Isolation in Endodontics PDF

Isolation in Endodontics Dr Nada M Ibrahim, BDS, SBE Rubber Dam Rubber Dam application is considered the Application standard of c...

Isolation in Endodontics Dr Nada M Ibrahim, BDS, SBE Rubber Dam Rubber Dam application is considered the Application standard of care!! Dr Nada Ibrahim - Isolation in Endodontics 2  – Advantages of Rubber Dam – Types of Rubber Dam – Rubber Dam Retainers What Are We – Preparation for Rubber Dam placement – Isolation of Teeth with Inadequate Coronal Going to Structures Cover? – Replacement of Coronal Structure – Corrective Surgery – Application Techniques – Techniques for Special Situations Dr Nada Ibrahim - Isolation in Endodontics 3 Dr. Nada Ibrahim,BDS, SBE History of Rubber Dam – 1864 : Dr Sanford Christie Barnum came up with the idea of using a punched sheet of rubber and pulling it over the treated tooth. Dr Nada Ibrahim - Isolation in Endodontics 5  – Provides protection for the patient – Creates an aseptic environment that enhances Advantages of vision, retracts tissues and makes treatment more efficient Rubber Dam – Soft tissues are protected from laceration by rotary Application instruments, chemical agents, and medicament – Protects the patient from swallowing or aspirating instruments and materials. Dr Nada Ibrahim - Isolation in Endodontics 6 A good 150 years have passed since that distant day and if Dr. Barnum could see us now, he would definitely tear his hair out…!!! Its quite incredible that after such a long period of time we are still discussing if the rubber dam is or is not necessary in Endodontics. Dr Nada Ibrahim - Isolation in Endodontics 7  Most Importantly … Protects the dentist and auxiliary employees from aerosols, provides a barrier from the patient’s saliva and bacteria Advantages of Rubber Dam & Application Decreases the potential for transmission of systemic diseases such as : COVID-19 , AIDS , hepatitis and tuberculosis Dr Nada Ibrahim - Isolation in Endodontics 8 Dr Nada Ibrahim - Isolation in Endodontics 9  Diffe rent c lamp s What is in the Rubber Dam Puncher Kit? Forceps Fram e Dr Nada Ibrahim - Isolation in Endodontics 10 Different types/sizes of frames are available Plastic Maintains borders of rubber dam in position Retracts soft tissues Improves access Metal Dr Nada Ibrahim - Isolation in Endodontics 11  Rubber Dam Punch A precision instruments having a metal table and tapered, sharp pointed plunger which is used to produce clean cut holes in the rubber dam sheet through which the teeth can be isolated Dr Nada Ibrahim - Isolation in Endodontics 12 Dr Nada Ibrahim - Isolation in Endodontics 13  Clean Cut Punch Hole Proper punching includes proper alignment of the punch table with the pin An improperly cut hole will result in a nick or tag that may cause the dam to rip while its being placed Dr Nada Ibrahim - Isolation in Endodontics 14  – Manufactured from latex, ( non latex available for patients with allergy to latex) – Different colors – Dull & shiny : dull side reflects less light Types of – Various thickness : Rubber Dam – Light : Mandibular anterior & partially erupted posterior teeth ( these teeth have little bulk of contour, so its less dislodging force on the clamp) – Medium : most recommended – fits better at the gingival margin and provides good retraction – Heavy & Extra Heavy: chair side bleaching Dr Nada Ibrahim - Isolation in Endodontics 15 Rubber Dam Retainers  Types of Rubber Dam Retainers Various styles & shapes are available , but the following selection is recommended Anterior Teeth Premolars Molars 1. Ivory #9 , #212 2. #0 , #2 3. # 14, #14A , 56 Dr Nada Ibrahim - Isolation in Endodontics 17  1. Permits the application of the rubber dam as a single unit during Winged Clamps are single tooth isolation Preferred for 2 2. Provides a broader bucco-lingual deflection of the dam from the isolated tooth - provides better access Reasons: Disadvantage : it