isolation in endodontics

Presentedby:
Anupma (9) and Shriya Kuriyal(89)

1. Introduction
2. Goals of operative field isolation
3. Components of oral environment that
need to be controlled during
operative procedure.
4. Methods of isolation
5. Advantages
6. References

 To achieve best results for endodontic
treatment plan ,it is very important that a
particular environment is created, which
enables good visibility ,accessibility ,
allows the material to react properly and
at the same time ensures that no harm
comes to patient.

Moisture control
Retraction and access
Harm prevention
Local anesthesia

1. Moisture control refers to excluding
sulcular fluid , saliva and gingival
bleeding from the operating field.
2. It also refers to preventing the
handpiece spray and restorative
debris from being swallowed or
aspirated by the patient.

 This provides maximal exposure of the
operating site and usually involves
maintaining an open mouth and depressing
or retracting the gingival tissue, tongue ,lips
and cheek .

 An important consideration of isolating
the operating field is preventing the
patient from being harmed during the
operation .
 Excessive saliva and handpiece spray can
harm the patient .
 Small instruments and restorative debris can
be aspirated or swallowed .

Soft tissue can be damaged accidently .
 moisture control and retraction
contributes not only to prevent harm
but also for patient’s comfort and operator’s
efficiency .

 Local anesthetics play a role in
eliminating the discomfort of dental
treatment and controlling moisture.
 Use of these agents reduce salivation,
apparently because the patient is more
comfortable ,less anxious and less
sensitive to oral stimuli reducing salivary
flow.

 Local anesthetics incorporating a
vasoconstrictor also reduce blood
flow, helping to control hemorrhage at
the opening site .

 Saliva
 Tongue
 Lips & cheek
 Gingival tissue
 Buccal & lingual vestibule
 Floor of the mouth
 Adjacent teeth and restoration
 Respiratory moisture

1. DIRECT
METHOD .
2. INDIRECT
METHOD

 Cotton rolls
 Gauze pieces
 Cellulose wafers
 Isolite
 High volume evacuator and saliva
ejector
 Gingival retraction cord
 Rubber dam
 Throat shield

 Mirror and evacuator tip retractor
 Air water syringe
 Mouth prop
 Cheek retractor
 Double ended aspirator

1. Comfortable position of patient and
relaxed surrounding
2. Local anesthesia
3. Drugs

 Cotton rolls are helpful for short period of
isolation of the teeth especially where
rubber dam application is not possible.

 it is Usually placed in Buccal & lingual
sulcus specially where salivary gland
ducts exit, to as to absorb saliva

 Gauze sponges may be supplied in pieces
of 2”x 2” or large.
 They perform the same function as cotton
rolls and are generally used for isolating
large areas.

 Gauze sponges are better tolerated
by the delicate tissues that are more
susceptible and have less chances of
adhesion to dry tissues.

 Cellulose wafers are absorbent pads made
up of cellulose.
 They are most commonly used inside the
cheeks covering the parotid ducts.
 Their absorbency is more than cotton rolls .
 They are available in various shapes and
sizes.

 Throat shield is important specially
when the maxillary tooth is being
treated.
 An unfold gauze is stretched over the
tongue and posterior part of the mouth.
 Avoid aspiration of restorations.

 Isolite is a proprietary patented
mouthpiece.
 It is constructed out of a polymeric
material that is softer than gingival tissue. It is
used for patient’s comfort and it has
excellent optical qualities.
 When isolation mouthpiece is put in
place, the patient’s cheek and tongue are
automatically retracted and protected
resulting in an immediate decrease in the risk
of patient injury.

 The mouthpiece obturates the entrance to
the throat minimizing the chance of debris
aspiration.
 Patient’s airway can be monitored by this.

