, and standard deviation (SD). Descriptive statistics of gingival horizontal displacement angles and gingival bleeding scores were presented as mean, SD, standard error (SE), minimum (Min), and maximum (Max). The Kolmogorov–Smirnov test was applied to check the normality of data. An Independent sample t-test was conducted to compare gingival horizontal displacement angles and gingival bleeding scores between groups. A paired sample t-test was applied to compare gingival bleeding scores before and after retraction. The level of significance was adjusted at 0.05 (p < 0.05).
Results
The CONSORT flow diagram is illustrated in Fig. 4. The mean age was (34.35 ± 9.72; range: 20–50), and approximately two-thirds (60.87%) of the participants were male (Table 1). The mean value of gingival horizontal displacement angles in the MS (25.09 ± 15.53) group was greater than the ACIKRC (19.93 ± 10.95) group, with a statistically insignificant difference (p = 0.158) (Table 2). The mean value of gingival bleeding scores was similar in the MS (1.69 ± 0.47) group and ACIKRC (1.67 ± 0.48) group (p = 0.634) at t0, indicating that the data was homogenous at the baseline before gingival retraction (Table 3). The mean value of gingival bleeding scores in the MS (0.02 ± 0.22) group was significantly lower than ACIKRC (0.77 ± 0.71) group (p < 0.05) at t1, indicating that the MS achieves better hemostasis compared to ACIKRC (Table 3). However, both groups achieved significant hemostasis at t1 when compared to t0 (p < 0.05) (Table 4).
Fig. 4
figure 4
CONSORT flow diagram.
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Table 1 Demographic characteristics of participants.
Full size table
Table 2 Descriptive statistics and independent sample-t test of gingival horizontal displacement angles.
Full size table
Table 3 Descriptive statistics and independent sample-t test of gingival bleeding scores.
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Table 4 Paired sample-t test of gingival bleeding scores.
Full size table
Discussion
MS was introduced by Ferrari et al.20 in 1996 and is a chemical derivative of the biocompatible polymer consisting of hydroxylated polyvinyl acetate. The MS expands upon the absorption of oral fluids, causing pressure on the surrounding tissues5. This study aimed to ascertain whether the MS can achieve adequate hemostasis and effectively retract the gingiva and compare it to the ACIKRC utilizing a digital gypsum model. Ateeq et al.21 state that Merocel is a liquid-absorbing, hemostatic material commonly used in ear, nose, and throat, gastroenterology, and thoracic procedures. However, using MS as a gingival retractor has some limitations, including the need for temporary crowns at the impression session because it is difficult to hold the material in place5. Therefore, this study evaluated the efficacy of MS when cut to a thickness of 0.75 mm and without the use of a temporary crown compared to the ACIKRC. It has been compared to the ACIKRC because it is a mechanical-chemical retraction cord, as impregnation of the alumina chloride cord before placement in the sulcus ensures hemostasis and does not reduce the cord’s ability to absorb sulcus fluids22. In addition, it is recommended because it is biocompatible at low concentrations of less than 15%23. Aluminum chloride solution acts as a hemostatic and astringent agent by precipitating protein, enhancing vasoconstriction, and removing tissue fluid5. Runyan et al.22 suggested that aluminum chloride may be effective in controlling bleeding. Aluminum chloride is the chemical agent with the least effect on gingival tissue of all the drugs used to impregnate retraction cords24.
