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Knowledge, attitude, and practice of gingival displacement for impressions in fixed prosthodontics: A need assessment survey
*Corresponding author: Shikha Kishor Chhangani, Department of Prosthodontics, Ranjeet Deshmukh Dental College and Research Center, Digdoh Hills, Hingna, Nagpur, Maharashtra, India. shikhachhangani75@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Chhangani SK, Banerjee R, Pande N, Deshpande S. Knowledge, attitude, and practice of gingival displacement for impressions in fixed prosthodontics - A need assessment survey. J Adv Dental Pract Res. doi: 10.25259/JADPR_55_2025
Abstract
Objectives:
Accurate reproduction of finish lines is essential for the success of fixed prosthodontic restorations. Gingival displacement plays a pivotal role in obtaining precise impressions, particularly in subgingival margin designs. Despite the availability of various techniques and materials, inappropriate use may compromise periodontal health. This study aims to evaluate the knowledge, attitude, and practice (KAP) regarding gingival displacement procedures for impressions in fixed prosthodontics among dental practitioners in Nagpur.
Material and Methods:
A cross-sectional observational survey was conducted among 100 dental practitioners practicing fixed prosthodontics in and around Nagpur. Data were collected using a pre-validated structured questionnaire distributed through Google Forms. The questionnaire assessed KAP domains related to gingival displacement. Descriptive statistics were computed, and KAP scores were categorized. A binomial test was used to assess the overall adequacy of KAP levels at a statistical significance level of p < 0.05.
Results:
Only 33% of participants considered gingival displacement important for fixed prosthodontic impressions, and 30% were aware of newer cordless displacement systems. The mean knowledge score was 1.35 ± 1.19 (out of 4), indicating limited awareness. Attitude scores were moderately positive (mean 0.80 ± 0.74), while practice scores were relatively better (mean 2.42 ± 0.82). The mean total KAP score was 4.57 ± 2.03 (out of 10). Binomial analysis revealed that only 19% of participants demonstrated adequate KAP, with a statistically significant overall lack of KAP (p = 0.00).
Conclusion:
Dental practitioners in Nagpur exhibit a significant deficiency in knowledge and attitude regarding gingival displacement procedures, despite moderate clinical practice. Targeted continuing dental education programs are required to improve awareness and promote evidence-based practice.
Keywords
Fixed prosthodontics
Gingival displacement
Impression accuracy
Knowledge attitude practice
Retraction cord
INTRODUCTION
The long-term success of fixed prosthodontic restorations is strongly influenced by the accuracy with which preparation margins are recorded and reproduced. Inadequate marginal adaptation has been associated with plaque accumulation, gingival inflammation, marginal discoloration, and eventual failure of the restoration. These complications are more pronounced when finish lines are placed at or below the gingival margin, making effective management of the surrounding soft tissues a critical clinical requirement.[1]
Gingival displacement is performed to temporarily displace the marginal gingiva laterally and vertically, thereby exposing the finish line and allowing sufficient space for impression material to flow without distortion. Previous studies have suggested that a minimum lateral displacement of approximately 200 μm is required to achieve an accurate and tear-free impression. Inadequate displacement may result in incomplete margin capture, whereas excessive displacement can compromise periodontal tissues.
From a biological standpoint, gingival displacement must be atraumatic and well-controlled. The epithelial attachment and connective tissue fibers can tolerate only limited pressure, beyond which irreversible tissue damage may occur. Excessive or uncontrolled pressure, particularly during mechanical displacement with retraction cords, has been associated with postoperative discomfort, inflammation, attachment loss, and gingival recession. Such adverse outcomes not only affect periodontal health but also compromise esthetics, especially in the anterior region.
Several gingival displacement techniques are currently available, including mechanical methods (retraction cords), chemical and chemicomechanical methods, electrosurgery, laser-assisted techniques, and newer cordless paste-based systems. While conventional retraction cords remain widely used due to their familiarity and low cost, newer cordless systems have been introduced with the aim of delivering controlled pressure and minimizing tissue trauma. However, the effectiveness of any technique depends largely on the clinician’s understanding of its biological implications, correct application, and appropriate case selection.[2,3]
In routine clinical practice, the choice of gingival displacement technique is influenced by factors such as gingival biotype, sulcular depth, margin location, and operator experience.[4] A lack of awareness regarding optimal pressure application, material properties, and newer alternatives may result in either underuse or improper use of gingival displacement procedures. Despite extensive research on materials and techniques, there appears to be a gap between available scientific evidence and its application in daily clinical practice.
