Ultrapak™ and Ultrapak™ E

Knitted & Epinephrine Knitted Cord

Ultrapak cord is made of 100% cotton, knitted into thousands of tiny loops to form long, interlocking chains. This unique knitted design exerts a gentle, continuous outward force following placement, as the knitted loops seek to open. Optimal tissue displacement occurs in 5 minutes. Ultrapak E knitted cord is impregnated with racemic epinephrine hydrochloride.

  • The original—and smallest—knitted cord
  • Provides rapid tissue displacement, detailed margins, and quality impressions
  • Facilitates easy packing and stays placed better than any twisted or braided cord
  • Cord is still considered the gold-standard technique1
  • Compresses upon packing then expands for optimal retraction
  • Does not entangle in diamond bur
  • Bright colors facilitate easy location and removal
  • Available with or without epinephrine*
  • High carbon steel blade ensures a clean cut
  • Thin plastic gate prevents cord from falling into the bottle upon cutting
  • Ruler printed on label provides easy cord measurement

*Note: Do not use Ultrapak E knitted cord or other epinephrine preparations with ferric sulfate solutions, including ViscoStat, Astringedent, and Astringedent X hemostatics, as a blue/black precipitate will occur. Ultrapak cord with Epinephrine is not available in all countries.

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Technical Details

The World’s Smallest Knitted Cord

Knitting a cord small enough to fit into the sulcus was no easy task. In fact, it took 9 months to knit the first 1 inch of the size #0 cord. Once we had learned the best methods and techniques to knit Ultrapak cord’s microscopic loops, we learned we could make even smaller cords—all the way to size #000, the smallest knitted retraction cord in the world.

Knitted, Not Braided or Twisted

Prior to Ultrapak cord, all retraction cords were either twisted or braided. When the clinician tries to pack a twisted cord with a packing instrument, the instrument slips between the fibers of the cord. Braided cord elimintated that problem, but a braided cord is very rigid, which makes packing into the sulcus challenging. Knitted cords are flexible and allow for easy packing with an instrument. The microscopic compressible loops of the knitted cord afford greater interthread space than braided cord. Upon packing, the loops compress and express hemostatic astringent to underlying tissues. As loops open, a gentle, continuous outward force is exerted. A knitted cord is like a chain; it bends and stays put when packed into place.

Gold-Standard Cord Packing Technique

Cord is still considered the gold-standard technique. The cord technique results in increased displacement of gingival tissue to the depth of the sulcus.

6 Sizes

Ultrapak knitted cord comes in cords as small as size #000 to as large as size #3, making Ultrapak cord suitable for any clinical situation. The smaller cords are ideal for pediatric cases where carious lesions have extended beyond the gumline  and as the first cord in the double-cord technique. The larger cords work well as the upper cord in the double-cord technique and for areas that have thick gingival tissues that require a significant amount of force to be retracted.

Uses

#000
  • Use as lower cord in the double-cord technique
  • Anterior teeth
  • Double packing

#00

  • Preparing and cementing veneers
  • Restorative procedures dealing with thin, friable tissues

#0

  • Lower anteriors
  • When luting near gingival and subgingival veneers
  • Class III, IV, and V restorations
  • Second cord for double-cord technique

#1

  • Non-impregnated #1 and #2 sizes are particularly effective for tissue control and/or displacement when soaked in coagulative hemostatic solution prior to and/or after crown preparations
  • Use as a protective pre-preparation cord on anteriors

#2

  • Upper cord for double-cord technique
  • Use as a protective pre-preparation cord

#3

  • Areas that have fairly thick gingival tissues where a significant amount of force is required
  • Upper cord for use with the double-cord technique

Clinicals

Rapid Tissue Displacement

Ultrapak

Ultrapak cord compresses upon packing and then expands for optimal tissue displacement.

Ultrapak

Ultrapak cord, saturated with ViscoStat hemostatic solution, controls bleeding and sulcular fluid near gingival and subgingival preparations.

Ultrapak CleanCut

Ultrapak

Ultrapak CleanCut design features a blade in the cap for efficient cutting. A special dispensing orifice prevents cord from falling into the bottle.

Ultrapak

Ruler printed on label provides easy cord measurement.

The One with the Stripe!™

Ultrapak

With easy packing, excellent absorption, and exceptional retention, the proprietary knitted design of the Ultrapak cord has been the preferred choice for years.

Procedures

Pre-Preparation Packing Technique

See Instructions for Use for complete instructions, warnings, and precautions.

