Isolation in Operative Field: Rubber Dam Application PDF

Isolation in operative field Dr.Doaa Alhelais  Application of Rubber Dam Isolation : Step 1:Testing and Lubricating the Proximal Contacts  Application of Rubber Dam Isolation : Step 2:Punching Holes  Punch an identification hole in the upper left (i.e., the patient’s left) corner of the...

Isolation in operative field Dr.Doaa Alhelais  Application of Rubber Dam Isolation : Step 1:Testing and Lubricating the Proximal Contacts  Application of Rubber Dam Isolation : Step 2:Punching Holes  Punch an identification hole in the upper left (i.e., the patient’s left) corner of the rubber dam for ease of location of that corner when applying the dam to the holder. Isolation of a minimum of three teeth is recommended except when endodontic therapy is indicated, and in that case, only the tooth to be treated is isolated. The number of teeth to be treated and the tooth surface influence the pattern of isolation.  The distance between holes is equal to the distance from the center of one tooth to the center of the adjacent tooth, measured at the level of the gingival tissue. When the distance between holes is excessive, the dam material is excessive and wrinkles between teeth. Too little distance between holes causes the dam to stretch, resulting in space around the teeth and leakage. When the distance is correct, the dam intimately adapts to the teeth and covers and slightly retracts the interdental tissue. When a thinner rubber dam is used, smaller holes must be punched to achieve an adequate seal around the teeth because the thin dam has greater elasticity.  When operating on the incisors and mesial surfaces of canines, isolate from first premolar to first premolar Metal retainers usually are not required for this isolation ,If additional access is necessary after isolating teeth retainer can be positioned over the dam.  When operating on a canine, it is preferable to isolate from the first molar to the opposite lateral incisor. To treat a Class V lesion on a canine, isolate posteriorly to include the first molar to provide access for placement of the cervical retainer on the canine.  When operating on Molars, punch holes as far distally as possible and isolate anteriorly to include the lateral incisor on the opposite side of the arch Anterior teeth included in the isolation provide finger rests on dry teeth and better access and visibility for the operator and the assistant.  When operating on premolars, punch holes to include one to two teeth distally, and extend anteriorly to include the opposite lateral incisor. When the rubber dam is applied to maxillary teeth: The first holes punched are for the central incisors. These holes are positioned approximately 1 inch (25 mm) from the superior border of the dam (providing sufficient material to cover the patient’s upper lip. For a patient with a large upper lip or mustache, position the holes more than 1 inch from the edge. For a child or an adult with a small upper lip, the holes should be positioned less than 1 inch from the edge. When the holes for the incisors are located, the remaining holes are punched. When the rubber dam is applied to mandibular teeth : The first hole punched is for the posterior anchor tooth that is to receive the retainer. To determine the proper location : Mentally divide the rubber dam into three vertical sections: left, middle, and right. If The anchor tooth is the mandibular first molar, punch the hole for this tooth at a point halfway from the superior edge to the inferior edge and at the junction of the right (or left) and middle thirds.  Application of Rubber Dam Isolation : Step 3: Lubricating the Dam A water-soluble lubricant applied in the area of the punched holes Avoid oil Based lubricant A water-soluble lubricant applied in the area of the punched holes  Application of Rubber Dam Isolation : Step 4: Selecting the Retainer  Application of Rubber Dam Isolation : Step 5: Testing the Retainer’s Stability and Retention Test the retainer’s stability and retention by lifting gently in an occlusal direction with a fingertip under the bow of the retainer. An improperly fitting retainer rocks or is easily dislodged.  Application of Rubber Dam Isolation : Step 6: Positioning the Dam over the Retainer Or Applying the dam and retainer simultaneously  Application of Rubber Dam Isolation : Step 7:Applying the Napkin Step 8:Positioning the Napkin  Application of Rubber Dam Isolation : Step 9:Attaching the Frame The frame is positioned outside the dam. The curvature of the frame should be concentric with the patient’s face.  Application of Rubber Dam Isolation : Step 10: Passing the Dam through the Posterior Contact  Application of Rubber Dam Isolation : Step 11: Passing the Septa through the Contacts without Dental Tape The operator passes the septa through as many contacts as possible without the use of dental tape by stretching the septal dam faciogingivally and lingogingivally with the forefingers.  