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Payal isolation

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Payal isolation

  1. 1. Isolation Of Operating Field Presented by : Dr Payal Singh Pg 1st yr Dept of Conservative dentistry and Endodontics 1
  2. 2. Contents  Introduction  History  Classification – Isolation from moisture – Direct methods - Indirect methods - Isolation from soft tissues Direct methods • Rubber dam • Cotton rolls & holder • Throat shield/Gauze piece • Absorbent wafers • Suction devices • Gingival retraction cord 2
  3. 3. Indirect methods • Comfortable position of the patient & relaxed surroundings • Local Anesthesia • Drugs - anti-sialogaogues, anti anxiety ,muscle relaxants  Isolation from Soft tissues • Retraction of cheeks, lips and tongue • Retraction of gingiva  Advancements  References  Conclusion 3
  4. 4. Introduction Isolation of operarting field is essential to the correct performances of most operative procedures. The term oral environment refers to the following items which require proper control to prevent them from interfering with the execution of any restorative procedures •Saliva •Moving organs, i.e. tongue •Lips & Cheek •The periodontium •The contacting teeth and restoration •The sulci, floor of the mouth and palate •Respiratory moisture 4
  5. 5. History •The rubber dam was first described over 120 years ago when in March 1864 Dr. Sanford Barnum first explained its use at meeting of Valley Dental Society in New York. •Rubber dam frames were described in early 20th century as Metal Fernauld’s design. More recent designs have taken advantages of developments in plastics to produce frames which are radiolucent. 5
  6. 6. Goals of isolation Acc.to Sturdevant 1. Moisture control  It refers to excluding sulcular fluid, saliva & gingival bleeding from the operating field. 2. Retraction & Access  retraction & access provides maximal exposure of the operating site 6
  7. 7. 3. Harm prevention • Small instruments and restorative debris can be aspirated or swallowed. •Soft tissue can be damaged accidentally. Hence along with moisture control and retraction, a rubber dam, suction devices, absorbents, throat shields and occasional use of a mouth prop prevents harm to the patient and improves operator efficiency. 7
  8. 8. Local anesthesia Use of these agents reduces salivation apparently because the patient is more comfortable, less anxious and less sensitive to oral stimuli thus reducing salivary flow. 8
  9. 9. Rubber Dam Isolation  First introduced in 1864 by S.C.Barnum. One of the best method for providing isolation from saliva & soft tissues. • Reasons for using a Rubber dam Safety Moisture control Patient management 9
  10. 10. Advantages of using a rubber dam 1. Dry, clean operating field. 2. Improved Accessibility & Visibility. 3. Improved properties of dental materials. 4. Protection to patient and operator. 5. Increased operator efficiency. 10
  11. 11. Disadvantages • Asthmatics and mouth breathers • Partially erupted and severely malpositioned teeth. • Some 3rd Molars. • Patients who are allergic to latex • Psychological reasons • Minor damage to marginal gingiva &cervical cementum during clamp removal. • Metal crown margins show microscopic defects following clamp removal. • Ceramic crowns could fracture if clamps are allowed to grip the margins. • Time consumption and patient objection. • Difficulty in taking radiograph- now avoidable due to radiolucent, flexible retainers 11
  12. 12. Armamentarium 1. Rubber dam sheets 2. Rubber dam clamps 3. Rubber dam retainer forceps 4. Rubber dam holder 5. Rubber dam punch 6. Rubber dam template/stamp 7. Dental floss 8. Wedget 9. Lubricant 10. Modeling compound 11. Anchorage other than retainers 12
