Isolation of operating field

• 1. Presented by: Piyush Verma Dept of Paedodontics & Preventive Dentistry

2. Contents Introduction Goals of isolation Advantage of isolation Methods of isolation Direct methods Indirect methods Conclusion 3. Introduction good accessibility and visibility , adequate room for instrumentation Necessary for easy manipulation and insertion of restorative materials This control is attained through isolation 4. Goals of isolation Moisture control Retraction and access Harm prevention Safe and aseptic operating field Prevent accidental swallowing of restorative materials and instruments 5. Advantages of isolation Patient related: A. Provides comfort B. Protect from swallowing or aspirating foreign bodies C. Protect soft tissues by retracting them 6. Operator related: A. dry clean operative field B. Infection control C. Increased accessibility to operative site D. Improved properties of restorative materials E. Improved visibility & less fogging of mirror F. Prevents contamination of tooth preparation 7. Methods of isolation Direct method : Rubber dam Cotton rolls & cellulose wafers Dri-angle Gauze piece Suction devices Gingival retraction cords Mouth props Mouth mirror 8. Rubber dam One of the most effective means of isolating teeth Developed by SC Barnum in 1864 9. Advantages of rubber dam Increases visibility & accessibility Provides a dry field Effectively retracts tongue, cheeks away from the field of operation Saves time Reduces the chances of injury to soft tissues Produces calming effect in children Protects against bad taste of the materials used Prevents any aspiration or ingestion of dental instruments 10. Case reports Panse A et al, 2012 presented 3 cases of ingestion of dental objects in 3 children in which rubber dam was not used 11. Case 1 X ray shows a bur at the level of L4 Vertebra in left lumbar region in a 4 yrs child, aspirated during access cavity preparation of 55 with an airoter hand piece 12. Case 2 X ray shows a finishing bur at the level of L5 vertebra in left lumbar region in a 6 yrs old male child, aspirated while finishing restoration in his decayed 64, 65 13. Case 3 X ray shows an airoter cap at the level of L5 vertebra in left lumbar region 14. Disadvantages of rubber dam Takes time to be applied Communication with the patient can be difficult Incorrect use may damage porcelain crowns/gingival tissues Insecure clamps can be swallowed or aspirated 15. Contraindications child with upper respiratory tract infection, congestion of nasal passage or nasal obstruction Presence of some fixed orthodontic appliances recently erupted tooth Patients with allergy to latex grossly carious teeth 16. Armamentarium Rubber dam sheet Rubber dam template Rubber dam punch Rubber dam clamps Rubber dam forceps Rubber dam frame Rubber dam napkin Waxed dental floss Scissors Lubricants 17. Rubber dam sheet made of latex or non-latex. Available in 2 sizes- 5*5 6*6 Available in varying thickness Thin 0.15 mm Medium 0.20 mm Heavy 0.25 mm Extra-heavy 0.30 mm Special heavy 0.35mm 18. Light and dark sheets are available, may be flavored for the children Has a shiny and dull surface, dull side will be facing the occlusal side 19. Rubber dam template Have positions of the teeth marked on them and are used to transfer them to the rubber dam sheet for holes to be punched 20. Rubber dam punch Used to make the holes in the sheet through which the teeth can be isolated 21. Common hole placement problems Holes punched too close together holes pull away from teeth causing leakage Holes punched too far apart dam bunches up between teeth Holes position too low on the dam dam covers patients eyes or nose Holes position too high on dam dam does not extend over upper lip 22. Rubber dam clamps Made of shiny & dull stainless steel consists of a bow & 2 jaws Aid in anchoring the dam to the tooth & in soft tissue retraction 2 types : Winged Wingless Wingless Winged 23. Frequently used clamps used in pediatric dentistry : 12A clamp -- maxillary left second primary molar and the mandibular right second primary molar 13A clamp -- maxillary right second primary molar and the mandibular left primary second molar. 12A clamp 13A clamp 24. 2A clamp -- first primary molars 14 clamp -- fully erupted permanent molars 14A clamp -- partially erupted permanent molars 2A clamp 14 clamp 14A clamp 25. Clamps for front teeth Ivory # 6 Ivory # 15 Ivory # 212SIvory # 90N Ivory # 9 26. Dental floss After selecting the appropriate clamp place a 12 inch piece of dental floss on the bow of the clamp to aid in retrieval of the clamp if it is dislodged from the tooth and falls into the posterior pharyngeal area 27. Rubber dam clamp forceps Used for placement and removal of retainer from the tooth. 28. Types of forceps Brewer 246-046 Stockes 246-047 Ivory 246-048 29. White 246-051 Plamer 246-052 30. Grooves on their outer surfaces to ensure positive location of the clamp during expansion & placement. 31. Rubber dam frame maintains the border of the dam in position Support the edges of the rubber dam Retract the soft tissues Available in metal and plastic 32. Plastic frame : Nygard-Ostby frame U-shaped frame made of plastic Because of its shape, exerts less tension on the dam Easier to use Requires no absorbent napkin, when taking radiographs Stands away from face 33. Metal frame : Young frame U-shaped metal frame with small metal projections for securing borders of the rubber dam. 34. Modifications Le Cadre Articule rubber dam frame (articulated frame) Developed in France by Dr. G Saveur Curved to fit the face and hinged in the middle to fold back Advantage -- Allows easier access for radiographic film placement 35. Handidam (Aseptico, Woodenville) Has a built in foldable radiolucent frame and a plastic tube inserted in prepared holes in rubber dam material to keep the dam open Available in one size 36. Advantages Pre-framed, flexible design facilitates access to the oral cavity for suction, X-ray films, or digital X- ray sensors Extremely low protein content reduces patient irritation (