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ISOLATION IN DENTISTRY

Presented by: Dr. Pallavi B. Gopeshetti, CODS, Dvg

CONTENTS
Introduction Oral environment & goals of isolation Isolation from moisture

-DIRECT METHODS
RUBBER DAM -history -advantages & disadvantages -indications & contraindications -additional uses -materials & instruments -preparation of the dam -selection & preparation of the clamp -preparation of the mouth -application techniques

-Application of rubber dam in children -Removal of the dam -Errors in application & removal -Special considerations -ADVANCES
Optra dam Opti dam Handi dam Derma dam Insti dam Dry dam Opal dam Flexi dam

Isolation of the root canals Isolation in periapical surgeries Isolation in laser therapy

Fluid absorbing materials Debris & fluid evacuation equipments Soft tissue isolation Tissue retractors & protectors

-INDIRECT METHODS

Comfortable positioning of patient & relaxed surroundings Local anesthetics Drugs Possible complications & corrective measures in isolation Refernces Conclusion

ORAL ENVIRONMENT
Saliva Moving organs Lips & cheeks Periodontium Respiratory moisture Deposits

GOALS OF ISOLATION
Moisture control Retraction and access Harm prevention

ISOLATION FROM MOISTURE

Direct methods
*Rubber dam
*Cotton rolls & holder *Gauge pieces *Absorbent wafers *Suction devices *Gingival retraction devices

Indirect methods
*Comfortable position &

relaxed surrounding to the patient *Local anesthetics *Drugs

RUBBER DAM
HISTORY: Dr. Sanford Christie Barnum on 15th march 1864,
Connecticut valley dental society, New York

1870, Dr. J.F.P. Hodson,7 types of clamps & no forceps used

1878,Dr.Elliot design

1879, Ainsworth rubber dam punch

1880, Dr.Hickmans lipped clamps

1880, Dr.Tees festooned clamps

ADVANTAGES
Dry and clean operating field Access & visibility Improved property of dental materials Protects patient and operator Operator efficiency

ABCDs of rubber dam


Adequate access and visibility in the operating field Better patient protection and management

Control of moisture in the operating field


Decreased operating time

DISADVANTAGES

INDICATIONS
Endo, bleaching, caustic chemicals

CONTRAINDICATIONS
o Allergies o Asthmatic patients o Psychological reasons

ADDITIONAL USES
Diagnosis Periodontal therapy Orthopedics Urology Wound draining Abdominal surgeries Bowel resection Facial plastic surgery

Materials and instruments


RUBBER DAM SHEET
55 & 66 Traditional dam- black Green, blue, natural
Thickness Thin Medium Heavy Extra heavy Special heavy mm 0.15 0.20 0.25 0.30 0.35

inch 0.006 0.008 0.010 0.012 0.014

Surfaces Shelf life

Non latex rubber dam


Synthetic/silicone, Powder free Size & thickess Shelf life Tensile strength (N= 27.6 MPa)

Types:

RUBBER DAM PUNCHES


Single hole
2 sizes

Multiple hole Ivory pattern


Ash/ainsworth pattern

Sterilization

Two main problems:

a) Blunting of the sharp cutting edges. b) Damage to the punch point & anvil.

RUBBER DAM FORCEPS


Parts. Sterilization.. Working life.
Sliding ring Forceps arms Hinge

Forceps handles

Pointed tips

Ivory pattern University of Washington pattern Ash/ strokes pattern

The second groove for removal of the rubber dam clamp

The tips of the rubber dam forceps modified for ease of use.

RUBBER DAM FRAMES


Fernaulds frame

Metallic Youngs frame Endon frame

PLASTIC Youngs Star visi frame Nygaard-Ostby Le cadre articule

Dr.G.Sauveur

HARNESSES
Advantages Advantages of frames over harnesses Types: Woodburry Wizzard

RUBBER DAM CLAMPS / RETAINERS


Parts Shelf life Sterilization

Types:
Bland

Winged Wingless

Winged Retentive Wingless

4 point contact Anchoring Circumfere clamps ntial contact

Metallic

Carbon steel plated

Plastic

Stainless steel

Single bow Double bow

Sizes:

Maxillary teeth Maxillary molar Central incisor Canine Premolars Molars

Clamps 6, 9, 210, 212 6, 9, 210, 00 6, 9, 210 0, 2, 2A, W2A 3, W3, W8A, 14,14A

Mandibular teeth Incisors Canine Premolars Molars

Clamps 6, 9, 210, 212 6, 9, 210 0, 00, 2, W2A 3, W3, W8A, 14, 14A

SPECIALIZED CLAMPS
Extended bows Modified bow clamps Cervical retainers Tiger clamps S-G (Silker Glickman) clamps Fit Cervical Clamp 214

