~ 1 ~ FIELD ISOLATION METHODS OF ISOLATION OF AREA OF THE MOUTH OR A TOOTH; Rubber Dam Isolite Svedopter Hygoformic Saliva Ejector Vac-Ejector Absorbent Paper & Cotton products RUBBER DAM Most complete method of obtaining field isolation. Sanford C. Barnum introduced rubber dam in 1864. Important barrier for prevention of microbial transmission from patients to members of dental care team and prevent the aspiration of small objects like; dental burs, endodontic files. ADVANTAGES; o Improve visualization o Complete isolation o Patient protection & comfort o Improved quality and quantity of restorative services o Reduction in microbial transmission/ airborne debris o Prevention of aspiration o Operative field free of saliva and other contaminants There is no any difference in the quality/ performance of restoration b/w use of rubber dam or non-rubber dam isolation methods. o Coz, effective bonding depends upon avoidance of contamination not on the method of field isolation. Even properly placed cotton rolls can give similar strength to the restoration which is placed under rubber dam. INSTRUMENTS AND MATERIALS Rubber dam material Napkin Hole-positioning guides Rubber dam holders Clamp forceps Clamps Other retainers Modeling compound Inverting instrument Wedge Scissors Dental tape and floss Interproximal contact disk Lubrican RUBBER DAM MATERIAL Colors; green, lavender, grey, ivory o In Operative Dentistry, use rubber dam which is in contrast with tooth. That’s why ivory colored dam is not used in operative dentistry. Grey colored dams are good for matching color in tooth colored restoration. It may be made of latex or non-latex material. o Non-latex materials are preferred now a day due to increased incidence of allergy. Available in rolls of 5-6 inches wide or 5-6 inches’ square. Thickness of rubber dam. (gauge of rubber dam) (table 8-1 in Summit) o The heavy [0.010(0.009-0.015) inch] and extra-heavy [0.012(0.0115-0.0135) inch] gauges are recommended for isolation in operative dentistry. o Advantages of heavy dam; Less tear Better seal Effective tissue retraction Shelf life of rubber dam o More than a year in latex dam Aging is accelerated by heating characterized by brittleness and easy tear. o Can be stored in refrigerator to extend shelf life. o Healthy/ strong dam will be very difficult to tear when sheet is grasped with thumbs and index fingers. NAPKIN It is a piece of strong, absorbent cloth/paper placed b/w rubber dam and patient’s face. (Fig; 8-1 in summit) Provide comfort to patient.
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FIELD ISOLATION METHODS OF ISOLATION OF AREA OF THE MOUTH OR A TOOTH;
Rubber Dam Isolite Svedopter
Hygoformic Saliva Ejector Vac-Ejector Absorbent Paper & Cotton products
RUBBER DAM
Most complete method of obtaining field isolation.
Sanford C. Barnum introduced rubber dam in 1864.
Important barrier for prevention of microbial transmission from patients to members of dental care team and prevent
the aspiration of small objects like; dental burs, endodontic files.
ADVANTAGES;
o Improve visualization
o Complete isolation
o Patient protection & comfort
o Improved quality and quantity of restorative services
o Reduction in microbial transmission/ airborne debris
o Prevention of aspiration
o Operative field free of saliva and other contaminants
There is no any difference in the quality/ performance of restoration b/w use of rubber dam or non-rubber dam isolation
methods.
o Coz, effective bonding depends upon avoidance of contamination not on the method of field isolation.
Even properly placed cotton rolls can give similar strength to the restoration which is placed under
rubber dam.
INSTRUMENTS AND MATERIALS
Rubber dam material
Napkin
Hole-positioning guides
Rubber dam holders
Clamp forceps
Clamps
Other retainers
Modeling compound
Inverting instrument
Wedge
Scissors
Dental tape and floss
Interproximal contact disk
Lubrican
RUBBER DAM MATERIAL
Colors; green, lavender, grey, ivory
o In Operative Dentistry, use rubber dam which is in contrast with tooth.
That’s why ivory colored dam is not used in operative dentistry.
Grey colored dams are good for matching color in tooth colored restoration.
It may be made of latex or non-latex material.
o Non-latex materials are preferred now a day due to increased incidence of allergy.
Available in rolls of 5-6 inches wide or 5-6 inches’ square.