  13. 13. Rubber dam sheets• Rubber dam is made from natural latex rubber • manufactured as continuous rolls in two widths (5×5 inch or 6×6inch) • Traditional rubber dam is black in color but it is now made in at least four alternative color green, blue, grey and natural (natural color is translucent). • Green & blue – colour contrast with teeth. Thickness Manufactured in range of five thicknesses: Grade Thickness mm(inches) Thin 0.15 (0.006) Medium 0.20 (0.008) Heavy 0.25 (0.010) Extra heavy 0.30 (0.012) Special heavy 0.35 (0.014) 13
  14. 14. 14  Rubber dam membrane/ sheets of different materials are available in various thicknesses, sizes & colors.  Thicker the material 1. the better the isolation. 2. places high stress on the retainers mainly in molars.  Thinner material has the advantage of passing through the contact easier, which is particularly useful when they are tight. • Thin – Isolation of anterior teeth • Thick – Isolation of posterior teeth. • Isolation of class V cavities. • Medium – Throughout the mouth. • Heavy & Extra heavy – Chairside bleaching.  Rubber dam material -shiny -dull side As the dull side is less light reflective, it is generally place facing the occlusal aspect
  15. 15. Rubber dam frame (Holder) The rubber dam frame maintains the borders of the dam in position. -The young holder is a U shaped metal frame with small metal projections for securing the borders of rubber dam. -Most popular, ease of application, minimal contact of rubber with skin -Disadvantage is they obstruct field of operation 15
  16. 16. Metal frames Fernauld’s Fernauld’s Frame Young’s Frame -The young holder is a U shaped metal frame with small metal projections for securing the borders of rubber dam. -Most popular, ease of application, provides minimal contact of rubber with skin -Disadvantage is they obstruct field of operation 16
  17. 17. PLASTIC FRAMES NYGARD-OSTBY FRAME It is a circumferential, contoured, plastic frame with 8 projections to hold the sheet SAUVEUR OVAL FRAME 17
  18. 18. Rubber dam clamps (Retainer) • Consists of 4 prongs and 2 jaws connected by a bow • Used to anchor the dam to the most posterior teeth to be isolated and also retract gingival tissues. Two types of retainer 1. Winged retainer 2. Wingless retainer WINGED RETAINERS have wing-like projections on the outer aspect of the jaws. They provide extra retraction of the rubber dam from the field of the operation. Clamps which have W in front of number indicates that clamp is having wings. WINGLESS RETAINERS have no wings on their jaws. These retainer is first placed on the tooth and the dam then stretched over the clamp onto the tooth. 18 WINGS
  19. 19. Alternative Rubber Dam Isolation Technique for the Restoration of Class V Cervical Lesions Operative Dentistry, 2006, 31-2, 277-280 Butterfly shaped clamp/ 212 SA For anteriors Modification of the #212 rubber dam retainer. Note the apical positioning of the facial retainer jaw for increased stabilization and soft tissue retraction. Picture showing altered position of the facial retainer jaw for correct placement on the tooth. 19 Retainers with prongs directed gingivally are helpful when the anchor tooth is only partially erupted.
  20. 20. WINGED CLAMP NO. 2 (PREMOLARS) WINGLESSCLAMP NO. 2 20
  21. 21. CLAMP NO. 7 (MOLARS) CLAMP NO. 14A PRONGSARE DIRECTED GINGIVALLY USED IN:- 1. PARTIALLY ERUPTEDTEETH 2. BROKENTEETH 21
  22. 22. CLAMP NO. 12A & 13B ,THE SIZEOF BUCCAL CLAMP JAW IS LARGER THANTHE LINGUAL JAWTHIS FACILITATES PLACEMENTONTAPEREDTEETH FOR Ex. MAXILLARY FIRST MOLARS 22
  23. 23. According to Sturdvent’s 23
  24. 24. According to Casterlucci Endodontics Front teeth IVORY # 6 IVORY # 9 IVORY # 90 N IVORY # 212 S IVORY # 15 PREMOLARS IVORY # 1 IVORY # 2 IVORY # 2A MOLARS THAT ARE COMPLETELY ERUPTED, WHOLE, OR COVERED BY FULL CROWNS IVORY # 7 MOLARS THAT ARE INCOMPLETELY ERUPTED WHOLE OR ALREADY PREPARED FOR FOR FULL CROWN IVORY # 14 IVORY # 14A IVORY # 7A 24
