ISOLATION OF THE OPERATIVE & ENDODONTIC FIELD

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

The goals of operative field isolation are Moisture control Infection control Retraction Harm prevention Increase the concentration of dentist

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

Advantages Patient related: Provides comfort to the patient Protect patients from swallowing or aspirating foreign bodies Protect patients soft tissues by retracting them. Operator related: A dry clean operative field Infection control Increased accessibility to operative site Improved properties of dental materials Improved visibility & less fogging of mirror Prevents contamination of tooth preparation.

Materials can be used Rubber Dam Cotton rolls & cellulose wafers High volume evacuators & saliva ejector Mirror & evacuator tip retractor Mouth props Air Water syringe Cheek retractor Medicine Atropine / Antihistamin

Rubber Dam Isolation 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 Disadvantage Takes time to be applied. Act as a raincoat for the tooth. Complete, long term moisture control. Maximizes access and visibility. Clean dry field while working. Protect lips, cheeks & tongue by keeping them aside. Prevents accidental swallowing or aspiration of foreign bodies. Improves the properties of dental materials Takes time to be applied. Communication with the patient can be difficult. Incorrect use may damage porcelain crowns/gingival tissues. Insecure clamps can be swallowed or aspirated.

Rubber Dam Isolation Contraindication 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 clamp holder. 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 heavy-medium & thin. Light and dark sheets are available for colour contrast. Has a shiny & dull side, dull side will be facing the occlusal side.

Rubber Dam Frame The 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.

Rubber Dam Punch

Rubber Dam Clamps These are used to fix the dam to the teeth, that are to be isolated. These also minimally retract the gingiva Subdivided into >Winged >Wingless

Rubber Dam Clamps Clamps without wings Clamps with wings

Rubber Dam Template It 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.

Disposable rubber dam For single use

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 & retention The clamp and reamer should be hold with dental floss to be removed in case of aspiration or inhalation

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.

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.

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