Evaluating The Effect Of Pressure Exerted During Mechanical Cord Packing Using A Custom-Made Pressure Indicating Device – A Randomised Clinical Trial

Preservation of periodontium is a vital factor in tooth preparation and soft tissue management. The force exerted while performing cord packing and its effect on the periodontium is an aspect that remains unexplored. The aim of the study was to evaluate the effect of pressure exerted by cord packing on the supporting structures at varying levels of pressure exerted by Graduate students. Pressure exerted while performing cord packing was evaluated using a custom-made instrument. 40 sites were evaluated for gingival recession (Labial and Lingual) and 80 sites were evaluated for probing depth and bleeding on probing (Labial, Lingual, Mesial, Distal) pre-operatively (Day 0) and post operatively (Day 4, Day 7, Day 14, Day 30). Statistical analysis such as ROC Curve (optimal pressure value), Kruskal Wallis, Mann-Whitney and Bonferroni Adjusted Wilcoxon Rank Test (associated gingival and periodontal changes) were performed. The threshold value at which cord packing can be performed safely is 1.05 Pa. While gingival recession ranged from 0.5mm to 3mm at Day 30; with increased pressure, bleeding on probing and probing depth elicited an initial increase followed by a decline. The study indicated Cord packing can be performed clinically at / below 1.05Pa pressure to prevent harmful effects on the periodontium. Maximum pressure value exerted was 5.7Pa, hence an improvised cord packer with an audio-visual feedback at threshold limit might facilitate to perform controlled cord packing