STEP 1
While folding the Mouthpiece's cheek shield forward toward the
tongue retractor, gently slide the isthmus of the Mouthpiece into
the cheek to avoid gag-sensitive areas. Continue moving the bite
block toward the center of the mouth, just behind the anterior
teeth. Be careful not to catch the bite block on the corner of the
mouth.
STEP 2
Move the bite block onto the occlusal surfaces of teeth, just distal
to the mandibular cuspid. Instruct the patient to “rest gently” on
the bite block; the patient does not need to bite down. Place the
isthmus behind the maxillary tuberosity, resting on the retromolar
pad.
STEP 3
Tuck the cheek shield into the buccal vestibule. Tuck the tongue
retractor into the lingual vestibule. Move the bite block distally if
you require more vertical or lateral working room.

 It is used to remove water from air motor
with high suction speed.
 Also helps in retracting the soft tissues.

 They are readymade cotton or
synthetic fibers woven in the form
of cords.
 Various types of cords e.g.
braided, non-braided ,plain or
impregnated are available in
different size .
 Gingival retraction cord is
used when the use of rubber
dam is not practical or
appropriate .

 Provides improved access and visibility .
 It protects gingiva from abrasion during
cavity preparation .
 It restricts excess restorative material from
pushing into the sulcus.

 A secondary function of the mirror and
evacuator tip is to retract the cheek, lip &
tongue

 Mouth prop is also used to
establish & maintain a suitable mouth
opening, thus help in tooth
preparation of posterior tooth.
 It is placed opposite to treatment
side.
 Provides sufficient mouth opening
for longer times.

 They are used to expand the mouth
opening.
 This is usually use when working on the
gingival border of upper & lower front
teeth and for the adjustment of
orthodontic bands.

 By air water syringe an air blast can be
useful to dry tooth and soft tissue during
examination or used during procedure.

 Anti-sialogogues
 Anti-anxiety
drugs
 Muscle relaxants

 These are drugs used to create a dry
zone in the oral cavity.
 These are anti-cholinergics ,that act
on smooth muscles of GIT ,urinary and
biliary tracts ,producing dry mouth as a
side effect.
 Dosage - 50mg of Banthine , 15mg
of probanthine (1 hr before the
application ).

 Oral sedation ,in the form of anti anxiety ,also
known as happy pills ,is prescribed for relieving
anxiety in the hours immediately before the
appontment
Mostly benzodiazepine family drugs are
prescribed. Benzos decrease anxiety by
binding with the receptors in the brain which
tone down activity in those parts of brain
responsible for fear .
 Dosage –temazepam (restoril) 10-40mg,
valium (diazepam) 5-10mg, lorazepam (ativan)
2-3mg.

 Ibuprofen 400-800mg TDS
 Ketoprofen 100g BD /TDS
 Adverse effects – headache ,dizziness,
renal toxicity , liver abnormalities,gi
discomfort.

 The use of drugs to control
salivation is rarely indicated in
restorative therapy, and is
generally limited to atropine.
 Contraindicated for nursing
mothers, and patients with
glaucoma.

By all these we can
achieve a moisture free
mouth for better operative
and endodontic
procedure.

 Patient related
 Operator related

A. Provides comfort to the patient
B. Protect patients from swallowing or
aspirating foreign bodies
C. Protect patients soft tissues by
retracting them.
D. It limits bacteria laden splash and
splatter of saliva and blood.
E. Protects lips ,cheeks and tongue by
keeping them out of way.

A. A dry clean operative field
B. Infection control by minimizing aerosol
production.
C. Increased accessibility to operative site
D. Improved properties of dental materials
hence better results are obtained.
E. Improved visibility & less fogging of
mirror
F. Prevents contamination of tooth
preparation.
G. Better diagnosis.

THANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOUTHANK YOU

Pickard’s manual of Operative Dentistry
Sturdevants’s art and science of operative
dentisry
Internet [dental isolation systems]
Textbook of conservative and Operative
dentistry by Sumeeta Sandhu.

isolation in endodontics

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