The periodontal tissues were assessed both clinically and through radiographic means14,15,16,17,18. Individuals with a thick gingival biotype were chosen due to their increased susceptibility to recession18. Moreover, a thin cord should be utilized and must not remain in place for longer than 15 min. This approach contrasts with the procedure protocol since MS has a thickness of 0.75 mm, and the procedure duration extends beyond 15 min. Patients selected had a gingival sulcus depth ranging from 1 to 2 mm to standardize the thickness of the MS. A consistent preparation protocol was implemented across all patients to guarantee the safety of the gingival tissues. Patients received guidance on maintaining oral health to support good oral hygiene throughout the treatment phases. The condition of the gingival tissues was evaluated two weeks following the implementation of the treatment protocol, and those patients who showed no improvement in gingival parameters and did not follow oral health instructions were excluded. The current study included two separate groups due to the differences in the methodology. Impressions were taken before and after gingival retraction in group A to calculate the horizontal displacement angle. However, in group B, impressions were taken only after retraction. The finish line was initially prepared above the gingival margin and then placed 0.5 mm below the gingival margin to minimize damage to the gingiva25. For group A, a conical bur with a non-cutting tip was utilized to protect the sulcular epithelium from damage and to exclude the possibility of the gingival retraction by the bur tip to calculate the horizontal displacement precisely. For group B, a conical bur was used to evaluate the ability of the studied gingival retractor materials to achieve hemostasis. Horizontal displacement was measured by calculating the angle of opening of the gingival sulcus, its sides being the abutment surface, the epithelium of the gingival sulcus, and its vertex being the bottom of the sulcus. The points measured were: midbuccal, mesiobuccal, distobuccal, midpalatal, mesiopalatal, and distopalatal. The average was then calculated for each abutment. It provides the accuracy of the measurement, as the two sides of the angle, the tooth surface and the sulcular epithelium, are fixed landmarks that cannot be deformed. In contrast, measuring horizontal displacement in microns depends on the distance of the gingival papilla from the tooth surface, which may be deformed. To the best of the authors’ knowledge, it is the only study that has evaluated the effectiveness of gingival retraction by calculating the angle formed between the tooth surface and the sulcus epithelium. The horizontal displacement angle was evaluated utilizing digital gypsum models on the exocad program, which provides better accuracy in measurement26. The conventional gypsum model has the possibility of material loss of the anatomical landmarks of the gingival papilla during cutting, which negatively affects the accuracy. In addition, matching the digital gypsum models before and after retraction to obtain a single model leads to an accurate measurement of the gingival displacement comparing conventional models. Due to their limited use, the method of using MS was modified. They are cut strips with a thickness of 2 mm, which may cause difficulty during application and discomfort for patients5. In addition, we needed a temporary crown to fix the strips within the sulcus5. Therefore, the strips were applied with a thickness of 0.75 mm to eliminate the use of a temporary crown and reduce the difficulty of application and patient discomfort. In addition, to determine whether MS is effective in retracting the gingiva, whether the retraction recorded in previous studies occurred as a result of the pressure of the edges of the temporary crown on the gingival margins, and whether the expansion of the strips after absorption of gingival fluids is effective in retracting the gingival margins. Participants with systemic diseases, including cardiovascular and hematologic disorders, were excluded because such conditions impact hemostasis27. The sample size was expanded for Group B to increase the accuracy and validity compared to Group A. For group A, multiple sections of each abutment were evaluated, and then their arithmetic mean was calculated, which adds to its validity and accuracy. The ACIKC was applied for 4 min based on the study of Baharav et al.13 The study indicated that the ACIKC can be applied for a maximum of 8 min and a minimum of 4 min. MS was applied for 4 min to standardize the procedure. Potential confounding variables were controlled by selecting healthy individuals with intact gingival tissues and a sulcus depth of 1–2 mm to standardize the retraction cord thickness and eliminate inflammatory factors that could influence the outcomes. The instrument used for cord insertion was also standardized, along with the method of application by the researcher, to ensure a consistent force during the placement of the retraction cord28,29. The efficacy of the retraction was assessed at three distinct points on each surface, and the average was calculated to enhance measurement precision. Patients were queried about their overall health to confirm the absence of any systemic diseases or medications that might influence hemostasis, ensuring clarity in the results when examining the materials’ hemostatic capabilities. The retraction measurements were digitized to prevent errors associated with traditional measurement techniques, and retraction was also analyzed using angles through the previously described method to eliminate potential measurement inaccuracies present in conventional methods28,29.
The result of the current study states that MS and ACIKC produce similar gingival retractions. It contrasts with the study by Madaan et al.5, which concluded that MS provided a higher horizontal retraction efficacy than ACIKC. In addition, it contrasts with the study by Thimmappa et al.30, who indicated that Merocel strips showed higher retraction scores horizontally and vertically than ACIKC. The controversial results were due to the different methodology, where the strip thickness was 0.75 mm instead of 2 mm without a temporary crown, which would cause additional stress on the sulcular epithelium, causing higher retraction. The result of the current study showed that MS showed higher potential for bleeding control compared to ACIKC, which is consistent with the results of Thimmappa et al.30 and Shivasakthy et al.8 studies, which concluded that MS is a promising material for bleeding control, due to the porous sponge-like microstructure that expands by absorbing oral fluids, compressing the gingival margins and surrounding tissues without damage. Thus, the null hypothesis was partly rejected since MS outperformed ACIKC in achieving adequate hemostasis, but both provided similar horizontal retraction.
