Expasyl has long been one of dentistry’s best-kept secrets for tissue management. Originally marketed as “a replacement for traditional retraction cord,” Expasyl has many other clinical uses beyond the scope of its originally intended use.
First, as a true replacement for retraction cord, while an excellent alternative to traditional retraction methods in many cases, it is still a challenge to deflect gingival tissues adequately for deep subgingival margins using Expasyl alone. But as an overall tool for soft-tissue management during restorative procedures, Expasyl is a material that I cannot practice efficiently without!
As a combination tissue deflection and hemostatic agent, Expasyl in many cases performs better than liquid hemostatic agents. Some of the many clinical uses of Expasyl are described below:
- Tissue Deflection (retraction) for master impressions. Depending on the position of margin placement relative to the free gingival margin, Expasyl can be used alone or in conjunction with retraction cord to gain absolute access to the intracrevicular area. The hemostatic component of Expasyl creates a dry environment, controlling bleeding and sulcular exudates, so that impression materials can routinely capture the entire restorative margin and the emergence profile of the tooth apical to the restorative margin. This is critical information for the dental ceramist to create a biologically acceptable ceramic restoration.
- Control of the gingival tissues during delivery procedures. This is one area often not discussed where Expasyl absolutely shines! Even with healthy gingival tissues, use of 37% phosphoric acid to condition teeth prior to placement of dentin adhesives during a resin cementation procedure can cause bleeding from the gingival sulcus. It is not advised to use iron containing astringents to control bleeding during use of resin cements, as they could cause a darkening of the cement color over time if not sufficiently removed from the tooth surface prior to cementation. When bleeding occurs after etching, Expasyl is placed in the affected area and compressed lightly with a cotton pellet. It is rinsed away after about one minute with an air-water spray combination. The gingival tissues are deflected and the bleeding is controlled. Wiping the tooth surface in the area with a cleansing agent, such as Tublicid (Global Dental), allows the adhesive process to continue without re-etching the area.
- Control of hemorrhage after adjunctive gingival surgical procedures.Today, many dentists use lasers or electrosurgery to trough or resect excess gingival tissues prior to making master impressions or placing Class V direct composite restorations. Although these technologies report excellent control of hemorrhage in many instances, neither is 100% effective, especially in inflamed tissue. Use of Expasyl after these respective procedures, however, ensures a bloodless field.
- Control of hemorrhage interproximally in the posterior regions during matrix procedures for Class II direct restorations. The clinical success of a Class II direct composite restoration depends on isolation from moisture and liquid contaminants in the preparation when performing bonding and placement procedures. Rubber dam and other isolation devices cannot always adequately keep contaminants out of the gingival proximal area, especially if the gingival margin of the proximal box extends below the gingival crest. And the replacement of old, poorly contoured restorations often means this tissue will be inflamed. It can be extremely difficult to ensure the preparation will remain contaminant free during the many steps involved in bonding and composite placement. If the tissue is bleeding, prior to matrix placement, Expasyl can be used to deflect the tissue away and control moisture and blood contamination. Using the same technique outlined in 2), Expasyl will allow placement of the matrix and wedging without contamination, and will prevent further contamination during the bonding and placement procedure.
Just some creative uses for Expasyl have been described here, including the intended use of tissue retraction for master impressions. Expasyl is a unique dental material by virtue of its ability to deflect tissue and control hemorrhage and moisture in the gingival sulcus, and it should be on every dentist’s bracket table.
Expasyl Gingival Retraction Paste
Expasyl deflects tissue AND controls hemorrhage and moisture in the gingival sulcus.
It is still a challenge to deflect gingival tissues adequately for deep subgingival margins using Expasyl alone.
The Bottom Line
With all the creative uses for Expasyl, including the intended use of tissue retraction for master impressions, it should be in every dentist's armamentarium.