Dental Lecture: Isolation (King Salman International University)

Faculty of Dentistry Endodontics Lecture : Isolation Dr.: Sherif AlHassan Heidar Date : 3/12/2024  1. Provides dry and clean operating field.  2. Enhanced access and visibility to the working area.  3. Protects patients from possible aspiration or swallowing of endodontic instr...

Faculty of Dentistry Endodontics Lecture : Isolation Dr.: Sherif AlHassan Heidar Date : 3/12/2024  1. Provides dry and clean operating field.  2. Enhanced access and visibility to the working area.  3. Protects patients from possible aspiration or swallowing of endodontic instruments, medicaments, irrigating solutions and debris.  4. Retracts and protects the soft tissues (gingival tissues, tongue, lips and cheeks) against possible trauma from rotary and hand instruments.  5. Reduces the microbial content of air turbine aerosols produced during endodontic procedures, thereby reducing the risk of cross-infection.  6. Improves the properties of dental materials by preventing the moisture contamination of restorative materials.  7. Enhances operating efficiency and increased productivity.  Caries, defective restorations should be removed before treatment.  Removal of all existing restorations has been advocated to improve restorability assessment, exact nature of disease.  Missing tooth structure preferably restored with reinforced intermediate restorative material (IRM) containing zinc oxide–eugenol, glass ionomers, or composite resin.  Bonded materials have better seal & improved strength.  During the placement procedure, it is important to protect the canals and pulp chamber by placing cotton. to avoid inter of the material with bonded materials  Orthodontic bands may be indicated in cases of cracked or fractured teeth to provide protection and support until a definitive restoration  The bands are available in various sizes and are appropriately contoured.  A band can be cemented, and the missing tooth structure replaced with IRM.  Clamp/Retainer  Forceps  Frame  Rubber dam sheets  Rubber dam Rubber dam R. Dam R. Dam R. Dam forceps clamp sheet frame Use: retain the sheet by anchoring tooth Several types designed according to tooth need anchorage for isolation  Butterfly clamp: anterior tooth  Premolar clamp  Molar clamp  Serrated clamps: Higher retention Used in minimal tooth structure (recently erupted or caries compromised tooth structure) Drawback: higher risk of tooth/restoration fracture Plastic clamps: radiolucent Less likely to damage tooth/restoration winged clamps: Rubber dam application as single unit  Passive clamps: do not retract gingiva (avoid gingival laceration)  Active clamps (Brinker): Extends below the gingiva. Indicated in loss of tooth structure.  rubber dam application as single units retract the give in case of extension do not retractic the gingiva loss of tooth structure  It may be necessary to use a caulking material or liquidam around the clamp to provide an adequate seal. Silver & black  Ligation the surgical procedure of closing off a blood vessel or other duct or tube in the body by means of a ligature or clip  Active clamps: subgingival tooth loss  Bonding:  Composite or GIC Building up before access Inadequate coronal structure or young patients (not be full erupted tooth), make the cervical area available for clamp retention not enough. ligation with floss or Wedjets (interproximal rubber) is indicated. When the loss of tooth structure extends subgingival It may be necessary to use a caulking material or resin around the clamp to provide an adequate seal. Sizes: 5x5 inch 6x6 inch Rubber dam material  Latex  Non latex (nitrile): for patients allergic to latex  Thickness: Thin: used for tight contacts Medium: Most frequently used Heavy: highest tear strength  1. The dam is placed on the frame so that it is stretched tightly across the top and bottom but has slack horizontally in the middle.  2. A hole is punched in the dam, and then the clamp wings are attached to the dam.  3. The dam, frame, and clamp are placed as a unit to engage the tooth near the gingival margin.  4. The dam is released apically off the clamp wings to allow it to constrict around the tooth neck. The dam is then flossed through the contacts  Necessary when an unobstructed view is required while the clamp is positioned.  Rarely used  Technique 1- Clamp is first placed on the tooth and secured. 2- Rubber dam is then stretched over the clamp 3- finally, rubber dam frame is fixed  1- Dam is stretched over the tooth and gingiva first by the operator or dental assistant  2- Clamp is placed on the tooth while the rubber dam is stretched.  3- Frame is fixed