  25. 25. ASSYMETRICAL MOLARS,IN PARTICULAR SECOND AND THIRD IVORY # 10 IVORY #11 IVORY #12 A IVORY #13A WINGLESS TO BE USED WHEN WING OBSTRUCT THE WORKING FIELD IVORY # W8A IVORY # 26N 25
  26. 26. •When positioned on a tooth, a properly selected retainer should contact the tooth in four areas-two on the facial surface and two on the lingual surface. •Retainer should not move on the anchor tooth or it will injure the gingiva and tooth, resulting in postoperative soreness or sensitivity. 26
  27. 27. Rubber dam punch • A precision instrument having a metal table and a tapered, sharp pointed plunger which is used to produce clean-cut holes in the rubber dam sheet through which the teeth can be isolated. • 1. single hole punch • 2. multi-hole punch a. Ivory pattern b. Ash or Ainsworth pattern 27
  28. 28. SINGLE HOLE PUNCH AINSWORTH PATTERN IVORY PATTERN 28
  29. 29. Punch is provided with six holes of varying sizes. Larger holes for molars, medium size for premolars, upper cuspids, upper incisors Small for lower incisors The holes are ideally punched according to the position of the tooth in the arch. 29
  30. 30. • INCORRECT CENTERING • CORRECT CENTERING 30
  31. 31. Clean-cut Hole (right), Incomplete cut with Residual tag of Dam (centre), and Irregular hole following removal of the Residual tag (left) The distance between holes is equal to the distance from center of one tooth to the center of adjacent tooth ,at level of gingival tissue i.e, approximately 6 mm. If the dam material is excessive it will wrinkle between the teeth. Conversely too little distance between holes causes the dam to stretch ,resulting in space around the teeth and leakage. 31
  32. 32. Rubber dam forceps • Forceps are needed to stretch the jaws of the clamp open in a controlled manner during placement and removal. Three widely used designs are • Ash or stokes pattern • Ivory pattern • Washington pattern LOCK HANDLE TIPS HOLES OF THE CLAMP 32
  33. 33. Ash-or- Stokes Pattern It has notches near the tips of their beaks in which to locate the holes of a rubber dam clamp. It allows a range of rotation for the clamp so that it may be positioned on teeth that are mesially or distally angled. Ivory Pattern It has stabilizers that prevent the clamp from rotating on the beaks. It limits the use of these forceps to teeth that are within a range of normal angulation. 33
  34. 34. University Of Washington Pattern Brewer Forceps 34
  35. 35. Rubber dam stamp & template It provides a very convenient and efficient way of marking the dam for punching. 35
  36. 36. Accessories Dental floss • Required for testing the Interdental contacts and for making ligatures when they are needed. • Also aid in flossing the rubber dam through tight contacts. 36
  37. 37. Napkin : It is a disposable paper which is placed between the patients skin and the rubber dam sheet. Uses: a) Prevents contact of rubber dam sheet to the skin thus preventing any possible allergic reaction. b) It absorbs saliva seeping through the corners of the mouth. c) It acts as a cushion. 37
  38. 38. Lubricant: A water-soluble lubricant applied in the area of the punched holes facilitates the passing of the dam septa through the proximal contacts. It is applied on both sides of the dam in the area of the punched holes. A rubber dam lubricant is commercially available, but other lubricants, such as shaving cream or soap slurry, are also satisfactory 38
  39. 39. Modeling compound • Low fusing modeling compound is used sometimes used to secure the retainer to the tooth to prevent retainer movement during the operator procedure. • Wedget This is an elastic cord generally used to secure the dam around the teeth farthest from the clamp. It can also be used to push the dam through the interproximal contact and also in some places as a retainer instead of clamp. 39
  40. 40. Application of rubber dam 40 For isolation of anteriors and mesial surface of canine ,1st premolars can be used as anchor teeth.
