isolation of the operting field FOR DENTAL STUDENT. BDS students conservative and endodontics

1. ISOLATION

2. INTRODUCTION
 Any operative procedure necessitates the need for adequate control
over the operating field.
 It is imperative that there should be proper moisture control ,good
accessibility and visibility as well as adequate room for
instrumentation around the working area.
 Also ensure that no harm comes to patient
 Isolating the working area isolation from moisture like saliva blood and
gingival crevicular fluid and isolation from the soft tissues like lips,
cheeks, gingiva and tongue.

3. GOALS OF ISOLATION
 Moisture control
 Retraction and access
 Patient safety
 Safe and aseptic operating field

4. MOISTURE CONTROL
 Achieved by-
 Rubber dam
 Saliva ejector
 High volume evacuators
 Absorbents cotton roll and
cellulose wafer
 Throat shields
 Retraction cord
Excludes saliva,
gingival
bleeding,
and Crevicular
fluid from
operating field.
Prevents water spray
and restorative debris
from being swallowed
or aspirated.

5. RETRACTION AND ACCESS
 Provides maximum exposure of operating site
 Involves maintaining and open mouth retracting the Gingival tissue,
tongue , lips , cheeks
 aids used
1. Rubber dam
2. High volume evacuators
3. Absorbent
4. Retraction cord
5. Mouth prop

6. PATIENT SAFETY
 Do no harm
 Isolation is imperative to prevent accidental expiration or swallowing of
small instruments or restorative debris
 Soft tissue damage can be prevented.

7. BENEFITS OF ISOLATION
 Dry clean operating field
 Good assess and visibility
 Improved properties of dental material
 protection of the patients( Swallowing or aspirating Foreign bodies)
 Enhanced operating efficiency
 Infection control.

8. METHODS OF ISOLATION

9. DIRECT METHODS
-Rubber dam
-Absorbents
1. Cotton rolls
2. Cellulose wafers
3. Throat shield
-Evacuation system
1. Saliva ejectors
2. High volume evacuators
-Retraction device
1. Mouth props
2. Svedopter
3. isolite
4. Hygoformic saliva ejector

10. INDIRECT METHOD
1. Comfortable position of the patient and relaxed surroundings.
2. Local anaesthesia with vasoconstrictor
3. Drugs
 Anti anxiety drugs
 Muscle relaxants

11. RUBBER DAM

12. HISTORY
 Developed in 19th century by SC bernum
 The rubber dam help in
-eliminating saliva from operating site
-retracts the soft tissue

13. ADVANTAGES
 Increases visibility and accessibility
 Provides a dry field
 Effectively retracts tongue, cheeks away from field of operation
 Reduces the chances of injury to soft tissue
 Potentially improved properties of dental materials
 Protection of the patient and the operator
 Operating efficiency

14. DISADVANTAGES
 Teeth that have not erupted sufficiently to support a retainer
 Some third molars
 Extremely malpositioned teeth.
 Time consuming
 Difficult to convince patient
 Injury to gingival tissues

15. TO BE USED WITH CAUTION IN CONDITIONS....!!!

16. COMPONENTS OF RUBBER DAM KIT
 Rubber dam material
 Rubber dam frame
 Rubber dam retainer
 Rubber dam punch
 Retainer forceps
 Napkins
 Lubricants

17. RUBBER DAM SHEET
 Made of either letters or latex free material.
 Available in a continuous role over into precut sizes
 Has a shiny and dull side.
 Available scented and flavoured sheet.
 because the dull side is less light Reflective it is generally placed facing the
occlusion of the isolated teeth
 Thicker dam is more effective in retracting tissue and more resistant to
tearing it is especially recommended for isolating class 5 lesions.
 Thinner material is particularly helpful when contacts are tight.

18. RUBBER DAM STAMP
 This inked stamp paper produces a series of
dots on the rubber corresponding to the
average position of the teeth
 The top edge of the rubber sheet should be
just below the patients nose does covering
mouth but not the nose.

19. RUBBER DAM PUNCH
 A precision instrument have a rotating metal
table with 6 holes of Varying size and a paper
shop pointed plunger.
 It is used to make round holes of different
diameters from 0.7 to 2 mm.

