ISOLATION OF THE OPERATIVE & ENDODONTIC FIELD Presentedby, KallolPramanik, Final yr
Operative dentistry can not be expressed properly unless themoisture in the mouth is properly controlled
The goals of operative field isolation are Moisture control Retraction Harm prevention
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
AdvantagesPatient related: Operator related:A. Provides comfort to the A. A dry clean operative field patient B. Infection controlB. Protect patients from C. Increased accessibility to swallowing or aspirating operative site foreign bodies D. Improved properties ofC. Protect patients soft dental materials tissues by retracting them. E. Improved visibility & less fogging of mirror F. Prevents contamination of tooth preparation.
Materials can be used1. Rubber Dam2. Cotton rolls & cellulose wafers3. Throat shields4. High volume evacuators & saliva ejector5. Mirror & evacuator tip retractor6. Mouth props7. Air Water syringe8. Cheek retractor9. Drugs
Rubber Dam IsolationIn 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.
Rubber Dam Isolation Advantage DisadvantageA. Act as a raincoat for the tooth. A. Takes time to be applied.B. Complete,long term moisture B. Communication with the patient control. can be difficult.C. Maximizes access and visibility. C. Incorrect use may damageD. Clean dry field while working. porcelain crowns/gingivalE. Protect lips,cheeks & tongue by tissues. keeping them aside. D. Insecure clamps can beF. Prevents accidental swallowing or swallowed or aspirated. aspiration of foreign bodies.G. Improves the properties of dental materials
Rubber Dam IsolationContraindication Asthmatic patients. Allergic to latex Mouth breathers Extremely malpositioned teeth Third molar (in some cases)
Armamentarium Rubber dam sheet. Rubber dam clamps. Rubber dam forceps. Rubber dam frame. Rubber dam punch.Accessories Lubricant/Petroleum jelly. Dental floss. Rubber dam Napkin.
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.
Rubber Dam FrameThe 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.
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.
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.
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.
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.
High volume evacuators & saliva ejector• It is used to remove water from airrotor with high suction speed.• Also helps in retracting the soft tissues.
Mirror & evacuator tip retractor• A secondary function of the mirror and evacuator tip is to retract the cheek, lip & tongue
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.
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.
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.
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.
By all these we can achieve a moisture free mouth for better operative and endodontic procedure.
References: Sturdevant’s Art and Science of Operative Dentistry Grossman’s Endodontic practice Textbook of Operative Dentistry Pickard’s manual of Operative Dentistry Internet
A special thanks to Department of Operative Dentistry & Endodontics, HIDSAR for providing me the opportunity of giving seminar.