  41. 41. TESTING & LUBRICATING PROXIMAL CONTACTS Passing floss through the contacts identifies any sharp edges of restorations or enamel that must be smoothed or removed to prevent tearing the dam. Using waxed dental tape may lubricate tight contacts to facilitate dam placement PUNCHING THE HOLES Punch the holes after assessing the arch form and tooth alignment. STEP 1 STEP 2 41
  42. 42. LUBRICATING THE DAM Lubricates both sides of the rubber dam in the area of the punched holes using a cotton roll or gloved fingertip to apply the lubricant This facilitates passing the rubber dam through the contacts. SELECTING THE CLAMP With the help of the rubber dam retainer forceps, place the retainer onto the tooth selected. If the retainer is fitting the anchor teeth properly than it can be adjusted or it can be changed with other retainer. STEP 3 STEP 4 42
  43. 43. TESTING THE CLAMP’S STABILITY & RETENTION If during trial placement the retainer seems acceptable, remove the forceps. Test the retainer's stability and retention by lifting gently in an occlusal direction with a fingertip under the bow of the retainer. An improperly fitting retainer will rock or be easily dislodged STEP 5 43
  44. 44. STEP 6 POSITIONING THE DAM OVER THE CLAMP  Before applying the dam, the floss tie may be threaded through the anchor hole, or it may be left on the under- side of the dam.  With the forefingers, stretch the anchor hole of the dam over the retainer (bow first) and then under the jaws.  The lip of the hole must pass completely under the jaws.  The septal dam must always pass through its respective contact in single thickness.  If it does not pass through readily, it should be passed through with dental tape later in the procedure. 44
  45. 45. STEP 7 STEP 8 APPLYING THE NAPKIN Now gather the rubber dam and pass it through the napkin . POSITIONING THE NAPKIN Pull the bunched dam through the napkin and positions it on the patient's face. The napkin reduces skin contact with 45
  46. 46. STEP 9 ATTACHING THE FRAME  Unfold the dam, while holding the frame in place, attaches the dam to the metal projections on the left side of the frame.  The curvature of the frame should be concentric with the patient's face.  The dam lies between the frame and napkin.  Now attach the dam along the inferior border of the frame.  Attaching the dam to the frame at this time controls the dam to provide access and visibility. 46
  47. 47. STEP 10 ATTACHING THE NECK STRAP [ OPTIONAL ] 47 It can be used to stabilize frame and hold the frame gently against the face.
  48. 48. STEP 11 STEP 12 PASSING THE DAM THROUGH POSTERIOR CONTACT APPLYING THE COMPOUND [ OPTIONAL] 48 If there is tooth distal to retainer then distal margin of the anchor hole should be passed through contact to ensure good seal around anchor tooth. But It should not cover the holes in the jaw of the retainer.
  49. 49. STEP 13 STEP 14 APPLYING THE ANTERIOR ANCHOR [ IF NEEDED ] PASSING THE SEPTA THROUGH THE CONTACTS WITHOUT TAPE 49 Anterior anchor tooth can be used to stabilize the anterior portion of dam. By streching the dam facio-gingivally and linguo-gingivally with the help of forefingers for this slight separation or wedging can be done with blunt hand instrument.
  50. 50. STEP 15 STEP 16 PASSING THE SEPTA THROUGH THE CONTACTS WITH TAPE TECHNIQUE FOR USING TAPE [ OPTIONAL ] 50 Waxed tape reduces the chances of tearing the edges of the holes and passes the rubber septa through the contacts.
  51. 51. STEP 17 STEP 18 INVERTING THE DAM INTERPROXIMALLY INVERTING THE DAM FACIOLINGUALLY 51 Inversion is best accomplished with dental tape. It is done to obtain complete seal around the tooth . Inversion is done using explorer by moving it around neck of tooth facially and lingually. It should be placed perpendicular to tooth surface and slightly directed gingivally.
  52. 52. STEP 19 STEP 20 USING A SALIVA EJECTOR [ OPTIONAL ] CONFIRMING A PROPERLY APPLIED RUBBER DAM 52 It can be used by making a small hole posterior to mandibular incisors and inserting the ejector through it.
  53. 53. STEP 21 STEP 22 CHECKING FOR ACCESS & VISIBILITY INSERTING THE WEDGES 53 FOR ROXIMAL SURFACE PREPARATIONCLASS(II, III ,IV) Wedges are used (12mm in length)
  54. 54. STEP 1 STEP 2 CUTTING THE SEPTA REMOVING THE RETAINER Removal of rubber dam 54 Stretch dam facially ,pulling septal rubber away from gingival tissue.
