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Rubber dam and isolation

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Rubber dam and isolation

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For those who want to seek simple and thorough understanding about the placement and application of the rubber dam and other isolation materials.
TARGET AUDIENCE : DENTAL STUDENTS.

REFRENCES : sturdevant and grossman

For those who want to seek simple and thorough understanding about the placement and application of the rubber dam and other isolation materials.
TARGET AUDIENCE : DENTAL STUDENTS.

REFRENCES : sturdevant and grossman

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Rubber dam and isolation

  1. 1. 1 Presented by : Rishi lakdawala Rollno : 18 Batch c Final year bds
  2. 2. 2 It is essential that there should be proper moisture control, good accessibility and visibility as well as adequate room for instrumentation around the working area . Such an environment is necessary for easy manipulation and insertion of restorative materials
  3. 3. 3 Isolation shall be studied under two heads:- a)Isolation from moisture b)Isolation from soft tissues
  4. 4. ISOLATION FROM MOISTURE 4 A)Direct methods:- 1.rubber dam. 2.cotton rolls and cotton roll holder. 3.guage pieces . 4.Absorbent wafers. 5.Suction devices. 6.gingival retraction cord.
  5. 5. B)Indirect methods:- 1.Local anesthesia 2.Drugs :-anti-sialogaogues, anti anxiety ,muscle relaxants 5
  6. 6. ISOLATION FROM SOFT TISSUES 6 1.Retraction of cheeks lips and tongue:- • Rubber dam • Cotton rolls and holder • Tongue guards • Tongue depressor • Cheek and lip retractors • Mouth mirrors Retraction of gingiva can be done via retraction cords or by surgical means
  7. 7. 7 Rubber dam provides the best possible isolation by far. In 1864 S.C.Barnum a New York city dentist introduced the rubber dam into dentistry. It is used to define the operating field by isolating one or more teeth from oral environment. When excavating a deep carious lesions and risking pulpal exposure, use of the rubber dam is strongly recommended to prevent pulpal contamination from oral fluids. The dam eliminates saliva from the operating site and retract the soft tissue.
  8. 8. ADVANTAGES 8 • Provision of dry clean operating field. • Improvement of access & visibility by eliminating tongue, lip, cheeks & saliva from the operating field . • Retraction & protection of soft tissues. • Prevention of inhalation & ingestion of foreign bodies.
  9. 9. •Improved properties of dental materials •Aid to patient management. •Aid to cross-infection control by reducing aerosol spread of micro- organisms. •Minimization of mouth breathing during inhalation sedation procedure.
  10. 10. DISADVANTAGES 10 • Usage is low amongst private practitioners. • Time consuming& patient’s objection. • Cannot be used in case of extremely malpositioned teeth. • Children suffering from asthma ,some upper respiratory infections or mouth breathing problems.
  11. 11. ARMAMENTARIUM 1. Rubber dam sheets 2. Rubber dam clamps 3. Rubber dam holders(frame) 4. Rubber dam retainer forceps 5. Rubber dam punch 6. Rubber dam templates or stamps 7. Dental floss 8. Wedget 9. Wooden wedges, orthodontic elastics & commercially available latex cord. rubber-dam-9-638.jpg
  12. 12. 1.Rubberdam sheet • Available as rolls or sheets •Available in 5x5 inches or 6x6inches •Thin --------------- 0.15mm •Medium------------0.2mm •Heavy--------------0.25mm •Special heavy----0.35mm •Shiny surface and dull surface. •Dull surface in occlusal 12
  13. 13. • Colors - blue ,green colors preferred to provide good contrast with the surrounding and may be flavored for the children.
  14. 14. 2. Rubber dam clamps • Used to secure the dam to the teeth that are to be isolated & to minimally retract the gingival tissue. • Parts - 4 prongs that rest on the mesial & distal line angle of the tooth and 2 jaws connected by a bow. 14