This study has limitations. The study was conducted on healthy individuals with no systemic or periodontal diseases. Therefore, materials were not tested for gingival or periodontal diseases. Individuals with a thick gingival biotype were selected. Further long-term clinical trials are recommended to evaluate the gingival tissue response in the healthy and diseased gingival tissue. In addition, to compare MS with other conventional retraction cords.
Conclusions
Based on our findings, MS and ACIKC provided similar horizontal gingival retraction abilities. MS showed better bleeding control than ACIKC. Thus, MS could be a potential substitute. MS in 0.75 mm thickness without a temporary crown provided good horizontal retraction. Therefore, the current study proposed a more effective method of retraction and hemostasis without a relatively complex clinical procedure.
Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Aswal, G. S., Rawat, R., Dwivedi, D., Prabhakar, N. & Kumar, V. Clinical outcomes of CAD/CAM (lithium disilicate and zirconia) based and conventional full crowns and fixed partial dentures: A systematic review and meta-analysis. Cureus 15, (2023).
Srimaneepong, V. et al. Fixed prosthetic restorations and periodontal health: A narrative review. J. Funct. Biomater. 13, 15 (2022).
CASPubMedPubMed CentralGoogle Scholar
Hickel, R. et al. Revised FDI criteria for evaluating direct and indirect dental restorations—Recommendations for its clinical use, interpretation, and reporting. Clin. Oral Invest. 27, 2573–2592 (2023).
MATHGoogle Scholar
Chaudhari, J., Prajapati, P., Patel, J., Sethuraman, R. & Naveen, Y. G. Comparative evaluation of the amount of gingival displacement produced by three different gingival Retraction systems: an: An: In vivo: Study. Contemp. Clin. Dent. 6, 189–195 (2015).
PubMedPubMed CentralGoogle Scholar
Madaan, R. et al. Comparative evaluation of the clinical efficacy of four different gingival Retraction systems: An in vivo study. Cureus 14, (2022).
Safari, S., Ma, V. S., Mi, V. S. & Hamedi, M. Gingival retraction methods for fabrication of fixed partial denture: Literature review. J. Dent. Biomater. 3, 205 (2016).
MATHGoogle Scholar
Phatale, S., Marawar, P. P., Byakod, G., Lagdive, S. B. & Kalburge, J. V. Effect of retraction materials on gingival health: A histopathological study. J. Indian Soc. Periodontol. 14, 35–39 (2010).
PubMedPubMed CentralGoogle Scholar
Shivasakthy, M. & Ali, S. A. Comparative study on the efficacy of gingival retraction using polyvinyl acetate strips and conventional retraction cord–An in vivo study. J. Clin. Diagn. Research: JCDR 7, 2368 (2013).
CASMATHGoogle Scholar
Rajambigai, M. A., Raja, S. R., Soundar, S. J. & Kandasamy, M. Quick, painless, and atraumatic gingival Retraction: An overview of advanced materials. J. Pharm. Bioallied Sci. 8, S5–S7 (2016).
PubMedPubMed CentralGoogle Scholar
Bousquet, P. J. et al. The consolidated standards of reporting trials (CONSORT) statement applied to allergen-specific immunotherapy with inhalant allergens: A global allergy and asthma European network (GA2LEN) Article. J. Allergy Clin. Immunol. 127, 49–56 (2011).
PubMedMATHGoogle Scholar
World Medical Association. World medical association declaration of Helsinki: Ethical principles for medical research involving human subjects. Jama 310, 2191–2194 (2013).
MATHGoogle Scholar
Kim, Y. S. et al. Accuracy of periodontal probe visibility in the assessment of gingival thickness. J. Periodontal Implant Sci. 51, 30 (2021).
PubMedMATHGoogle Scholar
Baharav, H., Laufer, B. Z., Langer, Y. & Cardash, H. S. The effect of displacement time on gingival crevice width. Int. J. Prosthodont. 10, (1997).
Deus, F. P. & Ouanounou, A. Chlorhexidine in dentistry: Pharmacology, uses, and adverse effects. Int. Dent. J. 72, 269–277 (2022).
Google Scholar
Löe, H. The gingival index, the plaque index and the retention index systems. J. Periodontology. 38, 610–616 (1967).
MATHGoogle Scholar
Patel, J. S. et al. Comparing gingivitis diagnoses by bleeding on probing (BOP) exclusively versus BOP combined with visual signs using large electronic dental records. Sci. Rep. 13, 17065 (2023).