Application of Rubber Dam Isolation : Step 12: Passing the Septa through the Contacts with Tape Use waxed dental tape to pass the dam through the remaining contacts. Dental tape is preferred over floss because its wider dimension more effectively carries the rubber septa through the contacts.  Application of Rubber Dam Isolation : Step 17: Inverting the Dam  Application of Rubber Dam Isolation : Step 17: Inverting the Dam Application of Rubber Dam Isolation : Removal of Rubber Dam : 1. Cutting the Septa 2. Removing the Retainer 3. Removing the Dam 4. Examining the Dam ERRORS IN APPLICATION AND REMOVAL Off-Center Arch Form: A rubber dam punched off-center (off-center arch form) may not shield the patient’s oral cavity adequately, allowing foreign matter to escape down the patient’s throat. An off-center dam can result in an excess of dam material superiorly that may occlude the patient’s nasal airway ERRORS IN APPLICATION AND REMOVAL Inappropriate Retainer : An inappropriate retainer may: Be too small, resulting in occasional breakage when the retainer jaws are overspread; Be unstable on the anchor tooth; Impinge on soft tissue; Impede wedge placement Retainer-Pinched Tissue : The jaws and prongs of the rubber dam retainer usually slightly depress the tissue, but they should not pinch or impinge on it ERRORS IN APPLICATION AND REMOVAL Inappropriate Distance between the Holes: Other Isolation Techniques: Cotton Roll Isolation: Absorbents, such as cotton rolls are isolation alternatives when rubber dam application is impractical or impossible. In conjunction with profound anesthesia and saliva ejector, absorbents provide acceptable moisture control for most clinical procedures. Cotton rolls should be replaced, when saturated with saliva. Other Isolation Techniques: Cotton Roll Isolation: - Absorbents, such as cotton rolls are isolation alternatives when rubber dam application is impractical or impossible. - In conjunction with profound anesthesia and saliva ejector absorbents provide acceptable moisture control for most clinical procedures. - Cotton rolls should be replaced, when saturated with saliva. Other Isolation Techniques: Cotton Roll Isolation: - Placing a cotton roll in the facial vestibule isolates maxillary teeth. - Placing a cotton roll in the vestibule and another between teeth and the tongue isolates mandibular teeth. Other Isolation Techniques: Throat shields - When the rubber dam is not being used, throat shields are indicated when the risk of aspirating or swallowing small objects is present. - Throat shields are particularly important when treating teeth in the maxillary arch - A gauze sponge (2 × 2 inch [5 × 5cm]), unfolded and spread over the tongue and the posterior part of the mouth, is helpful in recovering a small object Other Isolation Techniques: High-Volume Evacuators and Saliva Ejectors - High-volume evacuators are preferred for suctioning water and debris from the mouth because saliva ejectors remove water slowly and have little capacity for picking up solids. - The assistant places the evacuator tip as close as possible to the tooth being prepared. It should not, however, obstruct the operator’s access or vision, - For most patients, the use of saliva ejectors is not required for removal of saliva because salivary flow is greatly reduced when the operating site is profoundly anesthetized. Other Isolation Techniques: Mouth Props - A potential aid to restorative procedures on posterior teeth (for a lengthy appointment) i - Stablish and maintain suitable mouth opening, relieving the patient’s muscles of this task, which often pro- duces fatigue and sometimes pain.  Other Isolation Techniques: Mouth Props - A potential aid to restorative procedures on posterior teeth (for a lengthy appointment) i - stablish and maintain suitable mouth opening, relieving the patient’s muscles of this task, which often pro- duces fatigue and sometimes pain. - most outstanding benefits to the patient are relief of responsibility of maintaining adequate mouth opening and relief of muscle fatigue and muscle pain. - For the dentist, the prop ensures constant and adequate mouth opening and permits extended or multiple operations, if desired. -  Other Isolation Techniques: Retraction cord When properly applied, retraction cord often can be used for isolation and retraction in direct procedures involving accessible subgingival areas and in indirect procedures involving gingival margins. -  Other Isolation Techniques: Drugs The use of drugs to control salivation is rarely indicated in restorative dentistry and is generally limited to atropine. As with any drug, the operator should be familiar with its indications, contraindications, and adverse effects. Atropine is contraindicated for nursing mothers and patients with glaucoma. Thank you