  15. 15. TYPES-1) Winged retainers 15 • Retainers with wing like projections on the outer aspect of their jaws. • Provide extra retraction of the rubber dam from the field of operation. • The wings are passed through the punched holes in the dam and the dam and the retainer placed together on the concerned tooth . After placement, the dam is slipped carefully over the wings onto the tooth
  16. 16. 2).Wingless retainers 16 Having no wings. The retainer is first placed on the tooth and the dam then stretched over the clamp onto the tooth.
  17. 17. 3. Rubber dam holder (frame) • Used to maintain the borders of the rubber dam in position. • Types: • a).Young’s holder-It is a U- shaped metal frame with small metal projections for securing borders of the rubber dam. 17
  18. 18. b). Ash pattern - most suitable for children. • ). SweCnska N-Ǿ frames are suitable for taking radiographs with the dam. 18
  19. 19. 4. Rubber dam retainer forceps • Used for placement and removal of retainer from the tooth. Stockes Brewer 19
  20. 20. Beaks of some patterns of forceps • Grooves on their outer surfaces to ensure positive location of the clamp during expansion & placement. PALMER 20
  21. 21. 5. Rubber dam punch • Used for making holes in the dam • Parts • a). Rotating metal disc bearing 5 to 6 holes of different sizes according to size of teeth. • b). A sharp pointed plunger. 21
  22. 22. 6. Rubber dam template (stamp) • Both have positions of the teeth marked on them and are used to transfer them to the rubber dam sheet for holes to be punched. 23
  23. 23. 7. Dental floss Tied around the retainer before carried to the oral cavity to prevent accidental aspiration of clamp. 8. Wedget An elastic used to secure the dam around the teeth farthest away from the clamp. 24
  24. 24. PREPARATION OF THE PATIENT FOR RUBBER DAM. 25 The dam can be presented as a‘raincoat’ that keeps the tooth dry and held on by a button (clamp) & kept straight by a coat hanger (frame). Local analgesia should be administered where a clamp may impinge on the gingiva.
  25. 25. Step1:- Testing and lubricating the proximal contacts 26 Dental floss is used to test the inter proximal contact and remove debris from the tooth to be isolated
  26. 26. Step 2 :- Punching the holes 27
  27. 27. Step 3:- Lubricating the dam:- 28 The assistant lubricate both side of the rubber dam in the area of punched hole using a cotton role or gloved finger tip to apply the lubricant. The lips and corner of the mouth may be lubricated with petroleum jelly or cocoa butter to prevent irritation
  28. 28. Step 4:- Selecting the retainer 29 The operator receive the rubber dam retainer forceps with the selected retainer and floss tie in position .The free end of tie should exit from cheek side of the retainer.
  29. 29. Step 5:- Testing the retainers stability and retention:- 30 Test the retainers stability and retention by lifting gently in an occlusal direction with a finger tip under the bow of the retainer . An improperly fitting retainer rocks or easily dislodged .
  30. 30. Step 6:- Positioning the dam over the retainer 31 With the fore finger , stretch the anchor hole of the dam over the retainer and then under the jaws.
  31. 31. Step 7 :- Apply the napkin 32 The operator gathers the dam in the left hand while the assistance insert the finger and thumb of right hand through the napkin opening and grasp the bunched dam held by the operator.
  32. 32. Step 8 :- Positioning the napkin 33 The assistant pulls the bunched dam through the napkin and positioned it on the patient face
  33. 33. Step 9:- Attaching the frame 34
  34. 34. Step 10 :-Attaching the nap strap:- 35 The assistant attaches the neck strap to the left side of the frame and passes it behind the patients neck .the operator attaches it to the rt. Side of frame .
  35. 35. Step 11 :- 36 If there is a tooth distal to the retainer , the distal edge of the posterior anchor hole should be passed through the contact to ensure a seal around the tooth .
  36. 36. Step 12:- 37 If the stability of the retainer is questionable ,low fusing modeling compound can be used .
