Isolation of the operative & endodontic field
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The document discusses isolation of the operative field in dentistry. Proper isolation through moisture control is important for operative procedures. Several components need to be controlled, including saliva, tongue and surrounding tissues. Rubber dam provides complete isolation and advantages for both patient and operator, such as a dry field. Other isolation materials include cotton rolls, throat shields and evacuators. Correct application and removal of the rubber dam is described. The goals of isolation are moisture control, retraction and prevention of harm during dental procedures.
Isolation of the operative & endodontic field
- 1. ISOLATION OF THE OPERATIVE & ENDODONTIC FIELD Presentedby, KallolPramanik, Final yr
- 2. Operative dentistry can not be expressed properly unless the moisture in the mouth is properly controlled
- 3. The goals of operative field isolation are Moisture control Retraction Harm prevention
- 4. Following components of oral environment need to be controlled during operative procedure Saliva Tongue Mandible Lips & cheek Gingival tissue Buccal & lingual vestibule Floor of the mouth Adjacent teeth and restoration Respiratory moisture
- 5. Advantages Patient related: Operator related: A. Provides comfort to the A. A dry clean operative field patient B. Infection control B. Protect patients from C. Increased accessibility to swallowing or aspirating operative site foreign bodies D. Improved properties of C. Protect patients soft dental materials tissues by retracting them. E. Improved visibility & less fogging of mirror F. Prevents contamination of tooth preparation.
- 6. Materials can be used 1. Rubber Dam 2. Cotton rolls & cellulose wafers 3. Throat shields 4. High volume evacuators & saliva ejector 5. Mirror & evacuator tip retractor 6. Mouth props 7. Air Water syringe 8. Cheek retractor 9. Drugs
- 7. Rubber Dam Isolation In 1864, S.C.Barnum, a NY city dentist introduced the rubber dam. It is a flat thin sheet of latex/non-latex that is held by a clamp and a frame, that is preferred to allow the tooth/teeth to protrude through the perforations, while all other teeth are covered.
- 8. Rubber Dam Isolation Advantage Disadvantage A. Act as a raincoat for the tooth. A. Takes time to be applied. B. Complete,long term moisture B. Communication with the patient control. can be difficult. C. Maximizes access and visibility. C. Incorrect use may damage D. Clean dry field while working. porcelain crowns/gingival E. Protect lips,cheeks & tongue by tissues. keeping them aside. D. Insecure clamps can be F. Prevents accidental swallowing or swallowed or aspirated. aspiration of foreign bodies. G. Improves the properties of dental materials
- 9. Rubber Dam Isolation Contraindication Asthmatic patients. Allergic to latex Mouth breathers Extremely malpositioned teeth Third molar (in some cases)
- 10. Armamentarium Rubber dam sheet. Rubber dam clamps. Rubber dam forceps. Rubber dam frame. Rubber dam punch. Accessories Lubricant/Petroleum jelly. Dental floss. Rubber dam Napkin.
- 11. Rubber Dam Sheet It is made of latex or non-latex. Available in 2 sizes- ❶ 5”*5” ❷ 6”*6” New material should be used. Available in varying thickness. Light and dark sheets are available for colour contrast. Has a shiny & dull side, dull side will be facing the occlusal side.
- 12. Rubber Dam Frame The rubber dam frame maintains the border of the dam in position. Support the edges of the rubber dam. Retract the soft tissues. Available in metal and plastic.
- 13. Rubber Dam Punch Rubber dam punch is used to make the holes in the sheet through which the teeth can be isolated. The working end is designed with a plunger on one side and a wheel on other side. This wheel has holes of different sizes on the flat surface facing the plunger. The punch must produce a clean cut every time.
- 14. Rubber Dam Punch
- 15. Rubber Dam Clamps These are used to secure the dam to the teeth, that are to be isolated. These also minimally retract the gingiva Subdivided into >Winged >Wingless
- 16. Rubber Dam Clamps Clamps without wings Clamps with wings
- 17. Rubber Dam Template It is an inked rubber stamp which helps in marking the dots on the sheet according to position of the tooth. Holes should be punched according to arch and missing teeth.
- 19. Accessories • Dental Floss: It is used as flossing agent for rubber dam in tight contact areas. • Rubber Dam napkin: This is a sheet of absorbent material placed between the rubber dam and skin. • Lubricant: A lubricant is applied in the area of punch holes facilitates the passing of dam septa through proximal contacts.
- 20. Application of Rubber Dam
- 21. 1. Testing & lubricating the proximal contacts
- 25. 5.Testing the retainers stability & retaintion
- 26. 6.Positioning the dam over the retainer
- 29. 9.Applying the anterior anchor
- 30. 10.Passing the septa through the contacts
- 31. 11.Invert the dam interproximally
- 32. 12.Inverting the dam Faciolingually
- 33. 13.Confirming a properly placed rubber dam
- 34. 14.Checking for access & visibility
- 36. Removal of Rubber Dam
- 39. 3.Remove the dam
- 43. Cotton rolls • Cotton rolls, gauze & cellulose wafers absorbents are helpful for short period of isolation of the teeth especially where rubber dam application is not possible. • Usually placed in buccal & lingual sulcus specially where salivary gland ducts exit, to as to absorb saliva.
- 44. Throat Shield • 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.
- 45. High volume evacuators & saliva ejector • It is used to remove water from airrotor with high suction speed. • Also helps in retracting the soft tissues.
- 46. Mirror & evacuator tip retractor • A secondary function of the mirror and evacuator tip is to retract the cheek, lip & tongue
- 47. Mouth prop • Mouth prop is also used to establish & maintain a suitable mouth opening, thus help in tooth preparation of posterior tooth. • It is placed on the opposite to treatment side. • Provides sufficient mouth opening for longer times.
- 48. Cheek retractor • 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.
- 49. Air water syringe • By air water syringe an air blast can be useful to dry tooth and soft tissue during examination or used during procedure.
- 50. Drugs • 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.
- 51. By all these we can achieve a moisture free mouth for better operative and endodontic procedure.
- 52. References: Sturdevant’s Art and Science of Operative Dentistry Grossman’s Endodontic practice Textbook of Operative Dentistry Pickard’s manual of Operative Dentistry Internet
- 53. A special thanks to Department of Operative Dentistry & Endodontics, HIDSAR for providing me the opportunity of giving seminar.
- 54. THANK YOU