Isolation of the operating field: PDF

Isolation of the operating field Dr.Doaa Alhelais  Reference: Art and science 6th Edition - Chapter 7.  Introduction Operative dentistry cannot be executed properly unless the moisture in the mouth is controlled. Moisture control refers to excluding sulcular fluids, saliva, and gingi...

Isolation of the operating field Dr.Doaa Alhelais  Reference: Art and science 6th Edition - Chapter 7.  Introduction Operative dentistry cannot be executed properly unless the moisture in the mouth is controlled. Moisture control refers to excluding sulcular fluids, saliva, and gingival bleeding from the operating field. It also involves preventing the spray from the handpiece and restorative debris from being swallowed or aspirated by the patient. The rubber dam, suction devices, and absorbents are variously effective in moisture control. Introduction Raskin et al. and Fusayama have reported, however, that achieving effective isolation is more important than the specific technique used. Why to isolate?  Why to isolate? 1-Retraction and Access Retraction and access provides maximal exposure of the operating site and usually involves having the patient maintain an open mouth and depressing or retracting the gingival tissue, tongue, lips, and cheek. 2-Harm Prevention Excessive saliva and handpiece spray can alarm the patient ,Small instruments and restorative debris can be aspirated or swallowed Soft tissue can be damaged accidentally. All of this can be prevented by isolation Isolation techniques  Isolation techniques: 1- Rubber Dam: The rubber dam is used to define the operating field by isolating one or more teeth from the oral environment.  Dry, clean operating field. Improved access and visibility Advantages Potentially improved properties of dental materials Protection of the patient and the operator Operating efficiency. Disadvantages Time consumption and patient objection are the most frequently quoted disadvantages of the rubber dam. However, the rubber dam usually can be placed in less than 5 minutes. The advantages previously mentioned certainly outweigh the time spent with placement. Materials and Instruments:  1- Rubber Dam sheet The rubber dam material has a shiny side and a dull side. Because the dull side is less light reflective, it is generally placed facing the occlusal side of the isolated teeth. The rubber dam material has a shiny side and a dull side. The dull side is less light reflective, it is generally placed facing the occlusal side 5x5 Inch. 6x6 Inch of the isolated teeth.  1- Rubber Dam sheet The rubber dam material has a shiny side and a dull side. The rubber dam material has a shiny side and a dull side. Because the dull side is less light reflective, it is generally placed facing the occlusal side of the isolated teeth. The dull side is less light reflective, it is generally placed facing the occlusal side of the isolated teeth.  Light the contacts easier, Rubber which dam helpful when contacts are tight. is particularly Dark Rubber dam Advantage: of passing through the Advantages: Maximum retraction, Excellent contacts easier, which is particularly contrast, More resistance for tearing. helpful when contacts are tight. Disadvantages: Tear easily Disadvantages: Perforations need to be precised, Difficult to stretch 2- Frame easier, the contacts U-shaped which is metal frame particularly helpfulwith when small contactsmetal are tight.projections for securing the borders of the rubber dam. It maintains the borders of the rubber dam in position. 3- Retainer The rubber dam retainer consists of four prongs and two jaws connected by a bow the contacts easier, which is particularly helpful when contacts are tight. properly selected retainer should contact the tooth in its four line angles prevents rocking or tilting of the retainer. the contacts easier, which is particularly helpful when contacts are tight. 3- Retainer the contacts easier, which is particularly helpful when contacts are tight. No 8 W8 The wings designed : Provide extra retraction of the rubber dam from the operating field Allow attachment of the dam to the retainer before applying the clamp the contacts easier, which is particularly helpful when contacts are tight.  3- Retainer the contacts easier, which is particularly helpful when contacts are tight. Active Clamp: The prongs of some retainers are gingivally directed (inverted) Helpful when the anchor tooth is partially erupted or when additional soft tissue retraction is indicated Materials and Instruments: 3- Retainer the contacts easier, which is particularly helpful when contacts are tight. 3- Retainer the contacts easier, which is particularly helpful when contacts are tight. Retentive clamp : The retainer is used to anchor the dam to the most posterior tooth to be isolated. Retraction clamp: Retainers are used to retract gingival tissue the contacts easier, which is particularly helpful when contacts are tight. the contacts easier, which is particularly helpful when contacts are tight. the contacts easier, which is particularly helpful when contacts are tight. the contacts easier, which is particularly helpful when contacts are tight.  3- Retainer the contacts easier, which is particularly helpful when contacts are tight. The bow of the retainer (except the No. 212, which is applied after the rubber dam is in place) should be tied with dental floss approximately 12 inches (30 cm) in length before the retainer is placed in the mouth. The floss allows retrieval of the retainer or its broken parts if they are accidentally swallowed or aspirated. the contacts easier, which is particularly helpful when contacts are tight. Materials and Instruments: 4- Forceps the contacts easier, which is particularly helpful when contacts are tight. The rubber dam retainer forceps is used for placement and removal of the retainer from the tooth Materials and Instruments: 5- Puncher Precision instrument having a rotating metal table (disk) with holes of varying sizes and a tapered, sharp-pointed plunger the contacts easier, which is particularly helpful when contacts are tight. Materials and Instruments: 5- Puncher the contacts easier, which is particularly helpful when contacts are tight. Materials and Instruments: 5- Puncher the contacts easier, which is particularly helpful when contacts are tight. Materials and Instruments: 5- Puncher When the distance between holes is excessive, the dam material is excessive and wrinkles between teeth. Too little distance between holes the dam to stretch, resulting in space around the teeth and leakage the contacts easier, which is particularly helpful when contacts are tight. 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. Materials and Instruments: 6- Napkin the contacts easier, which is particularly helpful when contacts are tight. The rubber dam napkin, placed between the rubber dam and the patient’s skin, has the following benefits: 1. It improves patient comfort by reducing direct contact of the rubber material with the skin. 2. It absorbs any saliva seeping at the corners of the mouth. 3. It acts as a cushion. Materials and Instruments: 7- lubricant the contacts easier, which is particularly helpful when contacts are tight. A water-soluble lubricant applied in the area of the punched holes facilitates the passing of the dam septa through the proximal contacts. A rubber dam lubricant is commercially available, but other lubricants such as shaving cream also are satisfactory. Cocoa butter or petroleum jelly may be applied at the corners of the patient’s mouth to prevent irritation. These two materials are not satisfactory rubber dam lubricants, because both are oil-based and not easily rinsed from the dam when the dam is placed. Thank you