Evaluation of Different Intraoperative Patient Preference Factors on Sub-Gingival Clamps Versus Retraction Cord Placement in Non-Carious Cervical Lesions

Abstract

This study aimed to compare two gingival displacement and isolation techniques: rubber dam with sub-gingival clamps and retraction cord with cotton rolls. The study also assessed the factors influencing patients' preference for one method, including the need for anesthesia, gingival bleeding, gingival laceration, post-operative spontaneous sensitivity, and time consumption. The study was conducted as a randomized control trial with 34 patients, each with one pair of comparable non-carious cervical lesions (NCCL) on opposing sides of the same arch. A total of 68 restorations were placed, with each patient receiving one restoration using a retraction cord with cotton rolls (RC/CR) and the other using a rubber dam (RD) with sub-gingival clamps. Four dentists with at least five years of clinical experience under the supervision of two dental consultants with more than 14 years of clinical experience carried out the procedures to ensure uniformity in technique and assessment. The preferences of the patients were noted, and gingival bleeding, gingival laceration, spontaneous sensitivity, time consumed to apply RD and RC/CR, and the need for anesthesia were recorded immediately after the procedure. Two weeks later, gingival laceration and gingival bleeding were assessed again. Statistical analysis was performed on each criterion evaluated using a t-test, Chi-square test, and Mann-Whitney test with a significance level of P ≤ 0.05. The results showed statistically significant differences between the RD group and the RC/CR group in terms of patients' preference (P=0.0000), post-operative gingival laceration (P=0.0032), need for anesthesia (P=0.0000), and time of application (P=0.0000). 76% of patients preferred rubber dams with sub-gingival clamps. Gingival laceration, discomfort, and increased time of application were recorded in the RC/CR group. Spontaneous sensitivity reported by patients post-operatively (P=0.7204), gingival tissue laceration assessed after two weeks (P=1.0000), and gingival bleeding assessed immediately (P=0.6891) and in follow-up visits (P=1.0000) were insignificant in both groups. In conclusion, patients preferred rubber dam with sub-gingival clamps due to more comfort, lesser gingival tissue injury, and lesser time of application.