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Isolation in Dentistry

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Isolation in Dentistry

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In dentistry, separation of a tooth or group of teeth from oral tissues and saliva by use of a dental dam, cotton rolls, or other means to improve access, visibility, and control moisture contamination while restorative or operative dental procedures are performed.

In dentistry, separation of a tooth or group of teeth from oral tissues and saliva by use of a dental dam, cotton rolls, or other means to improve access, visibility, and control moisture contamination while restorative or operative dental procedures are performed.

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Isolation in Dentistry

  1. 1. “AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE.” ― BENJAMIN FRANKLIN
  2. 2. ISOLATION BY:- GAURAV JAWARIYA (B.D.S FINAL YEAR)
  3. 3. CONTENTS : • INTRODUCTION • GOALS OF ISOLATION • ISOLATION FROM MOISTURE (a) DIRECT METHODS :- RUBBER DAM COTTON ROLLS AND ABSORBER WAFERS EVACUATOR SYSTEM AND SALIVA EJECTOR GINGIVAL RETRACTION CORD MOUTH PROP (B) INDIRECT METHODS :- COMFORTABLE POSITION OF PT. AND RELAXED SURROUNDINGS. LOCAL ANESTHESIA DRUGS ISOLATION OF SOFT TISSUES :- RETRACTION OF CHEEKS , LIPS AND TONGUE RETRACTION OF GINGIVA CONCLUSION
  4. 4. INTRODUCTION  Good accessibility and visibility ,  Adequate room for instrumentation  Necessary for easy manipulation and insertion of restorative materials  This control is attained through isolation
  5. 5. GOALS OF ISOLATION : - Moisture control Retraction and access Harm prevention Safe and aseptic operating field Prevent accidental swallowing of restorative materials and instruments
  6. 6. ISOLATION FROM MOISTURE DIRECT METHOD • RUBBER DAM • COTTON ROLLS AND HOLDER • GAUGE PIECES • ABSORBENT WAFER • SUCTION DEVICES • GINGIVAL RETRACTION DEVICES INDIRECT METHOD • COMFORTABLE POSITION AND RELAXED SURROUNDING TO THE PT. • LOCAL ANESTHESIA • DRUGS :- ANTI-SIALOGOGUES ANTI-ANXIETY DRUGS MUSCLE RELAXANTS
  7. 7. RUBBER DAM (A GOLD STANDARD FOR ISOLATION)  One of the most effective means of isolating teeth Developed by SC Barnum in 1864.
  8. 8. ADVANTAGES OF RUBBER DAM • Increases visibility & accessibility • Provides a dry field • Effectively retracts tongue, cheeks away from the field of operation • Saves time • Reduces the chances of injury to soft tissues • Produces calming effect in children • Protects against bad taste of the materials used • Prevents any aspiration or ingestion of dental instruments
  9. 9. DISADVANTAGES OF RUBBER DAM • Takes time to be applied • Communication with the patient can be difficult • Incorrect use may damage porcelain crowns/gingival tissues • Insecure clamps can be swallowed or aspirated
  10. 10. CONTRAINDICATIONS Child with upper respiratory tract infection, congestion of nasal passage or nasal obstruction  Presence of some fixed orthodontic appliances  Recently erupted tooth With allergy to latex Grossly carious teeth
  11. 11. ARMAMANTERIUM • Rubber dam sheet • Rubber dam template • Rubber dam punch • Rubber dam clamps • Rubber dam forceps • Rubber dam frame • Rubber dam napkin • Waxed dental floss • Scissors • Lubricants
  12. 12. RUBBER DAM SHEET • Made of latex or non-latex. • Available in 2 sizes- (i) 5”*5” (ii) 6”*6” • Available in varying thickness :- Thin – 0.15 mm Medium – 0.20 mm Heavy – 0.25 mm Extra-heavy – 0.30 mm Special heavy – 0.35mm • Light and dark sheets are available, may be flavored for the children • Has a shiny and dull surface, dull side will be facing the operating field
  13. 13. RUBBER DAM TEMPLATE Have positions of the teeth marked on them and are used to transfer them to the rubber dam sheet for holes to be punched.
  14. 14. RUBBER DAM PUNCH • Used to make the holes in the sheet through which the teeth can be isolated.
  15. 15. RUBBER DAM CLAMPS • Made of shiny & dull stainless steel • consists of a bow & 2 jaws • Aid in anchoring the dam to the tooth & in soft tissue retraction • 2 types : (i) Winged (ii)Wingless
  16. 16. FREQUENTLY USED CLAMPS IN PEDO. • 12 A Clamp - Maxillary left second primary molar and the mandibular right second primary molar. • 13A Clamp – Maxillary right second primary molar and the mandibular left primary second molar. • 2A Clamp – First primary molars. • 14 Clamps – Fully erupted permanent molars. • 14 A Clamps - Partially erupted permanent molars. • Clamps for front teeth :- IVORY#6 , IVORY#9 , IVORY#90N , IVORY#212S ,IVORY#15