could interfere with radiographic interpretation of files/cones Dr Nada Ibrahim - Isolation in Endodontics 18  Universal Clamp Designs Ivory “Butterfly”#9 Ivory #56 01 has small beaks, deep reaching 02 will isolate most molars and can be applied to most teeth. Dr Nada Ibrahim - Isolation in Endodontics 19  Additional Designs Deep Reaching Clamps Serrated Clamps 01 has small beaks, deep 02 for cases with minimal reaching and can be applied coronal structure. to most teeth. Dr Nada Ibrahim - Isolation in Endodontics 20  Failure to have a steady clamp may result in damages to the gingival attachment and coronal structure or be dislodged The clamp must have 4-point contact between the tooth and Dr Nada Ibrahim - Isolation in Endodontics beaks 21  Clamp Selection Select a clamp that will maintain 4-point contact with the tooth’s proximal surfaces If a clamp is too large, it will impinge on the soft tissues If its too small, it will not properly grasp the tooth’s surface and will be unstable Dr Nada Ibrahim - Isolation in Endodontics 22  Rubber Dam Disposable Napkin Prevents contact of rubber It absorbs saliva dam sheet to the skin thus seeping through It acts as a cushion preventing any possible the corners of the allergic reaction mouth Dr Nada Ibrahim - Isolation in Endodontics 23 Preparation for Rubber Dam Placement  Preparation for Rubber Dam Placement 01 02 03 perform additional Identification of Removal of caries, the tooth requiring defective procedures to allow treatment restorations rubber dam placement. Dr Nada Ibrahim - Isolation in Endodontics 25 Isolation of Teeth with Inadequate Coronal Structures  Isolation of Teeth with Inadequate Coronal Structures 1. 2. 3. 4. 5. Ligation Deep Reaching Clamps Bonding Clamping the Gingiva Loss of tooth Missing tooth Loss of tooth Young patients structure extends structure including structure extends with not fully below the gingival the natural height below the gingival erupted teeth tissues but there is of contour. tissues or below ITEM 05 adequate structure the crestal bone. Ligation with above the crestal Green marketing is a floss bone Retention is practice whereby Interproximal increased by companies seek to go rubber Wedjets Deep reaching bonding resin on above and beyond Multiple tooth clamps lingual/facial traditional. isolation Anterior clamp surfaces Dr Nada Ibrahim - Isolation in Endodontics 27  Serrated “Tiger” Clamp Deep Reaching Clamp Dr Nada Ibrahim - Isolation in Endodontics 28  Additional Resin for added isolation Deep Reaching Clamp & Clamping the Gingiva Dr Nada Ibrahim - Isolation in Endodontics 29  Rebuilding tooth wall with GIC Using Anterior ”Butterfly” clamp on a molar Dr Nada Ibrahim - Isolation in Endodontics 30 Bonding Rebuilding missing tooth structure Dr Nada Ibrahim - Isolation in Endodontics 31 Ligation – Using Interproximal Rubber Wedjets Dr Nada Ibrahim - Isolation in Endodontics 32  Replacement of Coronal Structure Dr Nada Ibrahim - Isolation in Endodontics 33  Replacement of Coronal Structure 1 Temporary Restorations 2Band Placement 3Provisional Crowns Rebuilding the missing structure A band can be cemented, and They should be removed before using temporary restorative the missing tooth structure the treatment to increase visibility, materials ( IRM, GIC, resins) replaced with IRM and recemented after. Dr Nada Ibrahim - Isolation in Endodontics 34 Corrective Surgery Dr Nada Ibrahim - Isolation in Endodontics 35  Corrective Surgery 1 Gingivectomy 2 3 Orthodontic Extrusion Crown Lengthening loss of tooth structure extends below is a procedure requiring an intrasulcular indicated when there is inadequate the gingival tissues but there is incision and flap reflection before osseous tooth structure for isolation. adequate structure above the crestal recontouring bone 36 Dr Nada Ibrahim - Isolation in Endodontics Application Techniques Dr Nada Ibrahim - Isolation in Endodontics 37  Application