Step 1

PREPACK. To ensure cord retention during preparation, use a cord large enough to firmly compress into sulcus. Open proximal contacts and place Ultrapak knitted cord soaked in hemostatic solution. Because Ultrapak cord compresses upon packing, use a cord size that appears too large. The thin Ultrapak Packer packing instrument quickly slips cord into position. The knitted cord's unique design (interlocking loops) facilitates easy packing and locks it into place.

Step 2

PREPARATION. Extend margin subgingivally by cutting partway into knitted cord, which won't entangle in the diamond bur. Remove remnant of cord with calcium hydroxide applicator (tiny ball end). Bleeding is minimal. A small portion of uncut tooth above the gingival attachment is preserved to record in the impression.

Step 3

HEMOSTASIS AND IMPRESSION. Rub the Metal Dento-Infusor tip against bleeding tissue as solution is slowly expressed. Rinse with a firm air/water spray to clean and check for complete hemostasis. If bleeding is noted, repeat these steps. If additional retraction is required, repack with appropriate-size cord. Air dry and make impression.

Double-Cord Technique

See Instructions for Use for complete instructions, warnings, and precautions.

Step 1

The most common challenges in getting a quality impression are adequate tissue retraction and sufficient moisture control. Try a double retraction cord technique combined with effective hemostatic agents to alleviate both.

FIRST CORD. Once hemostasis is achieved, carefully place a single cord–such as Ultrapak cord #00–as deep as possible into the sulcus. Use Fischer's Ultrapak Packers packing instruments to place cords properly and efficiently.

Step 2

SECOND CORD. Place a second, thicker cord soaked in a hemostatic agent to expand the tissue laterally.

Step 3

RINSE/DRY. Rinse the area well and lightly dry.

Testimonials

"Nothing makes my day more than a crisp, clear crown impression on the first tray. Two-cord technique with Ultradent cord for the win!"

Dr. Anastasia Foufas

​"Ultrapak helps you get great impressions the first time! It is easy to pack, and when used with ViscoStat it is an unbelievable combination for a dry sulcus and a clear impression. So much detail even a patient could trim the die!"

Dr. Nick Abu Jamra – Green Bay, WI

​"I love the cutter cap of the Ultrapak retraction cord!"

Dr. Sharon Feller – Concrete, WA

​"Ultrapak is excellent at displacing the gingival tissue, allowing proper hemostasis, and is easy to place and remove. It works very well for all retraction purposes. The different sizes are good for all situations."

Dr. Y Clement Shek – San Francisco, CA

"​In dentistry, time is money. Ultrapak's woven design makes packing the cord quick and easy, plus the tooth can be prepped or touched up without snagging the cord. This increases patient comfort in shortening the appointment with far less repeat impressions."

Dr. Thomas J. Frankfurth – Tampa, FL

"​Ultrapak cord has taken the stress out of cord packing. This was the most frustrating part of my day when I was using other products. Add the amazing Astringedent and...LIFE IS GOOD!"

Dr. Lisa Marshall – Xenia, OH

Frequently Asked Questions

  • How long should the cord be left in the sulcus?

    In most cases, the knitted loops of the cord provide optimal retraction after 5 minutes.
  • What length of cord should I use?

    The length of cord will depend on the circumference of the preparation. Ultrapak cord’s bottle features a handy ruler on the side to help make sure you get the right length.
  • How will I know if the retraction is adequate?

    Retraction is adequate when the margins of the gingiva are pulled away from the preparation and the cord can be removed without the gingiva hemorrhaging. To help prevent the onset of bleeding upon removal, soak the cord in an astringent like Astringedent or ViscoStat hemostatics.

  • Are there times when I shouldn’t use cord impregnated with epinephrine?

    Yes. Cord impregnated with epinephrine should not be used on patients with cardiovascular disease, hyperthyroidism, hypertension, diabetes, arteriosclerosis, or on patients taking tricyclic antidepressants or having sensitivity or hypersensitivity to epinephrine. In addition, elderly individuals, pregnant women, and children under 66 lbs. may be at greater risk of developing adverse reactions after epinephrine administration.


    Do not use epinephrine cord with ferric sulfate hemostatics like ViscoStat or Astringedent hemostatics, as a temporary blue/black precipitate will occur.

  • What is the benefit of the knitted cord over braided cord?

    Braided cords are more rigid than knitted cords, which can cause an issue when packing into the sulcus. With rigid braided cords, when one portion of the cord is packed into the sulcus, another portion of the cord is typically raised. Knitted cords are more flexible and pack easily into the sulcus.
  • 1. Martins FV, Santana RB, Fonseca EM. Efficacy of conventional cord versus cordless techniques for gingival displacement: A systematic review and meta-analysis. J Prosthet Dent. 2021 Jan;125(1):46–55.