Clinical Assessment of Gingival Health Following Various Rubber-Dam Retraction Techniques

To assess the clinical effects of various rubber-dam retraction techniques on gingival health following anterior composite restorations.

Ninety-six restorations were performed on 24 patients. Each patient received four restorations on maxillary incisors, and each incisor was subjected to a different retraction technique under rubber-dam isolation randomly (#212 clamp, Brinker-B4 clamp, single-loop self-ligating tie, and self-ligating tie-#212 clamp combination). Assessment parameters included plaque index, bleeding, probing depth, keratinized and attached gingiva width, gingival margin level, and attachment level. All were measured initially, immediately after, at 1 week, 1 month, and 3 months. Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney-U, and Friedman tests were used for statistical analyses (< 0.05).

Bleeding on probing was highest immediately after (p < 0.001). Attached keratinized gingiva decreased immediately after (p < 0.001), while relative gingival margin level significantly increased (p < 0.001). All parameters completely returned to baseline at 3 months recall (p ≥ 0.05). No significant differences were found among the retraction techniques (p ≥ 0.05) and between the thick and thin gingival phenotypes (p = 0.772).

Rubber-dam retraction may cause temporary adverse effects in gingival health immediately after the restorations, which can completely reverse in 3 months. Besides, different retraction techniques presented similar effects. Gingival phenotype was not an influential factor.

Rubber dam retraction techniques may provide adverse effects on gingival health, whereas this effect might be temporary. Proper application of the retraction material, the surface finishing technique, and the retraction period might be the key factors in this regard.