Present status and future directions: Soft tissue management in prosthodontics

Table 1 Indications for different thickness cords

Cord	Indications
000	Anterior teeth
	Double packing
	Substitute for black silk suture as lower cord in the “two-cord”
	technique
00	Preparing and cementing veneers
	Restorative procedures dealing with thin, friable tissues
0	Lower anteriors
	When luting near gingival and subgingival veneers
	Class III, IV and V restorations
	Second cord for “two-cord” technique
1	Tissue control and/or displacement when soaked in coagulative hemostatic solution prior to and/or after crown preparations
	Protective “pre-preparation” cord on anteriors
2	Upper cord for “two-cord” technique
	Tissue control and/or displacement when soaked in coagulative
	Hemostatic solution prior to and/or after crown preparations
	Protective “pre-preparation” cord on anteriors
3	Areas that have fairly thick gingival tissues where a significant amount of force is required
	Upper cord for those desiring the “two-cord” technique

Table 2 The advantages and disadvantages of different chemical agents

Chemicals	Advantages	Disadvantages
Epinephrine	Good tissue displacement	Systemic reactions
	Minimal tissue loss	Epinephrine syndrome
	Good hemostasis	Risk of inflammation of the gingival cuff
		Rebound hyperemia
		Risk of tissue necrosis
Alum	Minimal tissue loss	Less hemostasis and tissue displacement
	Extended working time	Offensive taste
		Risk of necrosis if in high concentration
Aluminum chloride	Minimal tissue loss	Local tissue destruction
	Good hemostasis	Less vasoconstriction than epinephrine
	No systemic effects	Risk of sulcus contamination
	Least irritating of all chemicals	Modifies surface detail reproduction
	Hemostasis	Inhibits set of polyvinyl siloxane and polyether impressions
	Little sulcus collapse after cord removal
Ferric sulfate	Compatible with aluminum chloride	Non compatible with epinephrine
		Tissue discoloration
	Good displacement	Acidic taste
		Risk of sulcus contamination Inhibits set of polyvinyl siloxane and polyether impressions
Tannic acid	Good tissue response	Less displacement
		Minimal hemostasis