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8/13/2019 Isolation Pallavi
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Good morning..
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ISOLATION IN DENTISTRY
Presented by:
Dr. Pallavi B. Gopeshetti,
CODS, Dvg
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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-a lication techni ues
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-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
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Fluid absorbing materials
Debris & fluid evacuation equipments
Soft tissue isolationTissue retractors & protectors
-INDIRECT METHODS
Comfortable positioning ofpatient & relaxed surroundingsLocal anestheticsDrugs
Possible complications &corrective measures in isolationReferncesConclusion
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ORAL ENVIRONMENTSaliva
Moving organs
Lips & cheeks
Periodontium
Respiratory moistureDeposits
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GOALS OF ISOLATION
Moisture controlRetraction and access
Harm prevention
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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 thepatient
*Local anesthetics*Drugs
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RUBBER DAMHISTORY:Dr. Sanford Christie Barnum on 15thmarch 1864,
Connecticut valley dental society, New York
1870, Dr. J.F.P. Hodson,7 types of clamps & no forceps used
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1878,Dr.Elliot design
1879, Ainsworth rubber dam punch
1880, Dr.Hickmanslipped clamps
1880, Dr.Tees festooned clamps
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ADVANTAGES
Dry and clean operating field
Access & visibilityImproved 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
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DISADVANTAGES
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INDICATIONS
Endo, bleaching, caustic chemicals
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CONTRAINDICATIONS
o Allergieso Asthmatic patients
o Psychological reasons
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M l d
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Materials and instrumentsRUBBER DAM SHEET 55 & 66 Traditional dam- black Green, blue, natural
Surfaces
Shelf life
Thickness mm inch
Thin 0.15 0.006
Medium 0.20 0.008
Heavy 0.25 0.010
Extra heavy 0.30 0.012Special heavy 0.35 0.014
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Non latex rubber dam Synthetic/silicone, Powder free
Size & thickess
Shelf life
Tensile strength (N= 27.6 MPa)
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RUBBER DAM PUNCHESTypes:
Sterilization
Single hole
2 sizes
Multiple
hole
Ivorypattern
Ash/ainsworthpattern
T i bl
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Two main problems:a) Blunting of the sharp cutting edges.b) Damage to the punch point & anvil.
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RUBBER DAM FORCEPS
Parts.
Sterilization..
Working life.
Sliding ring
Forceps handles
HingeForceps arms
Pointed tips
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Ivory pattern
University ofWashington
pattern
Ash/ strokespattern
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The tips of the rubber dam forcepsmodified for ease of use.
The second groove for
removal of the rubberdam clamp
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RUBBER DAM FRAMESFernaulds frame
Metallic
Youngs frame
Endon frame
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HARNESSES Advantages
Advantages of frames over harnesses
Types: Woodburry
Wizzard
RUBBER DAM CLAMPS /
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RUBBER DAM CLAMPS /RETAINERS
Parts
Shelf life
Sterilization
Types:
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Types:
Winged
WinglessBland
Winged
WinglessRetentive
4 pointcontact
Circumferentialcontact
Anchoringclamps
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Single
bow
Doublebow
Metallic
Plastic
Carbon steel plated
Stainless steel
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Sizes:
Maxillary teeth Clamps
Maxillary molar 6, 9, 210, 212
Central incisor 6, 9, 210, 00
Canine 6, 9, 210
Premolars 0, 2, 2A, W2A
Molars 3, W3, W8A, 14,14A
Mandibular teeth Clamps
Incisors 6, 9, 210, 212
Canine 6, 9, 210
Premolars 0, 00, 2, W2A
Molars 3, W3, W8A, 14, 14A
SPECIALIZED CLAMPS
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SPECIALIZED CLAMPS
Extended bows
Modified bow clamps Cervical retainers
Tiger clamps
S-G (Silker Glickman) clamps Fit Cervical Clamp 214
ANCHORS/ OTHER RETAINERS
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ANCHORS/ OTHER RETAINERS
Dental floss(waxed)/ dental tape
Cut rubber dam sheet Wedjet Stabilizing cords Wedges Elastic rings
Modeling compound
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NAPKINS
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LUBRICANTS Hygienic or KY jelly or topical LA
Cocoa butter/ petroleum jelly
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TEMPLATES AND STAMPS
PREPARATION OF THE DAM
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PREPARATION OF THE DAMSelection
Position of the holes-Single tooth isolation
-Multiple tooth isolation
Heavy
Thin
Dark
Light/translucent Medium
GUIDELINES FOR MAKING THE HOLES
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GUIDELINES FOR MAKING THE HOLES
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PUNCHING OF THE DAM
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PUNCHING OF THE DAM
PUNCHING THE HOLES
LUBRICATING THE DAM
SELECTION OF THE CLAMP
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SELECTION OF THE CLAMPAnchor 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:..