  37. 37. Step 13 :- 38 The operator passes the septa through as many contacts as possible without the use of dental tape by stretching the septal dam forefingers . Each septum must not be allowed to bunch or fold .
  38. 38. Step 14:- 39 Use waxed dental tape to pass the dam through the remaining contacts .tape is preferred over floss because its wider dimension more effectively carries the rubber septa through contacts.
  39. 39. Step15:- 40 Invert the dam into the gingival sulcus to complete the seal around the tooth and prevent leakage .
  40. 40. Step 16:- 41 With the edges of dam invert inter proximally, complete the inversion facially and lingually using an explorer while the assistant directs a stream of air onto the tooth.
  41. 41. Step 17:- 42 The use of a saliva ejector is optional because most patient are able and usually prefer to swallow the saliva.
  42. 42. Step 18 :- 43 The properly applied rubber dam is securely positioned and comfortable to the patient . The patient should be assured that the rubber dam does not prevent swallowing or closing the mouth when there is a pause in the procedure .
  43. 43. Step 19 :- 44 Check to see that the completed rubber dam provides maximal access and visibility for the operative procedure.
  44. 44. Step 20 :- 45 For the proximal surface preparations many operators consider the insertion of inter proximal wedges as the final step in rubber dam application . Wedges are generally round tooth pick ends about half inch in length that are snugly inserted into the gingival embrasures from the facial or lingual embrasure , which is greater , using no.110 pliers .
  45. 45. REMOVAL OF RUBBER DAM 46 Step 1:- Stretch the dam facially , pulling the septal rubber away from the gingival tissue an tooth .protect the under lying tissue by placing the finger tip beneath the septum .
  46. 46. Step 2:- 47 Engage the retainer forceps . It is unnecessary to remove any compound,if used ,because it will break free as the retainer is spread and lifted from the tooth .
  47. 47. Step3 :- 48 After the retainer is removed ,release the dam from the anterior anchor tooth and remove the dam and frame simultaneously .
  48. 48. 49 Step4 :- Wipe the patient lip with the napkin immediately after the dam and frame are removed .
  49. 49. 50 Step 5 :- Rinse the teeth and the high volume evaculator .
  50. 50. 51 Step 6 :- Lay the teeth of rubber dam over a light - coloured flat surface or hold it it up to the operating light to determine that no portion of the rubberdam has remained between or around the teeth . Such a remnant would cause gingival inflammation .
  51. 51. Cotton rolls & cellulose wafers 53 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
  52. 52. 54 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
  53. 53. Gauze piece or throat shields 55  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 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
  54. 54. Dri – angle 56  A thin, absorbent, cellulose triangle  Unique replacement on the cotton roll in the parotid area  Covers the parotid or Stensen's duct and effectively restricts the flow of saliva Provides the required Dri-Field for  Composites  Bonding  Cementing Comes in twot ypes: plain and silver coated
  55. 55.  Saliva ejector & high volume evacuating equipment 57  Saliva ejector prevent pooling of saliva in the floor of the mouth  High volume evacuating equipment removes solid debris along with water  Types of saliva ejectors :  Metallic –  Autoclavable  Rubber tip to avoid irritating delicate tissues on floor of the mouth  Plastic – Disposable & inexpensive
  56. 56. Plastic saliva ejector 58 • PLASTIC SALIVA EJECTOR METAL SALIVA EJECTOR
  57. 57. Retraction cords Size Quality Diameter 0 Super thin 0.45 1 Thin 0.55 2 Medium 0.8 59  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 (Hemodent)
  58. 58.  Advantages – 60 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
  59. 59.  Indirect methods : 61 Local anaesthesia Drugs –  Anti sialogogues (Atropine) Anti anxiety ( Diazepam)
  60. 60. A thorough knowledge of the preliminary proced 62
  61. 61. 63

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