Soft Tissue Management

It is almost unanimous among researchers that the best margins are supra-gingival because impressions are much easier to take and the health of the gingival tissue around teeth is almost the same as around non-restored teeth.

Tissue Retraction, Hemostasis or Both?

With tissue retraction, the cord is placed sub-gingival in the sulcus between the gingiva and the prepared tooth. Once the cord is removed the impression material can record the gingival margin. Ideally, the smallest cord available should be used to avoid tearing of the gingival tissue, causing bleeding and/or stripping of the epithelial attachment. The use of cord prior to tooth preparation can protect gingival tissue during the prepping procedure and it helps to establish the depth of the prep. Some combine tissue retraction and hemostasis into a single procedure, however, with this method, gingival tissue may be over retracted and the result may be the loss of gingival crest height. This can mean a serious problem with esthetics especially in anterior teeth.

Double Cord Technique	Single Cord Technique
In the double cord technique, the first and smallest cord is packed under the prepped margin to control seepage and bleeding. The second and larger cord is placed above the first cord and is removed prior to taking the impression. The first cord is left in place during the impression. This helps control bleeding and maintains access for the impression material.	With this method, a single cord is placed in the sulcus and is removed prior to taking the impression. This works fine if the cord is the same height as the sulcus. In a deep sulcus the tissue will collapse over the cord making it impossible for the impression material to record the prepped area of tooth in the sulcus, leading to inaccuracies in the impression.