E E E
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CORRECT CLAMP PLACEMENT
TESTING THE CLAMPS
STABILITY & RETENTION
CUSTOMIZATION OF THE CLAMPS
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CUSTOMIZATION OF THE CLAMPSS.S clamps- cold working, carbon plated- heat working
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Dentsply pattern C, Hygenic Ferrier 212, Ash No. 6
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FLOSS TYING
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FLOSS TYING
PREPARATION OF THE MOUTH
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PREPARATION OF THE MOUTH Deposits
Contacts
Rinse mouth Shade selection
Anesthesia
Mark the tooth
Endodontic access
Post application rinsing TESTING & LUBRICATINGPROXIMAL CONTACTS
APPLICATION TECHNIQUES
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APPLICATION TECHNIQUES
DOUBLE MOTION TECHNIQUES:
Clamp placement prior to the rubber dam
TESTING THE CLAMPS
STABILITY & RETENTION
POSITIONING THE DAM
OVER THE CLAMP
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APPLYING THE NAPKIN POSITIONING THENAPKIN
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ATTACHING THE FRAME ATTACHING THE NECKSTRAP [ OPTIONAL ]
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PASSING THE DAMTHROUGH POSTERIOR
CONTACT
APPLYING THECOMPOUND [ OPTIONAL]
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APPLYING THE ANTERIORANCHOR [ IF NEEDED ]
PASSING THE SEPTA THROUGHTHE CONTACTS WITHOUT
TAPE
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PASSING THE SEPTATHROUGH THE
CONTACTS WITH TAPE
TECHNIQUE FOR USINGTAPE [ OPTIONAL ]
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INSERTING THE WEDGES
Cl l d ft th bb d
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Clamp placed after the rubber dam
SINGLE MOTION TECHNIQUE
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SINGLE MOTION TECHNIQUEClamp & rubber dam placed together ( endodontics)
Application of dam in children
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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
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REMOVAL OF THE RUBBERDAM
CUTTING THE SEPTA REMOVING THERETAINER
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REMOVING THE DAM WIPING THE LIPS
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MASSAGING THETISSUES
EXAMINING THE DAM
ERRORS IN APPLICATION &
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ERRORS IN APPLICATION &REMOVAL
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
SPECIAL CONSIDERATIONS
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SPECIAL CONSIDERATIONS
EVACUATION OF THE FLUID FROM DAM:
Modified saliva ejectors (Lambert)
Wash field apparatus
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Wash field apparatusChilders and Marshall
Benavides and Herrera
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Endon frames
SUBSTITUTION OF THE RETAINER
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WITH MATRIX
SEALING OF THE ROOT CONCAVITY/
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GAPS
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RADIOGRAPHIC TECHNIQUES
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RADIOGRAPHIC TECHNIQUES
Hemostats & Rinn Eezee- grip
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Tongue spatula Masel Precision endodontic holder
CALCIFIED CANALS
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CALCIFIED CANALS
UNUSUAL SHAPES AND POSITIONS
BLEACHING
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BLEACHING
Use of opal dam..
LOSS OF TOOTH/ PORCELAIN CROWNS/VENEERS
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VENEERS
SPLIT DAM TECHNIQUE
FIXED BRIDGE ISOLATION
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FIXED BRIDGE ISOLATION Slit tech.
