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Isolation of the operative field

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Isolation of the operative field

  1. 1. ISOLATION OF THE OPERATIVE FIELD Done by: Mohammed Yaqdhan
  2. 2. Operative dentistry can not be expressed properly unless the moisture in the mouth is properly controlled
  3. 3. The goals of operative field isolation are Moisture control Retraction Harm prevention
  4. 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. 5. Advantages Patient related: A. Provides comfort to the patient B. Protect patients from swallowing or aspirating foreign bodies C. Protect patients soft tissues by retracting them. Operator related: A. A dry clean operative field B. Infection control C. Increased accessibility to operative site D. Improved properties of dental materials E. Improved visibility & less fogging of mirror F. Prevents contamination of tooth preparation.
  6. 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. 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. 8. Rubber Dam Isolation A. B. C. D. E. F. G. Advantage Act as a raincoat for the tooth. Complete,long term moisture control. Maximizes access and visibility. Clean dry field while working. Protect lips,cheeks & tongue by keeping them aside. Reduces risk of cross contamination esp. to root canal system Prevents accidental swallowing or aspiration of foreign bodies. Improves the properties of dental materials Disadvantage A. Takes time to be applied. B. Communication with the patient can be difficult. C. Incorrect use may damage porcelain crowns/gingival tissues. D. Insecure clamps can be swallowed or aspirated. H.
  9. 9. Contraindication:  Asthmatic patients.  Epilepsy and other motor disabilities.  Allergic to latex  Mouth breathers  Presence of some fixed ortho app.  A recently erupted tooth that does not retain a clamp  Extremely malpositioned teeth  Third molar (in some cases)
  10. 10. Armamentarium  Rubber dam sheet.  Rubber dam clamps.  Rubber dam forceps.  Rubber dam frame.  Rubber dam punch. Accessories  Lubricant/Petroleum jelly.  Dental floss.  Liquid dam.  Rubber dam Napkin.
  11. 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. 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. 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. 14. Rubber Dam Punch Ainsworth type Ivory type
  15. 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. 16. Rubber Dam Clamps Clamps without wings Clamps with wings
  17. 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.
  18. 18. Rubber Dam Template
  19. 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. 20. Application of Rubber Dam
  21. 21. 1. Testing & lubricating the proximal contacts
  22. 22. 2.Punching the holes
  23. 23. 3.Lubricating the dam
  24. 24. 4.Selecting the retainer
  25. 25. 5.Testing the retainers stability & retaintion
  26. 26. 6.Positioning the dam over the retainer
  27. 27. 7.Applying the napkin
  28. 28. 8.Attaching the frame
  29. 29. 9.Applying the anterior anchor
  30. 30. 10.Passing the septa through the contacts
  31. 31. 11.Invert the dam interproximally
  32. 32. 12.Inverting the dam Faciolingually
  33. 33. 13.Confirming a properly placed rubber dam
  34. 34. 14.Checking for access & visibility
  35. 35. 15.Inserting the wedges(optional)
  36. 36. RUBBER DAM APPLICATION TECHNIQUES.  Clamp first technique.  Wing technique  Rubber first technique  Bracket technique
  37. 37. CLAMP FIRST TECHNIQUE Advantages:  It is two handed procedureore  It can be implemented with molar and premolar(single bracket), winged or wingless clamp  Excellent operative field visibility during placement Disadvantages:  Inserting the clamp into the mouth before the dam is dangerous since it might be displaced (fasten it with ligature)  The clamp is severely strained during placement  It cannot be used with double bracket clamps
  38. 38. WING TECHNIQUE Advantage:  It is two handed procedure  It is safe procedure for the clamp engaged within the sheet hole; if it gets disengaged from the plier there is no risk of falling into the oral cavity (swallowing or inhaling)  It is minimally invasive technique ; the patient does not feel the dentist’s hands in his/her mouth Disadvantages:  It can be implemented with winged clamps only  Limited visibility on the target tooth
  39. 39. RUBBER FIRST TECHNIQUE Advantages:  It is a clamp safe procedure when oral cavity is protected by the rubber sheet(no risk of swallowing or inhaling)  Suitable for every clamp type Disadvantages:  Invasive for the patient especially in posterior region  Limited visibility of the tooth to be clamped
  40. 40. BRACKET TECHNIQUE Advantages:  It is two handed procedure  it is safe; the clamp is engaged within the sheet hole and it won’t fall into oral cavity should it unfasten from the plier(swallowing or inhaling)  Compatible with winged or wingless (wingless is better) premolar and molar (single bracket clamp)  Excellent field visibility during clamping Disadvantages:  Not compatible with anterior clamps(double bracket).
  41. 41. Removal of Rubber Dam
  42. 42. 1.Cutting the septa
  43. 43. 2.Remove the clamps
  44. 44. 3.Remove the dam
  45. 45. 4.Wiping the lips
  46. 46. 5.Massage the tissue
  47. 47. 6.Examining the dam
  48. 48. 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.
  49. 49. 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.
  50. 50. High volume evacuators & saliva ejector • It is used to remove water from airrotor with high suction speed. • Also helps in retracting the soft tissues.
  51. 51. FAST DAM 17 suction holes along the perimeter
  52. 52. ISOLITE SYSTEM Retraction,protection, aspiration, illumination Size: pediatric, adult small, medium, large
  53. 53. Mirror & evacuator tip retractor • A secondary function of the mirror and evacuator tip is to retract the cheek, lip & tongue
  54. 54. 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.
  55. 55. 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.
  56. 56. 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.
  57. 57. 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.
  58. 58. By all these we can achieve a moisture free mouth for better operative and endodontic procedure.
  59. 59. References: Sturdevant’s Art and Science of Operative Dentistry Isolation game of styleitaliano Textbook of Operative Dentistry Pickard’s manual of Operative Dentistry  Internet
  60. 60. THANK YOU