VOCO Retraction Paste helps clinicians deal with blood and, in most cases, cut the cord.
Why This Retraction Paste Is So Special | Image Credit: © Ankur Gupta, DDS
In 2016, one of my patients—a frustrated mom who was about the same age as me—humorlessly asked me, “Isn’t there, like, a magic coating you can put on my teeth so I don’t get any more cavities?”
If I could sum up everything I learned in dental school in 1 sentence, it would be this: Blood ruins everything.
It ruins impressions.
It ruins bond strength.
It ruins cementation.
It ruins endodontic isolation.
Its presence indicates inflammation.
Its presence indicates disease.
It is just the worst.
Sadly, blood is here to stay. Even the most talented and extraordinary periodontist in history would have to admit that a significant percentage of his or her patient population comes in regularly with the type of gums that just ooze.
VOCO Retraction Paste
VOCO Retraction Paste is an astringent paste with aluminum chloride. It is designed to widen and dry the gingival sulcus, creating ideal conditions for successful impressions. The material is a bright turquoise color, providing high contrast to tooth structure and gingiva. It saves clinicians up to 50% of procedural time compared with other methods. Its 2-phase viscosity makes for simple application.
VOCO America Inc
888-658-2584 | vocoamerica.com
Having graduated dental school 20 years ago, I was taught 2 effective strategies to mitigate the headaches that blood causes:
The second one is easy and liberating. My dental work is difficult, and I can just blame the patient for their horrible home care.
The first one, sadly, is difficult and does not always work. If I were to survey every general dentist in the US about whether they enjoy packing cord, I am quite confident that the majority would mark the “no” checkbox. Not only is packing cord difficult, time-consuming, and painful (for the patient and the dentist), it does not always work. This is made worse in the presence of copious gingival hemorrhage. One of the worst of all clinical incidents is the rare occasion when a handpiece bur gets entangled with a stray fiber from a poorly packed cord. Blood and the remaining cord rotate like a helicopter around the shank of the handpiece. Not only does this ruin the procedure, but it also ruins lunch, it might ruin your white coat, and quite possibly might ruin your day. How ironic—we pack cord in attempts to gain control over blood, but it is the blood that can also make cord packing more difficult and less predictable.
The good news is that I graduated dental school 20 years ago, before iPhones,Amazon, and smartwatches were ubiquitous. Technology was very different. It would stand to reason that, although other areas of our lives have benefited greatly from the exponential increase in technological development, our work as dentists should benefit as well. The good news is that it has.
Several dental technologies and innovations have made the most difficult aspects of general dentistry easier, more predictable, and more patient friendly. Listed below are several incredibly easy and innovative agents to mitigate and often eliminate the presence of blood during difficult dental procedures, all of which I had never learned about in the early 2000s as I progressed through my dental education.
HybenX from EPIEN Medical and PerioDT from Young Specialties: These nonantibiotic chemical desiccants kill subgingival bacteria and desiccate the treated gingival tissue. They have not been marketed as agents designed to limit gingival bleeding but, in my experience, have been quite effective.
Any type of laser: These allow for incision, excision, tissue modulation, and cauterization. Lasers are incredibly effective at eliminating gingival bleeding, but drawbacks include the following:
ViscoStat or Astringedent X from Ultradent Products: These are topical ferric solutions that, when scrubbed onto the affected gingiva, result in excellent hemostasis. Sadly, this does not result in any gingival retraction.
VOCO Retraction Paste: This solution was introduced to my clinical repertoire most recently and will be the focus for much of the remainder of this article. This is an aluminum chloride-based astringent paste.
It is both an astringent and retraction agent. Designed as a 2-stage formula, it allows precise application without injury to the gingiva, and then offers increased stability in the sulcus, leading to effective temporary widening.
VOCO Retraction Paste is dispensed from an incredibly thin plastic tip, allowing maximum depth into the sulcus, and is packaged in a single-dose blister pack at 0.3 g per cap. This provides enough material for about 3 crown preps.
What differentiates it from the options summarized above is its ability to progress from phase 1 (dispensing) to phase 2 (increased viscosity). It is easily dispensed using a composite placement gun, and comes packaged in a single-use compule. Upon dispensation, the material quickly becomes more rigid, achieving gingival retraction as cord might. This transformation happens in 2 minutes or less.
After the more rigid phase of the retraction paste has created displacement of the gingiva away from the tooth prep, the material is rinsed off with a combination of air, water, and occasionally cotton, resulting in dry, highly visible margins. It has a bright turquoise color, so there is never any doubt about whether I have rinsed off all of the material.
Although there are clinical scenarios that require use of all the hemostatic and retraction options above, my preference usually is the VOCO Retraction Paste. It is inexpensive, user-friendly, and incredibly effective.
Not only does it work well with crown impression and/or scanning, but I have found myself using it in any restorative instances in which I need to control bleeding and achieve gingival retraction. This includes class V composites, class II composites, crown cementation, and endodontic procedures. Although plenty of clinical scenarios require packing cord, I have found that, even in those infrequent and inconvenient cases, I will still use the VOCO Retraction Paste to complement the cord.
Most clinical cases are traditional crown preps, just prior to taking an impression or scan. During this procedure, the material is dispensed around the entire gingival margin through a thin tip designed to allow material to extrude into the gingival sulcus.
I then place a cotton compression cap over the tooth (not required) and have the patient bite, causing more gingival displacement as the material transitions into more viscous phase 2. This process allows me to leave the operatory and see a patient in another room. Upon returning, the material is thoroughly removed, and I can have confidence in taking an excellent scan or impression.
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