The assessment of knowledge, attitude, and practice (KAP) among dental practitioners serves as an effective method to identify such gaps and to understand prevailing clinical trends. Evaluating these parameters can help determine whether deficiencies arise from a lack of awareness, misconceptions regarding biological effects, or inappropriate clinical habits. However, literature assessing KAP related to gingival displacement procedures among dental practitioners remains scarce, particularly in the Indian scenario. Therefore, the present study was conducted to evaluate the KAP regarding gingival displacement for impressions in fixed prosthodontics among dental practitioners in Nagpur. Identifying existing lacunae may help reinforce the importance of biologically sound gingival management and highlight the need for focused continuing dental education programs to improve clinical outcomes.
MATERIAL AND METHODS
Study design and setting
A cross-sectional observational study was conducted over a period of 6 months among dental practitioners practicing fixed prosthodontics in and around Nagpur.
Study population and sample size
A total of 100 dental practitioners who met the inclusion criteria and consented to participate were included in the study.
Inclusion criteria
Dental practitioners practicing fixed prosthodontics
Willingness to participate in the study.
Exclusion criteria
Practitioners unwilling to participate.
Data collection tool
A pre-validated structured questionnaire consisting of 10 close-ended questions was used [Table 1]. The questionnaire assessed:
| Question No. | Domain | Question | Response options |
|---|---|---|---|
| Q1 | Knowledge | Do you think gingival displacement is important for making impressions in fixed prosthodontics? | Yes/no/maybe |
| Q2 | Practice | Do you practice gingival displacement procedures for patients requiring fixed restorations? | Yes/no/maybe |
| Q3 | Practice | In which type of gingival margin design do you practice gingival displacement? | Supragingival/Equi-gingival/Subgingival |
| Q4 | Practice | Which technique of gingival displacement do you follow for obtaining gingival displacement? | Mechanical/Chemical/Chemical-Mechanical |
| Q5 | Knowledge | Are you aware of newer cordless gingival displacement procedures available in the market? | Yes/no/maybe |
| Q6 | Knowledge | Do you think the pressure exerted for placing the retraction cord can cause permanent gingival recession? | Yes/no/maybe |
| Q7 | Knowledge | How much should be the optimum pressure while placing gingival retraction cords? | 2400 kPa/5000 kPa/6500 kPa |
| Q8 | Practice | Have you seen or come across patients depicting gingival recession after placing fixed restorations? | Yes/no/maybe |
| Q9 | Attitude | Do you think improper pressure during gingival retraction might be a reason for permanent gingival recession following rehabilitation with a fixed prosthesis? | Yes/no/maybe |
| Q10 | Attitude | Do you think there is a need for a device to measure pressure during gingival retraction? | Yes/no/maybe |
Knowledge (4 questions)
Attitude (2 questions)
Practice (4 questions).
The questionnaire was distributed electronically using Google Forms.
Scoring system
Responses were coded as:
1 = Favorable/correct
0 = Unfavorable/uncertain.
Scores were summed to generate:
Knowledge score (maximum 4)
Attitude score (maximum 2)
Practice score (maximum 4)
Total KAP score (maximum 10).
Participants with total scores ≥7 were categorized as having “No Lack,” while scores <7 indicated a “Lack” of KAP.
Statistical analysis
Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation). A binomial test was applied to evaluate the proportion of participants with adequate KAP. Statistical significance was set at p < 0.05.
RESULTS
Knowledge assessment
Only 33% of practitioners acknowledged the importance of gingival displacement in fixed prosthodontic impressions, while 42% denied its importance. Awareness of newer cordless displacement systems was reported by only 30% of respondents. Regarding biological effects, 34% believed that excessive pressure from retraction cords could cause permanent gingival recession. Only 38% correctly identified 2400 kPa as the optimal pressure for gingival retraction. The mean knowledge score was 1.35 ± 1.19, indicating poor awareness levels.
Attitude assessment
Approximately 31% of participants agreed that improper pressure during gingival retraction could lead to permanent gingival recession, while 40% disagreed. Nearly half of the respondents (49%) felt that there is a need for a device to measure pressure during gingival displacement procedures. The mean attitude score was 0.80 ± 0.74, reflecting a moderately positive attitude.
Practice assessment
Gingival displacement was routinely practiced by 42% of respondents, while 40% did not practice it. Subgingival margins were the most common indication for gingival displacement (54.5%). Mechanical techniques were preferred by 45.5% of practitioners. Only 26% reported observing gingival recession following fixed prosthodontic treatment. The mean practice score was 2.42 ± 0.82, suggesting relatively better clinical implementation.
Overall KAP status
The mean total KAP score was 4.57 ± 2.03. Only 19% of participants demonstrated adequate KAP. Binomial test results showed a statistically significant lack of KAP among practitioners (p = 0.00).
