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Isolation and moisture control

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Isolation and moisture control

  1. 1. Dr. Rasha Alsheikh COD,UOD Field Isolation and Moisture Control 4th Year Operative Program
  2. 2. Isolation 1. Moisture control 2. Retraction 3. Harm prevention http://livingnetwork.co.za/wp-content/uploads/2009/08/rubber_dam_1.jpg
  3. 3. Oral Environment Contain the following items Saliva Tongue, Lips & Check The periodontium The contacting teeth and restoration The sulci, floor of the mouth and palate Respiratory moisture
  4. 4. Moisture Control Excluding sulcular fluid, saliva and gingival bleeding from the operative field. And preventing the inspiration of debris, hand piece spray and any other objects. http://livingnetwork.co.za/wp-content/uploads/2009/08/rubber_dam_1.jpg
  5. 5. Advantages Dry clean operating field Access and visibility Improved properties of dental materials Protection of patient and operator Operating efficiency
  6. 6. Absorbents Absorbents such as cotton rolls and cellulose wafer are useful for short periods of isolation example for examination, polishing etc. Where rubber dam application may not be possible.
  7. 7. High Volume Evacuators High volume evacuators are preferred for suctioning water and debris from the mouth when high speed hand-pice is used. The tips for these may be 1. Plastic Disposable 2. Metallic auto cleavable
  8. 8. The combined use of water spray and high volume evacuator has the following advantages. 1. Restorative and tooth debris are removed from the operating site. 2. Access and visibility are improved. 3. No dehydration of oral tissues. 4. Saving Time. 6. Quadrant dentistry is facilitated.
  9. 9. 1. The tip should be as near as possible to the tooth to be operated upon just distal to it. 2. It should not obstruct the operators view. 3. It should not be so close as to direct the water spray away from the rotary instrument Precautions
  10. 10. Saliva Ejectors The saliva ejector removes saliva that collects on the floor of the mouth. It is used in conjunctions with sponges cotton rolls and the rubber dam. Should not interfere with the operator view or movement.
  11. 11. Advantages A – adequate access and visibility B – better patient protection and management C – control of moisture in operating field D – decreased operating time of rubber dam i.e.
  12. 12. Rubber Dam
  13. 13. Rubber Dam was first described over 120 years by Dr. Sanford Barnum. In 1879 the Rubber dam punch was introduced. By the time G.V. Black produced his seminal text “Operative Dentistry” in 1908, the use of rubber dam was firmly established.
  14. 14. Advantages 1) Dry clean operating field. 2) Access and visibility. 3) Improved properties of dental materials. 4) Protection of patient and operator. 5) Operating Efficiency
  15. 15. Drawbacks 1) Time consumption and patient objection. 2) Minor damages can occur to marginal gingival and cervical cemetnum. 3) Damage to the restorations such as metal crown margins. 4) Accidental aspiration of the clamps. 5) Certain conditions which interfere with the use of rubber dam e.g:Malpositioned teeth or partially erupted tooth. 6) Patient suffering from respiratory diseases 7) Contact allergy to latex rubber dam sheet.
  16. 16. Materials and Instruments Rubber dam sheet Rubber dam Punch Clamps Clap holder Rubber dam frame Rubber dam napkin
  17. 17. http://www.sweethaven02.com/MedTech/Dental02/5030200.jpg
  18. 18. Rubber Dam Sheet Rubber dam material is made from natural latex rubber. They are manufactured as: Continuous rolls available in two widths (125 mm or 150 mm) Pre-cut form Shelf life:- Rubber dam material has shelf life of about 9 months at room
  19. 19. Rubber Dam Punch Two types of holes are made:- Single hole Multihole: 0.5 to 2.5mm in diameter.
  20. 20. The size of hole punched for each tooth depends on several factors. Whether the tooth is to be clamped or not Cervical diameter of the tooth The elasticity of rubber dam being used
  21. 21. Three widely used designs are:- ash or stokes pattern: notched and pointed tips. Ivory pattern: notched and pointed tips, stabilizers. University of Washington pattern: have notches near the tips of their beaks. Rubber Dam Forceps
  22. 22. Rubber Dam Frame Support the edges of rubber dam and so retract the soft tissue and improve access to isolated teeth. Metal “U” shaped (young’s). (Nygaard Ostby) is a complete circle. Obtra-Dam
  23. 23. Clamps can be divided into two main groups Bland: jaws which are flat and points directly towards each other Winged Wingless Retentive: have jaws which are directed more gingivally Winged Wingless
  24. 24. http://shop.aluro.co.nz/catalog/images/prodimg/img468.jpg
  25. 25. Metal Vs Non-metal clamps. To be secure a clamp must fit around the tooth below the level of maximum crown width. The points of the jaws of the clamps must all contact the crown below this level in four areas. ‘Four Point Contact’.
  26. 26. The jaws should not extend the mesial and distal line angles of tooth: They may interfere with the placement of matrix and wedge Gingival trauma is more likely to occur Complete seal around the anchor tooth is more difficult to achieve
  27. 27. Specialized clamps / retainer: Clamps with the extended bows e.g: extended distally Modified bow clamps designed to deal with problems e.g: third molar. a clamp can be modified by heating then bending Cervical retainer e.g: Ferrier 212
  28. 28. Alternatives to clamps: Employs the area beneath the interdental contacts for retention. ligatures of dental floss tied around the neck of the tooth or elastic rings.
  29. 29. Before a clamp is placed on any tooth, the dental floss should be tried. The clamp is carried to the tooth using clamp forceps. The clamp engaged in the beaks of forcep by means of holes in the jaws. The clamp is placed on the tooth by opening it sufficiently to pass over the maximum coronal diameter. Clamp placement:
  30. 30. The lingual (or palatal) jaw is placed first in contact with lingual surface of the anchor tooth. Then the clamp tilted bucally until buccal jaw below maxillary coronal diameter. The tension of clamp is released slowly as the buccal jaw is placed.