Technique 1. Single Motion Clamp , Rubber Dam, Frame together Dr Nada Ibrahim - Isolation in Endodontics 38  Application Techniques 2. Double Motion Clamp, Rubber Dam first, then the frame Dr Nada Ibrahim - Isolation in Endodontics 39 Techniques for Special Situations Dr Nada Ibrahim - Isolation in Endodontics 40  Multiple adjacent teeth needs treatment/ or extreme mobility 01 Posterior tooth is clamped normally, with a second clamp reversed Insufficient tooth structure/ or porcelain crowns where intact posterior tooth is in place 02 Split Dam technique AGENDA SLIDE 03 Bridge abutments, splints, orthodontics with wire Punch a larger than normal hole in the dam, use Liquidam for extra isolation Tooth with calcified pulp chamber and canals 04 Use the 3-tooth isolation technique. Posterior tooth is clamped normally, with a second clamp reversed Dr Nada Ibrahim - Isolation in Endodontics 42  1. Plaque is removed by rubber cup and pumice Disinfection of 2. Rubber dam is placed the Operating 3. Tooth surface, clamp , and surrounding rubber dam are scrubbed with 30% hydrogen peroxide Field 4. The surfaces are swabbed with 5% tincture of iodine or with sodium hypochlorite Dr Nada Ibrahim - Isolation in Endodontics 43 Butterfly clamp on a prepared molar Liquidam/GIC Using the adjacent tooth We do all of this…. Dr Nada Ibrahim - Isolation in Endodontics 44 To avoid this…. Courtesy of Dr Basem Othman Dr Nada Ibrahim - Isolation in Endodontics Bariatric Surgery Consultant 45 And this… Sodium Hypochlorite Accident Dr Nada Ibrahim - Isolation in Endodontics 46  You, your patient, and your assistant should ALWAYS ALWAYS ALWAYS wear eye protection gear !! Dr Nada Ibrahim - Isolation in Endodontics 47 Glasses.. Glasses.. Glasses !! Dr Nada Ibrahim - Isolation in Endodontics 48  Loss of Sight Caused by Calcium Hydroxide Paste Accidentally Splashed into the Eye during Endodontic Treatment: Case Report – A dentist accidentally splashed calcium hydroxide into her own eye while applying an aseptic endodontic treatment to a second mandibular premolar. Dr Nada Ibrahim - Isolation in Endodontics 49 – Alkali burns are typically more serious than acid burns because the alkali can rapidly penetrate the cornea into the anterior chamber of the eye (5–15 minutes) and damage the iris, ciliary body, lens and trabecular network. Lipski et al, Loss of Sight Caused by Calcium Hydroxide Paste Accidentally Splashed into the Eye during Endodontic Treatment: Case Report; J Can Dent Assoc 2012 50 Dr Nada Ibrahim - Isolation in Endodontics  Sodium Hypochlorite Chemical Burn in an Endodontist’s Eye during Canal Treatment Using Operating Microscope Desiree et al. Sodium Hypochlorite Chemical Burn in an Endodontist’s Eye during Canal Treatment Using Operating Microscope;JOE 2014 Dr Nada Ibrahim - Isolation in Endodontics 51  Difference Between Alkali & Acidic Burns Calcium hydroxide /Sodium Hypochlorite Alkali Burns Acidic Burns More Frequent Less Frequent Penetrates Quicker Penetrates slower Damages all structures Superficial injuries Liquefactive necrosis Coagulative necrosis Dr Nada Ibrahim - Isolation in Endodontics 52  This case report emphasizes the importance of taking special care with calcium hydroxide, a commonly used endodontic treatment, to avoid eye contamination because it can cause blindness. Conclusion Both the patient and the care provider should wear eye protection, such as glasses or a dental safety face mask. If calcium hydroxide is splashed into the eye, the eyelid flip should be done immediately with copious washing, followed by prompt ophthalmologic consultation. Dr Nada Ibrahim - Isolation in Endodontics 53 In the end simply.. NO RUBBER DAM NO ENDO Dr Nada Ibrahim - Isolation in Endodontics 54 References : Endodontics Principles and Practice : Chapter 14 : Isolation, Endodontic Access, and Length Determination Dr Nada Ibrahim - Isolation in Endodontics 55 Thank You ! Any Questions?!