Get Back to Control - How to Deal with Bleeding Gingiva During Restorative Procedures

Contributed by Dr. Leo Tjäderhane DDS, PhD, professor

Hemostatic agents are coagulants. However, mere contact of the agents with the bleeding surface results with only very superficial coagulation. The trick to profound hemostasis is simple: scrubbing copious amounts of hemostatic against the bleeding tissue. Scrubbing removes the superficial coagulum and forces the coagulum deeper into the capillaries. (Fig. 2) This is easiest to achieve with the Metal Dento-Infusor™ tip (Ultradent Products, Inc.) (Fig. 1) and Astringedent™ hemostatic (Ultradent Products, Inc.) or Astringedent™ X hemostatic (Ultradent Products Inc.). The scrubbing force required is approximately equal to that required to scratch a lottery ticket.

After 5–10 seconds of scrubbing, wash the gingival margin vigorously to remove all loose coagulum and see where bleeding may still occur (Fig. 3). Usually, no more than two rounds are needed to achieve profound hemostasis. At this point, retraction cord can be placed if needed (Fig. 4).

Two Metal Dento-infusor tips

It all began in 1978...

The Problem 

In the late 1970s, there was a major problem in dentistry, and Dr. Dan Fischer, founder of Ultradent, knew it. Of all the available hemostatics on the market, none of them stopped bleeding sufficiently and predictably enough to allow for quality impressions. Why is this a problem? Because, as Dr. Fischer says, “There is nothing one can do—in a quality way—in the presence of blood.”

The Solution: Astringedent

After careful research and trial, Dr. Fischer discovered that one of his ferric ion compositions, later known as Astringedent, instantly coagulated blood. He eagerly began using it for patient impressions, hoping it was the solution he had been looking for. But instead, he discovered it was a mess. Yes, it coagulated the blood, but it left that coagulum everywhere; it was in the impression, and when he washed, there was bleeding underneath the coagulum. “Yes, I was discouraged, but not ready to give up,” he says.

Astringedent + Metal Dento-Infusor Tip

Soon after, Dr. Fischer discovered that if he delivered his Astringedent using a syringe and a tip with a stiff brush end, he could overcome the challenges caused by the residual coagulum. So he created the Metal Dento-Infusor tip.

“This process taught me the value of putting the solution in a syringe,” Dr. Fischer says. “I discovered that for my ferric ion solution to work, I needed to scrub it firmly into the sulcus. I learned that by rubbing and scrubbing firmly, I could infuse the solution into the cut capillary openings. To my delight, it worked! The coagulum left in the capillary openings effectively plugged them up, stopping the blood from oozing out.”

“And just like that, Ultradent was born”

Knowing that this “scrub and rub” technique would seem counterintuitive to many dentists, Dr. Fischer began travelling to dental trade shows to demonstrate the product and the technique—often using his own blood. After some time, Dr. Fischer realized he would need a company to back his groundbreaking product and to lend Astringedent the credibility it deserved. And just like that, Ultradent was born.

The invention of Astringedent paved the way to Ultradent’s family of flagship tissue management products, including ViscoStat, ViscoStat Clear, and Astringedent X. Countless dentists have found amazing success using these products along with Dr. Fischer’s scrub and rub technique. Try them for yourself and you will too!

Metal Dento-infusor tip in detail

FIG. 1

The Metal Dento-Infusor tip allows scrubbing while delivering the hemostatic.

Illustration of metal dento-infusor tip in contact with mouth tissue

FIG. 2 

The Metal Dento-Infusor tip delivers the hemostatic agent right at the orifices of the bleeding capillaries.

Illustration of vigorous washing removing coagulum

FIG. 3

Vigorous washing effectively removes the loose coagulum that could mask slight bleeding underneath.

Illustration of cord being placed in the tissue

FIG. 4 

Retraction cord, dry or soaked with the hemostatic agent, is easy to place when the sulcus is no longer bleeding.

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This article was originally published in the Clinical Life™ magazine: Winter 2020 edition

Clinical Life™ magazine is a premier periodical publication by Clinical Research Dental Supplies & Services Inc. Discover compelling clinical cases from Canadian and US dental professionals, cutting-edge techniques, product insights, and continuing education events.
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