I was asked to give an update (via a current literature review) on the use of Expasyl during a recent workshop here at Spear. A 2012 article compared pressure created by traditional cord packing and cordless techniques, stressing the importance of application technique with Expasyl. That was not a surprise. A 2013 article compared gingival displacement measured under magnification in 16 subjects who received full coverage crowns on premolars. The study showed very favorable and comparable results, especially in the horizontal displacement. Having used Expasyl on a limited basis in my career so far, this was slightly surprising to me.
What was most surprising to me was the conversation in the room after the brief presentation. It began with “general agreement” that a double cord technique would be our standard for the foreseeable future and that Expasyl would fade. The surprise followed: As we sat in a safe learning environment embracing an amazing sense of community, several participants discussed very intentional and favorable uses for Expasyl in which they use it routinely.
- Provisionals only (direct or indirect) When preparing teeth on a day that final impressions will not be taken, a quick application of Expasyl to better expose the margins before fabricating the provisionals directly or before taking an impression to fabricate them indirectly.
- Second layer of retraction Place the first layer of traditional cord at the base of the sulcus during the preparation, as always, and use the Expasyl for the second layer of horizontal displacement. For some, this worked very well and saved time.
- Only retraction after soft tissue laser One participant has not placed cord for routine dentistry in years. He has integrated the use of a soft tissue laser after preparations. Expasyl has been more than adequate for his impressions, with routine positive feedback from the lab.
Yes, there are still many concerns and limitations with the routine use of paste for a cordless technique, from technique, to chemical interaction with impression materials, difficulty rinsing, limitations with furcations, learning curve, shelf-life and many others. I get it. But it’s also encouraging and refreshing to see so many great dentists finding appropriate uses that make sense, as opposed to the alternative. I thought you might like to hear that too. Sources:
- June 2012, The Journal of Prosthetic Dentistry,Volume 107 Issue 6, pp388-392, A comparison of pressure generated by cordless gingival displacement techniques, Bennani et al
- J Contemp Dent Pract. 2013, Mar 1;14(2):217-21. Evaluation of efficacy of different gingival displacement materials on gingival sulcus width. Prasanna GS1, Reddy K, Kumar RK, Shivaprakash S.
Kevin Kwiecien, D.M.D., M.S., Spear Faculty and Contributing Author