  55. 55. STEP 3 STEP 4 REMOVING THE DAM WIPING THE LIPS 55
  56. 56. MASSAGING THE TISSUES EXAMINING THE DAM STEP 5 STEP 6 56 By placing dam over light colored flat surface to determine no portion is left between and around teeth. It enhances the circulation.
  57. 57. APPLYING THE DAM & RETAINER SIMULTANEOUSLY 57 Advantages- reduces the risk of retainer being swallowed before dam is placed. This approach reduces the difficulty of trying of pass the dam over a previously placed retainer ,the bow of which pressing against oral tissues. Operator holds the retainer by forceps and passes the bow through the hole from the underside of the dam and then strecth the dam to engage the wings also.
  58. 58. APPLYING THE DAM BEFORE THE RETAINER 58 Distadvantage – reduction in visibility of underlying gingival tissue ,which may become impinged on by he retainer.
  59. 59. 59 Split-Dam Technique  Used to isolate anterior teeth without using a rubber dam clamp.  It is also useful when there is insufficient crown structure eg. horizontal fractures  Prevents chipping the margins of porcelain crowns or laminates from the jaws of the clamp . PROCEDURE Two overlapping holes are punched in the dam. The rubber dam is stretched over the tooth to be treated and over one adjacent tooth on each side. The edge of the dam is carefully teased through the contacts on the distal sides of two adjacent teeth with Dental floss. The tension produced by the stretched dam, aided by the rubber dam frame, secures the dam in place. If the dam has a tendency to slip, a premolar clamp may be used on a tooth distal to the three isolated teeth or even on an adjacent tooth.
  60. 60. 60 Isolation of broken maxillary lateral incisor. Premolar clamp on maxillary central incisor along with ligation on the maxillary canine prevents dam slippage of dam. Post removal and retreatment of a maxillary central incisor SPLIT-DAM TECHNIQUE
  61. 61. CERVICAL RETAINER PLACEMENT 61 Hole placement is slightly facial to the arch form to compensate for extension of dam to cervical area. and hole should be slightly larger. Lingual jaw touching HOC while facial jaw is not touching
  62. 62. CERVICAL RETAINER PLACEMENT 62 Facial rubber is stretched apically to expose lesion and soft tissue. Facial jaw is positioned against tooth 0.5-1mm apical to lesion . Addition of compound to bow and gingival embrasures. Removal of retainer by spreading of the jaws.
  63. 63. Fixed bridge isolation Indication -restoration of adjacent proximal surface and cervical restoration of abutment tooth 63 Apply dam except in the area of fixed bridge. Thread blunted suture needle from facial to lingual aspect through anterior abutment hole.Then needle is passed under anterior connector and back through same hole on lingual surface. Pass needle facially through the hole for second bridge unit then under the same connector and through the hole for second unit.
  64. 64. Fixed bridge isolation 64 Tie off first septum Cut septum to initiate removal of dam.
  65. 65. Substitution of a clamp with matrix band Problem – tendency of dam to slip occlusally over matrix. 65 Terminal tooth with retainer in place . Dam is stretched distally and gingivally as retainer is being removed. Retainer removed before placement of matrix. Matrix is placed and mouth mirror is used to reflect dam distally and oclusally
  66. 66. Severely broken down tooth 66  In case of a badly broken down teeth ,it is necessary to build up the crown of the tooth with a stainless steel band and to contour and cement the band in place before treatment begun. A core of gutta-percha can be placed first in the pulp chamber to keep cement out of the root canals. The band is cemented with GIC and excess cement and Gutta percha is removed .  Gingivectomy can also be done before a rubber dam clamp can be applied.
  67. 67. 1. Off-centre arch form 2. Inappropriate distance between the holes 3. Inappropriate retainers 4. Retainer pinched tissue 5. SHREDDED –or- TORN DAM 6. Incorrect location of the hole for class-v lesion 7. SHARP TIPS ON no.212 retainer 8. Incorrect technique for cutting the septa Errors in application of rubber dam STUDERVANTS 67
  68. 68. Cotton rolls and holder 68
  69. 69. Placement of cotton rolls 69 Cotton rolls should be changed when saturated .or else we can use evacuator tip next to end of cotton roll to permit suction of free moisture. Cotton roll holders have an advantage that it retracts the cheeks and tongue from the teeth.