  31. 31. Rubber Dam Napkin It prevents skin contact with rubber to reduce the possibility of allergies Absorbs saliva seeping at the corners of mouth Act as cushion Provides a convenient method of wiping the patient’s lips on removal of dam
  32. 32. Lubricant A water soluble lubricant applied in the area of punched holes facilitates the passing of dam septae through the proximal contacts. Commercially available lubricants. shaving cream or soap slurry petroleum jelly may be applied at the coroners of patient’s mouth to prevent irritation
  33. 33. Hole-Positioning Guides Teeth as a guide. Template. Rubber dam stamp
  34. 34. Guide Lines for positioning the holes: 1. When operating on incisors or mesial of canine isolate from first premolar to 1st premolar. Metal retainer are not required for this isolation. 2.When operating on canine, it is preferable to isolate from 1st molar to opposite lateral incisor. 3.When operating posterior teeth, isolate anteriorly to lateral incisor of opposite side.
  35. 35. 4.When operating premolar punch holes to include two teeth distally and extend anterior up to opposite lateral incisor. 5.When operating molars, punch holes as far distally as possible and extend anteriorly to include opposite lateral incisors. 6.Isolation of minimum of three teeth recommended except in endodotnic therapy in which the tooth to be treated is isolated.
  36. 36. 7.The distance between holes is equal to the distance from the center of one tooth to the center of adjacent tooth measured at the level of gingival tissue. It is generally 1/4 inch (6.3 mm). 8.When the rubber dam is applied to the maxillary teeth the first holes are punched of central incisors which are placed approximately 1 inch (25mm) from the upper border so that sufficient material to cover upper lip. 9.When the rubber dam is applied to mandibular tooth, the first hole punched is for the post anchor tooth that receives the retainer.
  37. 37. 10.When a cervical retainer is applied to isolate a class V lesion, a heavier rubber dam is usually recommended for better tissue retraction and the hole should be punched slightly facially to the arch form to compensate for the extension of the dam to the cervical area. 11.When a thinner dam is used, smaller holes must be punched to achieve an adequate seal around the teeth because the thin dam greatly elastic.
  38. 38. Patient’s mouth is examined carefully for calculus deposits, and sharp edges on restoration. All contact points in operating field are checked with dental floss. All roughness and deposits present interdentally must be removed toallow free passage of rubber dam and prevent tearing. Anaesthetize the gingiva when indicated Rinse an dry the operating field. Application Techniques:
  39. 39. Technique 1: Clamp placement prior to rubber 1:- Testing and lubricating the proximal contacts 2:- Punching the holes after assessing the arch and teeth 3:- Lubricating the dam 4:- Selecting the retainer and trying it 5:- Testing retainer stability and retention 6:- Positioning the dam over the retainer, using four fingers to stretch the dam sheet
  40. 40. Technique 1 cont. 7:- Applying and positioning the Napkin 8:- Attaching the frame 9:- Passing the tooth to distal contact 10:- optional, applying compound or anterior anchor 11:-Passing the septa through contacts 12:-Inverting the dam interproximally then faciolingually
  41. 41. 13:-Using a saliva ejector 14:- Confirming a properly applied rubber dam 15:- Checking for access and visibility 16:- Inserting the wedges
  42. 42. Winged/ clamps are used in this technique Place the retainer in hole punched for the anchor tooth by stretching the dam to engage these wings Technique 2: Applying dam and retainer simultaneously
  43. 43. Technique 3: Applying dam before the retainer The dam may be stretched over the anchor tooth before the retainer is placed. It is recommended for anterior teeth perhaps including first premolar. Preferred technique when double bow or butterfly clamps are selected.
  44. 44. Multiple tooth isolation Whenever possible clamps should not be placed on the tooth which requires restoration of proximal surfaces. When several teeth require treatment the operating field is extended mesially or across the arch The more teeth included the better the retraction of lips, cheek and tongue and better the access.
  45. 45. Removal of Rubber Dam Before removal of rubber dam, rinse and suction away any debris that may have collected.
  46. 46. 1: Cutting the septa 2:- Removing the retainer 3: Removing the dam 4:- Wiping the lips 5:- Rinsing the mouth and managing the tissue
  47. 47. Endodontics: essential to ensure the patient’s safety during treatment and best prognosis Soft tissue control Cavity preparation Fixed bridge isolation: A blunted curved suture needle with dental floss attached is threadedfrom the facial aspect through the hole from the anterior abutment and bask through the same hole on lingual side. Rubber dam in clinical restorative procedures
  48. 48. Errors in Application and Removal Off center arch form It can result in excess of material superiorly that may occlude the patient’s nasal airway Inappropriate distance between the holes, in the other hand too much distance causes wrinkles between the teeth. Incorrect arch form of holes
  49. 49. Inappropriate retainers:- a. If too small, resulting in occasional breakage when jaws are overspread. b. Unstable on anchor tooth c. Impinge on soft tissue d. Impede wedge placement
  50. 50. Retainer pinched tissue Incorrect location of hole for class V lesion Sharp tips on No.212 retainer Incorrect technique for cutting septa
  51. 51. Alternative isolation aids Retraction cord when properly applied can be used for isolation and retraction in the direct procedures of treatment of cervical lesions in facial veneering as well as in indirect veneers. Help prevent abrasion of gingival tissue during cavity preparation
  52. 52. Anti-salivary drugs To control salivation is rarely indicated Operator should be familiar with its indications contra indications and side effects of the drug to be used. Some Anti histaminics cause dryness of mouth due to anti cholinergic action
  53. 53. QUESTIONS?