DISCUSSION
Accurate marginal reproduction is a critical determinant of the longevity and biological success of fixed prosthodontic restorations. Gingival displacement enables adequate exposure of finish lines and prevents impression distortion, especially in equigingival and subgingival margin designs. The present study aimed to evaluate the KAP of gingival displacement among dental practitioners in Nagpur and revealed a statistically significant overall deficiency, particularly in the domains of knowledge and attitude.[5,6]
Knowledge domain
The findings demonstrate a concerning lack of fundamental knowledge regarding gingival displacement. Only 33% of participants considered gingival displacement important for impressions in fixed prosthodontics, while 42% believed it was not important. This contradicts established prosthodontic principles that emphasize gingival displacement as an essential step for achieving marginal accuracy.[7]
Awareness of newer cordless gingival displacement systems was reported by only 30% of practitioners, indicating limited exposure to recent advances. Similar observations have been reported by Acar et al.[4], who emphasized that newer cordless systems provide clinically acceptable impressions with reduced tissue trauma when used appropriately. Furthermore, only 34% of respondents recognized that excessive pressure from retraction cords can cause permanent gingival recession, and just 38% correctly identified 2400 kPa as the optimal pressure. Bennani et al.[2], demonstrated that pressures exceeding the physiological tolerance of the epithelial attachment can lead to irreversible tissue damage. The low knowledge scores (mean = 1.35 ± 1.19 out of 4) observed in this study suggest insufficient theoretical understanding of the biological implications of gingival displacement.
Attitude domain
The attitude of practitioners toward gingival displacement was moderately positive but still inadequate. Only 31% agreed that improper pressure during gingival retraction could cause permanent gingival recession, while a larger proportion (40%) disagreed. This lack of concern toward biological consequences reflects an underestimation of periodontal risks associated with improper technique.[8,9]
Encouragingly, nearly 49% of participants felt there is a need for a device to measure pressure during gingival retraction, indicating receptiveness toward technological aids and safer clinical practices.[10,11] This highlights an opportunity for innovation and education in pressure-controlled gingival displacement methods.
Practice domain
Despite deficiencies in knowledge and attitude, clinical practice scores were relatively higher (mean = 2.42 ± 0.82). About 42% of practitioners reported routinely performing gingival displacement, primarily for subgingival margin designs (54.5%), which is consistent with clinical indications described in the literature.
Mechanical displacement techniques were preferred by 45.5% of respondents, followed by chemical and chemical– mechanical methods. This preference may be attributed to ease of use, cost-effectiveness, and familiarity. However, reliance on mechanical techniques without adequate understanding of pressure control may increase the risk of periodontal damage. Interestingly, only 26% of practitioners reported encountering gingival recession following fixed prosthodontic treatment, while 45% denied observing such complications. This discrepancy may be due to under-recognition of iatrogenic periodontal changes or lack of long-term follow-up, rather than true absence of complications.
Overall KAP interpretation
The overall mean KAP score (4.57 ± 2.03 out of 10) indicates a moderate but insufficient level of competency. The binomial test confirmed that only 19% of practitioners demonstrated adequate KAP, and the proportion of practitioners with adequate knowledge and practice was significantly less than the expected 50% (p = 0.00). These findings clearly establish a significant lack of KAP regarding gingival displacement among dental practitioners in Nagpur.
Limitations
Self-reported responses may introduce response bias
The study population was limited to a single geographic region
Inferential comparisons between practitioner categories were not performed.
Clinical implications
Emphasis on biologically safe gingival displacement techniques is necessary
Training programs should focus on pressure control and newer atraumatic systems
Development of pressure-measuring devices may enhance clinical safety.[4]
Future scope
Further multicentric studies with larger sample sizes and interventional designs are recommended to evaluate the effectiveness of targeted educational programs in improving gingival displacement practices.
CONCLUSION
The study concludes that there is a significant lack of knowledge and attitude regarding gingival displacement procedures among dental practitioners in Nagpur, although clinical practice appears relatively better. Bridging this gap through targeted education and evidence-based training is essential to improve treatment outcomes and preserve periodontal health.
Authors’ contributions:
SKC: Conceptualization, methodology, software, data curation, writing original draft preparation, writing, reviewing and editing; RB: Visualization, Investigation, supervision, validation; NP, SD: Supervision.
Ethical approval:
The research/study was approved by the Institutional Review Board at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, number ECR/885/INST/MH/2017/ RR-21, dated 19th July 2024.
Declaration of patient consent:
The authors certify that they have obtained all appropriate participants’ consent.
Conflicts of interest:
Dr. Neelam Pande and Dr. Saee Deshpande are on the Editorial Board of the Journal.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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