  70. 70. Throat shields/gauze pieces • used when there is a danger of aspirating or swallowing objects • especially used when treating teeth in the maxillary arch • 2×2 inch (5×5 cm) 70
  71. 71. Absorbent pads and wafers • made of cellulose, & hence also called cellulose wafers • available in different shapes • most commonly used inside the cheeks to cover the parotid ducts • more absorbent than cotton rolls & gauze pieces 71
  72. 72. Evacuation systems • Are of two types: 1. High volume evacuators 2. Low volume evacuators 72
  73. 73. High volume saliva evacuators • High volume evacuators are preferred for suctioning because saliva ejectors remove water slowly • Place tip of evacuator just distal to the tooth to be prepared • For maximum efficacy tip should be parallel to the facial (lingual) surface of the tooth being prepared. 73
  74. 74. Low volume saliva ejectors • Meant to remove saliva that collects at the floor of the mouth • When used with rubber dam passed thro a hole in rubber dam or beneath it. 74
  75. 75. Svedopter 1) For isolation and evacuation of mandibular teeth ,the saliva ejector with attached tongue deflector is excellent. 2) Most effective when used with patient in upright position. 3) Access to lingual surface of mandibular teeth is drawback. 4) The anterior part of the svedopter should be placed in the incisor region, with the tubing under the patients arm. 75
  76. 76. These are readymade cotton or synthetic fibers woven in the form of cords. They can be – a) Braided or non braided b) Impregnated or plain They come in different sizes, as ‘0’ ‘00’ ‘000’. Ready made cotton or synthetic woven. Gingival retraction cord 76
  77. 77. MEDICAMENTS FOR CORD IMPREGNATION -Epinephrine (8%) -ALUM (Potassium Aluminium Sulphate) Epinephrine causes local vasoconstriction, which results in transitory gingival shrinkage. And it should not be used on patients with cardiovascular diseases or taking ganglionic blocker or epinephrine potentiating drugs. ALUM Used in patients with Cardiovascular diseases or with Hyperthyroidism or a known Hypersensitivity to adrenaline. Placement of cord in the sulcus A) CORRECT B) INCORRECT 77
  78. 78. 78 Retraction cord delivery system ShortCut (Braided Retraction Cord) All-in-one-system that fits comfortably in the hand Built-in cutter, no need for scissors Rotary mechanism dispenses each time the same amount of cord with a simple click (1cm) Durable, waterproof label Improved hygiene control ShortCut is available non-impregnated or impregnated with 10% aluminum potassium sulfate. Sizes: 0 (thin), 1, 2 (thick)
  79. 79. 79 Retraction cords in a bottle GingiBraid+ (Braided Retraction Cord) Specially treated braid for faster absorption allowing immediate use and effectiveness. Will not split or collapse in the sulcus No memory effect Cords are easily identified by different color strands GingiBraid+ is available non-impregnated or impregnated with 10% aluminum potassium sulfate. Sizes: 0 (thin), 1, 2, 3 (thick) GingiKnit (Knitted Retraction Cord) Constructed of many tiny, absorbent loops knitted in long, interlocking chains. Places easily without fraying or memory Cords are easily identified by different color strands GingiKnit is available non-impregnated or impregnated with 10% aluminum potassium sulfate. Sizes: 000 (very thin) 00, 0, 1, 2, 3 (thick) GingiGel (Gel-Coated Braided Retraction Cord) This completely saturated braid is made of synthetic fiber and packed in a hemostatic gel. Provides immediate hemostasis and keeps the cord soft and pliable. GingiGel is saturated and coated with 20% buffered aluminum chloride gel. Sizes: 1 (thin), 2, 3 (thick)
  80. 80. Indirect methods • Comfortable & relaxed position of the patient 80
  81. 81. Local anesthesia • Helps in reducing discomfort associated with the treatment. • Makes the patient less anxious and less sensitive to stimuli. • Vasoconstrictor in LA helps to reduce salivary secretion and controls hemorrhage 81