20. RUBBER DAM CLAMP OR RETAINERS
 These are metal clips which fit the neck of the
tooth and hold the rubber dam in position.
 Parts of clamp
1. Bow: rounded portion of clamp
2. Jaws: promise that seat around the tooth
create the extension and balance necessary
to stabilize the clamp.
 Available as:
1. Wingless
2. Winged

21. RUBBER DAM HOLDER OR FRAME
 This holds the free edge of the rubber and
prevents them from falling into the mouth or
back against the patients face
 stabilize and stretch the dam so it tightly fits
around the teeth and out of the operator’s way.
 Available in plastic and metal frames
1. U-shaped frame
2. Young frame
3. Otsby frame

22. RUBBER DAM FORCEPS
 It is an instrument for placing,
adjusting and removing
clamps.

23. STEPS OF RUBBER DAM APPLICATION
 Dental dam equipment and supplies readied.
 Introduce the materials to the child.
 Dam is punched.
 Clamp selected, ligated, and positioned on forceps.
 Tie a length of floss to the clamp.
 Placement of clamp.
 Placement of dam.
 Placement of frame.
 Dam secure

26. STEPS OF REMOVAL OF RUBBER DAM
 Remove any ligatures that are stabilizing the dam.
 Using crown and bridge scissors, cut each hole creating one
slit.
 Position forceps in clamp.
 Remove everything as one unit.
 Evaluate patient.
 Evaluate dam.

27. ABSORBENTS

28. COTTON ROLLS
 Placed into the areas of mouth where salivary gland ducts exist
 Prevent contamination of operating field
 Useful for the procedures
1. Examination
2. Sealant placement
3. Impression taking
4. Topical fluoride application

29. CELLULOSE WAFERS
 Used to retract the cheek and provide
additional absorbency
 Most commonly used inside the cheeks to
cover the parotid gland.

30. THROAT SHIELD
 Used when there is danger of aspiring or
swallowing small objects
 A Gauge sponge 2 * 2 inch unfolded and
spread over the tongue and the posterior part
of the mouth.
 Prevents as well as recovers small objects
such as an indirect restoration during try-in.

31. EVACUATION SYSTEMS

32. TWO TYPES OF EVACUATION SYSTEM
 High volume evacuation system
 Low volume evacuation system

33. HIGH VOLUME EVACUATORS
 Speed is 150 ml water in 1 second
 Cutting of tooth and restorative material and
other debris are removed from the
operating site
 Dehydration of oral tissue does not occur

34. LOW VOLUME EVACUATORS OR SALIVA EJECTORS
 It is small , straw like oral evacuation
system that is used during many types of
dental procedures
 Not sufficiently strong vacuum to be
used solely during a restorative dental
procedure
 Used in conjunction with sponges, cotton
rules and rubber dams

35. RETRACTION DEVICES

36. MOUTH PROPS
 Potential aid for lengthy appointment on
posterior teeth
 Maintain suitable constant and adequate mouth
opening
 Relief of muscle fatigue and muscle pain to
patient
 Types : block and ratchet
 Available in various sizes: small , medium and
large

37. GINGIVAL RETRACTION CORD
 These are readymade cotton or synthetic fibre woven
in form of cords.
 Please gently into the gingival sulcus
 They provide improved visibility and access and also
protects gingiva from abrasion.
 Special types of code
1. Flattened
2. Knitted
3. Twisted
4. Braided

38. RECENT ADVANCEMENTS

39. SALIVA EJECTOR MIRROR
 Mirror saliva ejector are disposable mirror combine evacuator and
mirror function into a efficient instrument
 Used for
1. Transillumination
2. retraction
3. Saliva ejector
4. Indirect vision
5. Tissue protection

40. ISOLITE SYSTEM
 The isolite device deliver continuous throat
protection, illumination retraction and
isolation.
 It has a unique soft flexible mouthpiece
which isolates both quadrants
simultaneously retract and protract the soft
tissue from accidental damage from high
speed turbines, believer’s shadow less
illumination continuously aspirates fluid and
prevent the aspiration of foreign objects.

41. INDIRECT ISOLATION
TECHNIQUES

42. DEFINE THE ANXIETY LEVELS OF THE PATIENT
 Increased anxiety levels increases salivation.
So, the patient should be calm and relaxed

43. LOCAL ANAESTHESIA WITH VESOCONSTRICTOR
 Reduces discomfort
 Controls moisture by decreasing salivation
 Make special comfortable , less and shares and less
sensitive to stimuli.
 Causes veso construction which reduces
hemorrhage

44. CONCLUSION
 A thorough knowledge of preliminary procedure reduces the physical
strain on the dental team, reduces patients anxiety and their by
enhances the quality of operative dentistry.
 Achievement of proper isolation and hanses successful outcome of
operative procedures as well as operator efficiency.

45. REFERENCES:
STURDEVANT’S ART AND SCIENCE
Thank you