  17. 17. DENTAL FLOSS • After selecting the appropriate clamp a 12 inch piece of dental floss is placed on the bow of the clamp to aid in retrieval of the clamp if it is dislodged from the tooth and falls into the posterior pharyngeal area.
  18. 18. RUBBER DAM CLAMP FORCEPS • Used for placement and removal of retainer from the tooth.
  19. 19. 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
  20. 20. PLASTIC FRAME Nygard - Ostby frame :-  U-shaped frame made of plastic  Because of its shape, exerts less tension on the dam  Easier to use  Requires no absorbent napkin, when taking radiographs  Stands away from face
  21. 21. METAL FRAME YOUNG FRAME :-  U-shaped metal frame with small metal projections for securing borders of the rubber dam.
  22. 22. MODIFICATIONS Le Cadre Articule rubber dam frame (articulated frame):-  Developed in France by Dr. G Saveur.  Curved to fit the face and hinged in the middle to fold back.  Advantage -- Allows easier access for radiographic film placement.
  23. 23. Handidam (Aseptico, Woodenville):- • Has a built in foldable radiolucent frame and a plastic tube inserted in prepared holes in rubber dam material to keep the dam open • Available in one size
  24. 24. Quick dam :-  Comes with an attached flexible plastic frame or rim that supports dam intraorally  Effective in saliva control anterior part of the mouth than posterior part  Has a pliable plastic frame around perimeter of the rubber dam
  25. 25. Instidam (Zirc company):- • Simple & effective isolation system • It is a pre punched rubber dam mounted on a frame • Compact design fits outside patient lips
  26. 26. COTTON ROLLS & CELLULOSE WAFERS • Available in different diameters, cut to variant lengths & have plain or woven surfaces • Stabilized & held sublingually with specific holders or with an anchoring rubber dam clamp • Can be applied without holders, over or lateral to salivary gland orifices • Cellulose wafers provide additional absorbency
  27. 27. Advantage : - Slight retraction of cheeks aiding in visibility & access Precaution: - Moisten the cotton rolls & cellulose wafers while removing to prevent inadvertent removal of epithelium from cheeks, floor of mouth or lips
  28. 28. GAUZE PIECE OR THROAT SHIELD • Indicated when there is danger of aspirating or swallowing small objects, when rubber dam is not being used • Used in pieces of 2”x2” or larger • Particularly important when treating teeth in maxillary arch
  29. 29. • Gauze sponge unfolded & spread over the tongue& posterior part of the mouth Advantage –  Better tolerated by delicate tissues  Less adherence to dry tissues compared to cotton
  30. 30. SALIVA EJECTOR & HIGH VOLUME EVACUATING EQUIPMENT • Saliva ejector prevent pooling of saliva in the floor of the mouth • High volume evacuating equipment removes solid debris along with water Saliva ejector High volume evacuator
  31. 31. GINGIVAL RETRACTION CORDS • Used for isolation & retraction in direct procedures of treatment of accessible sub gingival area. • Diameter of cord should be selected such that it is gently inserted into gingival sulcus, producing lateral displacement of the free gingiva without blanching. • Cord may be moistened with a non caustic styptic before insertion.
  32. 32. • SIZES AVAILABLE :-
  33. 33. ADVANTAGES :-  May help restrict excessive restorative materials from entering the gingival sulcus  Provide better access for contouring & finishing the restorative material  Prevent abrasion of gingival tissue during tooth preparation  Used primarily to push the gum tissue away from the prepared margins of the tooth, in order to create an accurate impression of the teeth
  34. 34. MOUTH PROPS • Can be potential aid for lengthy appointment on posterior teeth • Should maintain suitable mouth opening • Types – (i)Block (ii)Ratchet
  35. 35. • IDEAL REQUIREMENTS :-  Should be adaptable to all mouths  Should be easily positioned & removed with no patient discomfort  Should be stable once applied  Should be either sterilizable or disposable
  36. 36. MOUTH MIRROR • Secondary function – • Helps to retract cheeks, lip & tongue in the absence of rubber dam
  37. 37. INDIRECT METHODS LOCAL ANESTHESIA DRUGS :- ANTI – SIALOGOGUES (ATROPINE) ANTI – ANXIETY (DIAZEPAM)
  38. 38. REFERENCE • Sturdevant’s Art and Science of Operative Dentistry. • Grossman’s Endodontic practice. • Sanjay Marwah, Textbook of Pedodontics .
  39. 39. This Photo by Unknown Author is licensed under CC BY This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-NC-ND

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