  82. 82. Drugs • Antisiologogues: Atropine, (5mg , 30min before the Procedures) Anticholinergics- Propantheline bromide(50mg), Methantheline bromide(15mg) 1 to 2 hour before appointment • Contraindicated is – Nursing mothers and Glaucoma pts – Cardiovascular problem • Anti anxiety and Barbiturates: • Valium - 5 to 10mg 30min before. • Diazepam 5-10mg or barbiturates 24 hours before appointment • Muscle relaxant can also be tried 82
  83. 83. Isolation from soft tissues • Retraction of cheeks, lips & tongue 1. Rubber dam 2. Cotton rolls and holder 3. Tongue holder 4. Tongue depressor 5. Cheek and lip retractors 6. Mouth mirrors 83
  84. 84. Mouth props • For lengthy appointment • Mouth props of different designs and different material are available i.e. block type or ratchet types • Benefits to patient as, it relief them of maintaining adequate mouth opening. • For dentist prop ensure constant and adequate mouth opening 84
  85. 85. Retraction of gingiva 1. Physio-mechanical means 2. Chemical means 3. Electrosurgical means 4. Surgical means 85
  86. 86. Physiomechanical means • Rubber dam • Gingival retraction cord • Wooden wedges • Cotton twills combined with fast setting ZOE • Eugenol packs. 86
  87. 87. Chemical means • Vasoconstrictors • Epinephrine/Nor epinephrine • Contraindicated in pts with: • Hypertension • Diabetes • Hyperthyroidism • Cardiac patients 87
  88. 88. ASTRINGENTS AND STYPTICS • Biological fluid coagulants • Coagulate blood & tissue fluids locally, • Creating surface layer that is an efficient sealant against blood & crevicular fluid seepage. • They are safe with no systemic effects. • 10% Alum • 15-25% Aluminium chloride • 15-25% Tannic acid 88
  89. 89. Surface layer tissue coagulants • Coagulate surface layer of sulcular & free gingival epithelium as well as the seeped fluids, thus creating a temporary impenetrable film for underlying fluids. • 8% ZINC CHLORIDE • SILVER NITRATE 89
  90. 90. ELECTROSURGICAL MEANS • 4 functions seen depending on amount of energy produced 1. Cutting 2. Coagulation 3. Fulgeration (destruction of tissues) 4. Dessication Use - employed in situation where gingiva can not be handled alone with retraction cord.(areas of inflammation and granulation tissue) Contraindication- patients with pace maker. Principle - current flows from a small cutting electrode which produces a high current density and rapid temperature rise at its point of contact. Hence cells directly adjacent to the electrode volatized at this temperature. Surgical means: sharp knife is used to remove interfering gingiva 90
  91. 91. Advancements 1. Handi dam 2. Opti dam 3. Opal dam/Liquid dam 4. Insti dam 5. Optra dam 6. Non-latex Flexi dam 7. Silicone Non-Latex rubber dam 8. Derma dam 91
  92. 92. HANDI DAM • The latest addition to the DENTSPLY Ash® Instruments. • It comes with a built-in frame and a rod for insertion to keep the dam open. • Smaller than average rubber dam material/frame: increases patient comfort as the material and frame are less intrusive. • Medical grade rubber latex used (vanilla scented): provides flexibility and the good tensile strength helps to minimize tearing. • HandiDam Tubes: used to keep the HandiDam steady and are single use. SUMMITTS 92
  93. 93. Opti dam ACTA MEDICA (UNIVERSITAS CAROLINA) 2014; 57(1):15–20 93
  94. 94. Assembling Opti dam 1.Stretch the ergonomic rubber dam over the 3-dimensional frame. 2. Cut off the appropriate rubber projections. 3. Insert the winged clamp into the opening. 94
  95. 95. FOR ANTERIOR TEETH 1. Insert OptiDam 2. Use dental floss to push the dam through the mesial contact. Starting with the central incisors. 3. Slip the rubber dam over the remaining teeth to be isolated. 95
  96. 96. FOR POSTERIOR TEETH 1. Position the clamp with OptiDam Posterior in one step. 2. Place the rubber dam behind the wings of the clamp. 3. Slip the rubber dam over the remaining teeth to be isolated. 96