ADSCASPubMedPubMed CentralMATHGoogle Scholar
Chung, H. et al. Periodontal probing on digital images compared to clinical measurements in periodontitis patients. Sci. Rep. 12, 1616 (2022).
ADSCASPubMedPubMed CentralMATHGoogle Scholar
Rijal, A. H., Dhami, B., Khapung, A. & Ghimire, P. Evaluation of width and thickness of the attached gingiva and its association with age, gender, and arch location in the nepalese population. Sci. World J. 2023, 8877273 (2023).
Google Scholar
Gupta, A., Prithviraj, D. R., Gupta, D. & Shruti, D. P. Clinical evaluation of three new gingival retraction systems: A research report. J. Indian Prosthodontic Soc. 13, 36–42 (2013).
CASMATHGoogle Scholar
Ferrari, M., Cagidiaco, M. C. & Ercoli, C. Tissue management with a new gingival retraction material: a preliminary clinical report. J. Prosthet. Dent. 75, 242–247 (1996).
CASPubMedGoogle Scholar
Ateeq, M. P., Soorya, P. T., Kashinatha, H. M. & Muralidhara, G. Conventional and new techniques in gingival displacement. J. Dent. Oral Biosci. 2, 33–37 (2011).
Google Scholar
Runyan, D. A., Reddy, T. G. Jr & Shimoda, L. M. Fluid absorbency of retraction cords after soaking in aluminum chloride solution. J. Prosthet. Dent. 60, 676–678 (1998).
Google Scholar
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. 17, 435–444 (2017).
CASPubMedGoogle Scholar
Prasad, K. D., Hegde, C., Agrawal, G. & Shetty, M. Gingival displacement in prosthodontics: A critical review of existing methods. J. Interdisciplin. Dentistry. 1, 80–86 (2011).
MATHGoogle Scholar
Kazakova, R. et al. A comparative analysis of post-retraction changes in gingival height after conventional and surgical gingival displacement: Rotary curettage, diode and Er: YAG laser troughing. Healthcare 11, 2262 (2023).
PubMedPubMed CentralMATHGoogle Scholar
Diab, M., Karkoutly, M., Kanout, S. & Nassar, J. A. Effect of a novel mesh design and the sandblasting technique on the bond strength of computer-designed and three-dimension laser printed resin bonded bridges: An in vitro study. Sci. Rep. 14, 8412 (2024).
ADSCASPubMedPubMed CentralMATHGoogle Scholar
Aynalem, M., Shiferaw, E., Gelaw, Y. & Enawgaw, B. Coagulopathy and its associated factors among patients with a bleeding diathesis at the university of Gondar specialized referral hospital, Northwest Ethiopia. Thromb. J. 19, 1–12 (2021).
Google Scholar
Kuhn, K. et al. Influence of the gingival condition on the performance of different gingival displacement methods—A randomized clinical study. J. Clin. Med. 10, 2747 (2021).
CASPubMedPubMed CentralMATHGoogle Scholar
Tan, K., Pjetursson, B. E., Lang, N. P. & Chan, E. S. A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years: III. Conventional FPDs. Clin. Oral. Implants. Res. 15, 654–666 (2004).
PubMedGoogle Scholar
Thimmappa, M., Bhatia, M., Somani, P. & Kumar, D. R. V. Comparative evaluation of three noninvasive gingival displacement systems: An: In vivo: Study. J. Indian Prosthodontic Soc. 18, 122–130 (2018).
Google Scholar
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Funding
This research is funded by Damascus University – funder No. 501100020595.
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Authors and Affiliations
Department of Fixed Prosthodontics, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
Leen Dannan & Jihad Abou Nassar
Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syrian Arab Republic
Mawia Karkoutly
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Leen Dannan
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Contributions
L.D. carried out the experiment, and drafted the manuscript. M.K. performed the statistical analysis, and wrote the manuscript. J.A.N. planned the experiments, supervised the project, and critically reviewed the manuscript. All authors have read and approved the manuscript.
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Correspondence to Mawia Karkoutly.
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Dannan, L., Karkoutly, M. & Nassar, J.A. Efficacy of hemostasis and gingival retraction of Merocel strip compared with conventional retraction cord utilizing digital gypsum model: a randomized controlled trial. Sci Rep 15, 10508 (2025). https://doi.org/10.1038/s41598-025-95612-8
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Received:11 October 2024
Accepted:24 March 2025
Published:27 March 2025
DOI:https://doi.org/10.1038/s41598-025-95612-8
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