ANCHORS/ OTHER RETAINERS


Dental floss(waxed)/ dental tape Cut rubber dam sheet Wedjet Stabilizing cords Wedges Elastic rings

Modeling compound

NAPKINS

LUBRICANTS
Hygienic or KY jelly or topical LA Cocoa butter/ petroleum jelly

TEMPLATES AND STAMPS

Selection

PREPARATION OF THE DAM


Dark Heavy Thin Medium

Light/ translucent

Position of the holes -Single tooth isolation -Multiple tooth isolation

GUIDELINES FOR MAKING THE HOLES

PUNCHING OF THE DAM

PUNCHING THE HOLES

LUBRICATING THE DAM

SELECTION OF THE CLAMP


Anchor teeth.. Endo treatment and cervical lesions Anterior teeth Most distal tooth Acid etching Maximal coronal diameter four point contact Length of the clamp jaw = MD width of the root Criterion:..

CORRECT CLAMP PLACEMENT

TESTING THE CLAMPS STABILITY & RETENTION

CUSTOMIZATION OF THE CLAMPS


S.S clamps- cold working, carbon plated- heat working

Dentsply pattern C, Hygenic Ferrier 212, Ash No. 6

a)Fit sloped root surface b)Versatile application c)Curvature of labial surfaces of lower incisor.

FLOSS TYING

PREPARATION OF THE MOUTH


Deposits Contacts Rinse mouth Shade selection Anesthesia Mark the tooth Endodontic access Post application rinsing

TESTING & LUBRICATING PROXIMAL CONTACTS

APPLICATION TECHNIQUES
DOUBLE MOTION TECHNIQUES:

Clamp placement prior to the rubber dam

TESTING THE CLAMPS STABILITY & RETENTION

POSITIONING THE DAM OVER THE CLAMP

APPLYING THE NAPKIN

POSITIONING THE NAPKIN

ATTACHING THE FRAME

ATTACHING THE NECK STRAP [ OPTIONAL ]

PASSING THE DAM THROUGH POSTERIOR CONTACT

APPLYING THE COMPOUND [ OPTIONAL]

APPLYING THE ANTERIOR ANCHOR [ IF NEEDED ]

PASSING THE SEPTA THROUGH THE CONTACTS WITHOUT TAPE

PASSING THE SEPTA THROUGH THE CONTACTS WITH TAPE

TECHNIQUE FOR USING TAPE [ OPTIONAL ]

INSERTING THE WEDGES

Clamp placed after the rubber dam

Clamp & rubber dam placed together ( endodontics)

SINGLE MOTION TECHNIQUE

Application of dam in children


Sheet55" Frame5 Youngs pattern Clamps S.S White No. 27 for primary and Ivory No. W14 for young permanent teeth, retentive type Tell-show-do tech. Euphemisms like rubber rain coat

REMOVAL OF THE RUBBER DAM

CUTTING THE SEPTA

REMOVING THE RETAINER

REMOVING THE DAM

WIPING THE LIPS

MASSAGING THE TISSUES

EXAMINING THE DAM

Off-center arch form Inappropriate dist. between the holes Incorrect arch form of the holes Inappropriate retainer Shredded/ torn dam Sharp tips on No. 212 retainer Incorrect technique of cutting septa

ERRORS IN APPLICATION & REMOVAL

SPECIAL CONSIDERATIONS
EVACUATION OF THE FLUID FROM DAM: Modified saliva ejectors (Lambert)

Wash field apparatus


Childers and Marshall Benavides and Herrera

Endon frames

SUBSTITUTION OF THE RETAINER WITH MATRIX

SEALING OF THE ROOT CONCAVITY/ GAPS

REPAIR OF THE TORN DAM

CERVICAL RETAINER PLACEMENT


Markley

RADIOGRAPHIC TECHNIQUES

Hemostats & Rinn Eezee- grip

Tongue spatula

Masel Precision endodontic holder

CALCIFIED CANALS

UNUSUAL SHAPES AND POSITIONS

BLEACHING
Use of opal dam..