Large hole technique(Antrium)
EXTENSIVE LOSS OF TOOTHE
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STRUCTURE Periodontal procedures
Orthodontic procedures Restorative procedures: Canal projection
MEDICAL PROBLEMS
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MEDICAL PROBLEMS
Mouth breathing
Allergies
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High risk patients
ADVANCES
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DERMA DAMADVANCES
INSTI DAM
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FLEXI DAM
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FLEXI DAM
OPTI DAM
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HANDI DAM
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HANDI DAM
DRY DAM
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DRY DAM
(Svenska)
OPTRA DAM
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OPTRA DAM
OPAL DAM
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OPAL DAM
ISOLATION OF THE ROOT CANALS
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FROM MOISTURE-Absorbent points-Needle of the syringe in the canal andwithdrawing the plunger slowly.-Stropko drier
Stropko irrigator / drier with
ultradent microtip
Isolation in periapical surgeries
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Isolation in periapical surgeries Profound anesthesia
Micro mirrors and retractors Preoperative considerations
Localized haemeostasis Suction tips
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Suction tips
Wire styletFraser suction tip
Stropko irrigator / drier with
ultradent microtip
ISOLATION IN LASER THERAPY
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Ventilation, evacuation, respiratory protection
Adequate suction Protection of non target tissues
FLUID ABSORBING MATERIALS
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COTTON ROLLS AND HOLDERS
Holders
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Application techniques
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pp q
Application techniques
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pp q
ABSORBENT PADS/ CELLULOSEWAFERS
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WAFERS
DRI AID
(Young dental)
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GAUZE PIECES/ THROAT SHIELDS
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2 2 (5 5 cm)
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DEBRIS AND FLUID EVACUATIONEQUIPMENTS
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HIGH VOLUME EVACUATION
-0.5 l of water in 2 sec-75%-95% water & 100% debris
Metallicautoclavable tips
Disposable plastic
TRK-O-VAC (Plasdent)
EQ MEN
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SALIVA EJECTORS
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Metallicautoclavable tips
Disposableplastic
Placement
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MODIFIED SALIVA
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EJECTORS
WASH FIELD APPARATUS
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WASH FIELD APPARATUS
SWEFLEX SALIVA EJECTORS
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SVEDOPTER
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E. C Moore
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HYGOFORMIC SALIVA EJECTORS
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FAST DAM
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17 suction holes along the perimeter
(Practicon)
MIRRO-VAC SALIVA EJECTORMIRRORS
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MIRRORS
DRY FIELD SYSTEM
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SOFT TISSUE ISOLATION- TISSUERETRACTION & PROTECTION
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TONGUE RETRACTORS:
Guards and depressors
Svedopter
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LIP RETRACTORSSi l li t t 11 4 "
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Simple lip retractor, 11cm 4 "
Wire lip retractorOringer lip retractor
Plastic lip retractors, adult 12cm 4 "
CHEEK AND TONGUE RETRACTORSDISPOSABLE SPAND EZZ EXPANDERS
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DISPOSABLE SPAND- EZZ EXPANDERS
Sizes: small (green)
medium (blue)large (red)
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GINGIVAL RETRACTION AIDS
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Gingival retraction collars
Retraction cords
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MOUTH PROPS
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Mouth
props
Rubber
LatexNonlatex
Molt
Ratchettype
MIRROR AND EVACUATOR TIPS
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ISOLITE
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Size- adult small
-adult medium-adult large
-pediatric
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Attach mouthpiece to Isolite tube
Align Bite Block at 1st or 2nd bicuspid area keeping Cheek Shield outside the mouth.
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Place Isthmus behind maxillary tuberosity. Position Cheek Shield in buccal vestibule
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INDIRECT METHODS
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COMFORTABLE POSITION OF PATIENT
AND RELAXED SURROUNDINGS
LOCAL ANESTHESIA
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DRUGS
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Antisailogouges
Antianxiety drugs and barbiturates sedatives Muscle relaxants
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Swallowing/ aspiration of the foreign bodies
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CONCLUSION
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THANK YOU.
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