BDS 11131 Isolation Techniques PDF

Moisture control Harm Prevention Retraction Achieve proper treatment A thin latex or non latex sheet that is stretched around a tooth to isolate it from oral environment during dental work and prevent migration of fluid or objects into or out the operative field. 1. A dry, clean operative...

Moisture control Harm Prevention Retraction Achieve proper treatment A thin latex or non latex sheet that is stretched around a tooth to isolate it from oral environment during dental work and prevent migration of fluid or objects into or out the operative field. 1. A dry, clean operative field. 2. Improved accessibility and visibility. 3. Improved properties of dental materials. 4. Protection of patient and operator. 5. Retracts and protects the soft tissues (gingival tissues, tongue, lips and cheeks) against possible trauma from rotary and hand instruments 6. Improve treatment efficiency. 7. Reducing flooding of the oral cavity with fluids, especially those with unpleasant taste e.g (NaOCl) 8. Eliminates the need for repeated change of cotton rolls and frequent rinsing by the patient. 9. Minimizing patients’ conversation during treatment and encouraging them to maintain their mouths open. 1. Concerns over patient acceptance 2. Time required for application 3. Cost of equipment and materials 4. Insufficient training 5. Difficulty in use 6. Difficulty of taking radiographs Contraindication to the use of the rubber dam : 1. Asthmatic patients 2. Patients with latex allergy 3. Psychological reasons • Rubber dam sheet • Rubber dam clamp(retainer) • Rubber dam forceps • • • • • • • Rubber dam frame (holder) Rubber dam punch Rubber dam template Scissors Lubricant Dental floss Rubber dam napkin • Available in different thickness and color • Available in 5x5 inches or 6x6 inches • Made from latex • Has a shiny (Tissue) and dull side (Occlusal) • Have a sharp pointed plunger • A rotating metal disc with six holes of varying sizes according to tooth being isolated ✓Small holes-----anterior ✓Large holes----- posterior • The distance between the holes : • If excessive ---- will wrinkle between the teeth • Too little--- dam will stretch, leakage Parts of the clamp • Classification of clamps Butterfly Clamps Winged clamps Wingless clamps Gingivally approaching clamps • A properly selected clamp should contact tooth at four points. • Two on the facial surface and two on the lingual • Used to apply or remove the clamp from the tooth. Ivory Pattern Ash-or-Strokes Pattern • It is a U-shaped frame • Can be made from metal or plastic • Has small projections to hold the dam • Functions: 1. Maintains borders of the dam in position 2. Retracts soft tissues Placed between rubber dam and patient’s skin 1.Avoid direct contact with latex so avoid allergy. 2.Absorb any saliva seeping at corner of the month. • It is preferred to punch a hole on either the upper right corner or upper left corner of the rubber dam as identification hole to facilitate relocation of that corner when applying the dam to the holder. • FIRST METHOD:- Clamp Placed Prior To Rubber Dam • SECOND METHOD:- CLamp And Rubber Dam Together • THIRD METHOD:- Rubber Dam Before Clamp Placement To restore function due to difficulty in mastication • Proper orientation • Better sealing of chamber floor • Easier insertion of rotary instruments Or Functional Prevent gingival overgrowth inside the cavity or To allow soft tissue to heal before crown lengthening Build up Aesthetic To restore badly decayed tooth in the aesthetic zone • Rubber dam should not obstruct patient’s airway • It should not cover his nose • Holes should be prepared in rubber dam for patients with upper respiratory tract obstruction • Patients with allergy to latex ----Latex free rubber dam should be used • Clamps can be tied with floss to ease their grip with any accident • breakage or swallowing • When several teeth require treatment the operating field extended mesially or across the arch. • The more teeth included the better retraction of the lip, cheek, tongue and better the access. cord roll Floss Ligatures: Used to retract/displace the rubber dam sheet more apically 1. Aid in retraction of soft tissue 2. Increase visibility of the tooth • Light cured resin barrier used for isolating tissue adjacent to teeth • Used in areas : • undercuts • large embrasures • around periodontially involved teeth. Clamps • Clamp with anterior extension. • Indication: used with severely broken-down tooth • The clamp itself is placed on a tooth proximal to the one being treated Clamps • It is used to retract, protect the cheek and tongue along with isolation • Can be used with gauze and cotton rolls for retraction of tongue and cheeks Clamps • Clamps with serrated jaws 1- Increase stabilization 2- Indication: • Partially Erupted • Badly Broken Tooth Clamps • Increases patient comfort through • Enhances rubber dam seal • Protect natural tooth structure • Protects delicate, costly restorations. • Reduces clamp slippage. Clamps • Disposable. • Will not interfere with x-rays. • Gentle on tissue/implants. Rubber Dam • it is a rubber dam with a 3-dimensional shape • Designed to reduce tension for easier rubber dam application and low risk of clamps coming off Rubber Dam • It differs from Optidam by having Embedded frame and Printed dots • Used mainly for anterior teeth isolation • It is a pre-framed rubber dam thus, no need for traditional frames. • Easy to place, allows easy access to oral cavity during the root canal procedure. Rubber Dam • It has a small rubber sheet in the center. • It fits like a face mask with an absorbent lining. • More Comfort • Less allergic risk. • No frame. • Isolation of Anterior teeth. t. Isolation Techniques • Isolation of a badly broken down tooth. • Technique: one hole is punched ,stretched over the clamped tooth and to the anterior tooth where the dam is stabilized with wedge. Isolation Techniques Indication: • inadequate tooth structure Technique: • one clamp is placed on the distal tooth that will take up the elasticity of the dam • The second clamp is gently positioned on the offended tooth. Isolation Techniques Option 1: Posterior teeth is clamped normally whereas second clamp is reversed (with the bow pointing mesially) on the most anterior tooth Option 2: The most posterior tooth is clamped normally and the anterior portion of the dam is retained without a clamp. Option 3: Quadrant Isolation with one clamp on most posterior tooth and the other clamp retained on contralateral tooth Isolation In Difficult Clinical Situations • Option 1: Gingivally Approaching Clamps/ modified bow clamp • Option 2: Tiger Clamps serrations help in stabilization of the clamp • Option3: Self curing resin beads can be placed on the cervical area of the tooth; this will help in stabilizing the clamp in position during treatment. Option 1: Gingivally approaching clamps Option 2: S-G (Silker Glickman) clamp Option 3: Double clamp technique Option 4: Split dam technique • Problem: no enough space to place the clamp in position • Option1: rubber dam is placed on the tooth which is teased beneath the contact area with the help of a floss and is stabilized by two fragments of the dam instead of the clamp. • Option 2: Widgets can also be used in place of dam. • Option 3: quadrant isolation Orthodontic wire prevents tight sealing of the rubber dam sheet. Tight seal can be achieved by: 1- Oraseal application. 2- Position the clamp above the orthodontic attachment Errors During Rubber Dam application and Removal 1-Inappropriate distance between the holes. • Too close – holes pull away from teeth causing leakage • Too far apart–will be wrinkles between the teeth 2-Incorrect arch form of holes. -Too small holes: sheet will be stretched permitting leakage. -If the punched arch form is too large, the dam will wrinkle around the teeth and thus may interfere with access. 3-Retainer-pinched tissue. If the clamp was applied on the gingiva not on the toot 4- Shredded / torn sheet 5- Unstable clamp when little tooth structure remains can result in damage to gingival attachment and coronal structure. • Latex allergy • Symptoms: • swelling • redness of the skin • cracked, itchy and dry skin