Thickness of rubber dam. (gauge of rubber dam) (table 8-1 in Summit)
o The heavy [0.010(0.009-0.015) inch] and extra-heavy [0.012(0.0115-0.0135) inch] gauges are
recommended for isolation in operative dentistry.
o Advantages of heavy dam;
Less tear
Better seal
Effective tissue retraction
Shelf life of rubber dam
o More than a year in latex dam
Aging is accelerated by heating characterized by brittleness and easy tear.
o Can be stored in refrigerator to extend shelf life.
o Healthy/ strong dam will be very difficult to tear when sheet is grasped with thumbs and index fingers.
NAPKIN
It is a piece of strong, absorbent cloth/paper placed b/w rubber dam and patient’s face. (Fig; 8-1 in summit)
Provide comfort to patient.
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Smaller napkins are used with rubber dam frames.
Larger napkin is used with strap- or harness-type rubber dam holders. (Retracting straps).
PUNCH (FIG; 8-2, 8-3, & 8-4 IN SUMMIT)
These causes holes in the rubber dam
Ainsworth-design (Hygenic) rubber dam punch
Ivory-design (Heraeus Kulzer) rubber dam punch
o Has self-centering coned piston or punch point.
This prevent partial punching of holes.
Contain hardened steel cutting tables/anvils with range of holes’ size for different teeth.
Incomplete holes in rubber dam causes;
o Improper seal
o easy tear
HOLE-POSITIONING GUIDES
These helps to determine where holes should be punched.
1. Teeth as guide
a. In this dam is placed on teeth in mouth or on a cast of patient and then teeth under treatment is marked
with pen and then holes are punched.
b. Advantages; precise positioning even teeth are mal-aligned.
c. Disadvantages; time consuming, dam is punched after the seating of patient.
2. Template (fig;8-5 in summit)
a. Of same size and shape of unstretched dam.
b. In this template is placed over dam and tooth is marked with pen which is then punched.
c. Advantages; dam is punched before the patient and less time consuming.
3. Rubber dam stamp (fig; 8-6 & 8-7 in summit)
a. They are very convenient and efficient way of marking the dam for punching.
b. Max centrals are positioned approx. one inch from the top of dam.
RUBBER DAM HOLDERS
1) Strap holders/Woodbury holder
2) Frame holders
3) Pre-attached frames
STRAP HOLDERS (FIG; 8-8 IN SUMMIT)
Provide most cheek and lip retraction, access and stability.
But, cause high patient discomfort that’s why rubber dam napkin is necessary in this type.
FRAME HOLDERS (FIG; 8-10 IN SUMMIT)
1. Young frame
2. Nygaard-Ostby frame
YOUNG FRAME
U shaped, made of metal or plastic.
Available in both adult & child size.
Plastic frame is advantages when radiographs are taken after rubber dam coz it is radiolucent.
o But these have shorter life span and are damaged by heat sterilization.
While metal is less bulky and last for years.
They have balls at the ends for support of dam and hold it in place.
Young frame is placed outside of dam and is not touched with patient.
While Nygaard-Ostby frame is placed inside of rubber touching skin of patient or dam napkin.
Some young frame contains hooks for attachment of strap holder to give additional support & retraction to rubber
dam.
PRE-ATTACHED FRAMES (FIG; 8-11 IN SUMMIT)
Example; Handidam, Aseptico,
These are types of rubber dam which come in built-in frames for holding.
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Optra Dam Plus (ivoclar Vivadent) fits intraorally and assist in cheek retraction.
o Optra Gate is useful for retracting lips and cheeks in anterior region.
CLAMP FORCEPS
A. Ivory-type clamp forceps
a. Have differently angled beaks
b. Prevent the rotation of clamps on the beaks.
i. This prevent the proper placement of clamp on those teeth which are not in normal angulation.
c. Ivory are most popular because of cost
B. Stroke-type clamp forceps
a. Allows rotation of clamps around the beaks.
b. It easily places the clamp on those teeth which are mesially or distally angled.
CLAMPS
These are devices which retain rubber dam around tooth.
3 types; (Fig; 8-13 in summit)
o Winged rubber dam clamp
o Wingless rubber dam clamp
o Butterfly rubber dam clamp
In posterior teeth, the clamp is placed on most distal most exposed tooth. (Fig; 8-14 in summit)
o It can be placed on unexposed tooth. (Fig; 8-15 in summit)
Some clamps have number written on the clamp for tooth, while some have ‘W’ written which means wingless, if
‘W’ is not written then that clamp is winged.
o Wings help in attachment of dam on the clamp before dam placement intraorally.