ISOLATION OF THE OPERATIVE &ENDODONTIC FIELD

Presented by,Kallol Pramanik, Final yr

Operative dentistry can not be expressed properly unless the moisture in the mouth is properly controlled

The goals of operative field isolation are

Moisture controlRetraction

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:A. Provides comfort to the

patientB. Protect patients from

swallowing or aspirating foreign bodies

C. Protect patients soft tissues by retracting them.

Operator related:A. A dry clean operative fieldB. Infection controlC. Increased accessibility to

operative siteD. Improved properties of

dental materialsE. Improved visibility & less

fogging of mirrorF. 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 IsolationAdvantage

A. Act as a raincoat for the tooth.B. Complete,long term moisture

control.C. Maximizes access and visibility.D. Clean dry field while working.E. Protect lips,cheeks & tongue by

keeping them aside.F. Prevents accidental swallowing or

aspiration of foreign bodies.G. Improves the properties of dental

materials

DisadvantageA. Takes time to be applied.B. Communication with the patient

can be difficult.C. Incorrect use may damage

porcelain crowns/gingival tissues.

D. Insecure clamps can be swallowed or aspirated.

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 PunchRubber 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.

Rubber Dam Punch

Rubber Dam ClampsThese are used to secure the dam to the

teeth, that are to be isolated.These also minimally retract the gingivaSubdivided into >Winged

>Wingless

Rubber Dam Clamps

Clamps without wings Clamps with wings

Rubber Dam TemplateIt is an inked rubber stamp which helps in

marking the dots on the sheet according to position of the tooth.

Holes should be punched according to arch and missing teeth.

Rubber Dam Template

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.

Application of Rubber Dam

1. Testing & lubricating the proximal contacts

2.Punching the holes

3.Lubricating the dam

4.Selecting the retainer

5.Testing the retainers stability & retaintion

6.Positioning the dam over the retainer

7.Applying the napkin

8.Attaching the frame

9.Applying the anterior anchor

10.Passing the septa through the contacts

11.Invert the dam interproximally

12.Inverting the dam Faciolingually

13.Confirming a properly placed rubber dam

14.Checking for access & visibility

15.Inserting the wedges(optional)

Removal of Rubber Dam

1.Cutting the septa

2.Remove the clamps

3.Remove the dam

4.Wiping the lips

5.Massage the tissue

6.Examining the dam

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 DentistryGrossman’s Endodontic practiceTextbook of Operative DentistryPickard’s manual of Operative DentistryInternet

A special thanks to Department of Operative Dentistry & Endodontics, HIDSAR for

providing me the opportunity of giving seminar.

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