  97. 97. Optra dam By ivoclar vivadent Advantages: Easy application because of integrated frame and prepunched arch template. High patient comfort because of flexible 3 dimensional design. Simultaneous isolation of both arches. 97
  98. 98. Opal dam It is a methacrylate based light cured resin barrier used for isolating tissue adjacent to teeth. 98
  99. 99. Vital Bleaching with OpalDam Apply a barrier of OpalDam 4-6mm wide on the gingiva. Seal interproximal spaces. Overlap resin approximately 0.5mm onto dry enamel to seal. Extend resin one tooth beyond the last tooth to be bleached.Visually check that all gingival tissues at resin margin are covered and seal is established. 99
  100. 100. Light cure resin 20 seconds per light guide width. Note reflective properties of OpalDam! After applying gel and light activating according to instructions, remove gel using suction to avoid splattering. 100
  101. 101. Rinse and suction to evaluate color change and determine if additional whitening is necessary. Cured OpalDam resin is quickly and easily removed in one or a few large pieces. Check interproximally for retained resin. OpalDam is designed to easily remove from embrasures and undercuts. 101
  102. 102. Insti dam Advantages: • Compact design fits outside patients mouth. • Built-in flexible frame, with pre- punched hole off-center 1/2” • Pre-punched hole helps eliminate tearing. • Made with translucent natural latex that is very stretchable, tear-resistant and provides easy visibility • Radiographs may be taken without removing the Insti-Dam™, by bending Insti-Dam™ to the side COHEN’S102
  103. 103. Features: • Can be mounted to wall or cabinet or can sit on a counter • Holds 35 Insti-Dams • Non-slip rubber bottom • Available in White (A) - for latex or Neon Blue (N) - for latex-free • 4-7/8" x 4-7/8" x 6-1/8“ INSTI-CLAMP Advantages: • Single use only • Can be adapted with a carbide bur • Available in 2 sizes to fit most applications • When removing, simply cut with a carbide bur, no need for a Rubber Dam forceps • INSTI-DAM™ Dispenser 103
  104. 104. DERMA DAM • The most pure latex rubber dam available • Reduces the possibility of latex reactions. • Quality processing ensures the lowest known content of surface proteins (1.92 mg/g latex vs up to 440 mg/g latex for some competitors). • DermaDam Synthetic contains 0 mg of sensitizing proteins. Powder-free to eliminate allergic reactions to powder and contamination to preparation. • Shelf Life: 24 months. 104
  105. 105. Non-Latex Flexi Dam • Flexi Dam has an ultra-convenient, built-in- frame. • The flexible frame is designed with a convenient working size of 100 mm x 105 mm to ensure for easy placement without getting in the way. • The smooth surface of the plastic frame helps to maximize patient comfort when positioned on their skin. • Features : • Convenient built-in-frame – saves time • Highly elastic Flexi Dam material – tear resistant and easy placement • Latex free – allergy free • Odorless – patient comfort COHEN’S105
  106. 106. Silicone non latex Dental Dam • Roeko, Coltene Whaledent • For patients, doctors and assistants with latex allergies and those who are sensitized to latex. Autoclavable up to 134° C. 106
  107. 107. •A thorough knowledge of preliminary isolation procedures reduces the physical strain on the dental team associated with daily dental practice. •Maintaining optimal moisture control is necessary component in the delivery of high quality operative dentistry. Summary 107
  108. 108. REFERENCES: •Sturdevent – Art and Science of Operative Dentistry, 5th edition •Ingle – Fifth edition •Cohen – Pathways of Pulp, 8th edition •Fundamentals of operative dentistry –Summitt •Casterlucci Endodontics VOL1 •ACTA MEDICA (UNIVERSITASCAROLINA) 2014; 57(1):15–20 •Alternative Rubber Dam Isolation Technique for the Restoration of Class V Cervical Lesions Operative Dentistry, 2006, 31-2, 277-280 108
  109. 109. ThankYou 109

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