LOSS OF TOOTH/ PORCELAIN CROWNS/ VENEERS SPLIT DAM TECHNIQUE

FIXED BRIDGE ISOLATION


Slit tech. Large hole technique(Antrium)

Periodontal procedures Orthodontic procedures Restorative procedures: Canal projection

EXTENSIVE LOSS OF TOOTH STRUCTURE

MEDICAL PROBLEMS
Mouth breathing

Allergies

High risk patients

ADVANCES
DERMA DAM

INSTI DAM

FLEXI DAM

OPTI DAM

HANDI DAM

DRY DAM

(Svenska)

OPTRA DAM

OPAL DAM

ISOLATION OF THE ROOT CANALS FROM MOISTURE


-Absorbent points -Needle of the syringe in the canal and
withdrawing the plunger slowly. -Stropko drier

Stropko irrigator / drier with ultradent microtip

Isolation in periapical surgeries


Profound anesthesia Micro mirrors and retractors Preoperative considerations

Localized haemeostasis Suction tips

Fraser suction tip

Wire stylet

Stropko irrigator / drier with ultradent microtip

ISOLATION IN LASER THERAPY


Ventilation, evacuation, respiratory protection Adequate suction Protection of non target tissues

FLUID ABSORBING MATERIALS


COTTON ROLLS AND HOLDERS

Holders

Application techniques

Application techniques

ABSORBENT PADS/ CELLULOSE WAFERS

DRI AID

(Young dental)

GAUZE PIECES/ THROAT SHIELDS


2 2 (5 5 cm)

DEBRIS AND FLUID EVACUATION EQUIPMENTS


HIGH VOLUME EVACUATION
Metallic autoclavable tips Disposable plastic -0.5 l of water in 2 sec -75%-95% water & 100% debris

TRK-O-VAC (Plasdent)

SALIVA EJECTORS
Metallic autoclavable tips Disposable plastic

Placement

MODIFIED SALIVA EJECTORS

WASH FIELD APPARATUS

SWEFLEX SALIVA EJECTORS

SVEDOPTER
E. C Moore

HYGOFORMIC SALIVA EJECTORS

FAST DAM
17 suction holes along the perimeter

(Practicon)

MIRRO-VAC SALIVA EJECTOR MIRRORS

DRY FIELD SYSTEM

SOFT TISSUE ISOLATION- TISSUE RETRACTION & PROTECTION TONGUE RETRACTORS: Guards and depressors

Svedopter

CHEEK AND LIP RETRACTORS


Photographic purposes

OPTRA GATE

Hygiene Restorative

Ortho Photography

Impression Taking

LIP RETRACTORS
Simple lip retractor, 11cm 4 " Wire lip retractor Oringer lip retractor Plastic lip retractors, adult 12cm 4 "

CHEEK AND TONGUE RETRACTORS


DISPOSABLE SPAND- EZZ EXPANDERS

Sizes: small (green) medium (blue) large (red)

GINGIVAL RETRACTION AIDS


Gingival retraction collars Retraction cords

MOUTH PROPS
Mouth props

Rubber

Molt

Latex

Non latex

Ratchet type

MIRROR AND EVACUATOR TIPS

ISOLITE
Size- adult small -adult medium -adult large -pediatric

Attach mouthpiece to Isolite tube

Align Bite Block at 1st or 2nd bicuspid area keeping Cheek Shield outside the mouth.

Place Isthmus behind maxillary tuberosity. Position Cheek Shield in buccal vestibule

INDIRECT METHODS
COMFORTABLE POSITION OF PATIENT AND RELAXED SURROUNDINGS

LOCAL ANESTHESIA

DRUGS
Antisailogouges Antianxiety drugs and barbiturates sedatives Muscle relaxants

POSSIBLE COMPLICATIONS & CORRECTIVE MEASURES IN ISOLATION


Injury to the soft tissues Strained muscles Painful TMJ (subluxation) Facial emphysema Rubber dam left over Gagging

Swallowing/ aspiration of the foreign bodies

Sturdevants art and science of operative dentistry; Roberson , Heymann, Swift- 5th edition Rubber dam in clinical practice; Reid/ Callis/ Patterson Pathways of the pulp; Stephen Cohen, Kenneth. Hargreaves 9th edition Ingels endodontics; Ingel, Bakland, Baumgartner- 6th edition Fundamentals of Operative Dentistry; A contemporary approach; Summitt/ Robbins/ Schwatrz- 2nd edition Operative dentistry. Modern theory and practice; Marzouk, Simonton, Gross- 1st edition Text book of operative dentistry; Baum, Phillips, Lund- 3rd edition Text book of operative dentistry; Vimal Sikri- 2nd edition Surgical endodontics; Gutmann, Harrison Lasers in dentistry; Miserendino, Rober pick Google.com

REFERENCES

CONCLUSION

THANK YOU.