methods of isolation and rubber dam.pptx

Rubber dam method of isolation rubber clamp locks rubber sheets

1. Methods of Isolation and Rubber Dam -Dr.Meghna Punjabi 2nd Year Post Graduate Student Department of Pediatric & Preventive Dentistry Nair Hospital Dental College,Mumbai

2. Introduction Isolation of the operating area in dentistry is the separation of a tooth or a group of teeth from other oral tissues, saliva and blood.  The idea of dental isolation was first put forward by Sanford Christie Barnum, an American dentist from New York in 1864. It is mainly done to improve the access, visibility and reduce the contamination.

3. Goals of isolation 1.Moisture control 2.Tissue Retraction 3 .Prevent accidental swallowing of restorative materials and instruments 4 .Prevent bacterial contamination from saliva 5.Protection 6.Improved quality of treatment

4. Methods of Isolation

5. Isolation from moisture Direct methods- 1) Cotton rolls and cellulose wafers 2) Rubberdam 3)Saliva ejector and evacuator systems 4)Gingival retraction cord 5)Throat shield

6. b) Indirect methods- 1)Patient comfort and relaxation 2)Local anaesthesia 3)Drugs- a)Anti-Sialagogues b)Anti - Anxiety

7. COTTON ROLLS AND CELLULOSE WAFERS They provide satisfactory dryness for most clinical procedures especially if used along with saliva ejectors.

8. RUBBER DAM -Introduced by S.C.Barnum in 1864

9. Grossman has stated that “in the eyes of the court, when an endodontic instrument escapes from the dentist’s fingers and is ingested or aspirated, expert opinion is unnecessary to justify claims of negligence . ”

10. Indications- A ll the restorative and endodontic procedures . Its use is imperative for reducing bacterial contamination in pulpal therapy. Bleaching High risk patients

11. Contra indications- Partially erupted teeth (serrated clamps/split dam) Latex allergies Asthma patients (airway obstruction) Severely malpositioned teeth

12. Advantages – 1.Improves the physical properties of restorations due to moisture control. Rubber dam shields the child from any sensations of debris or tastes of materials /prevents aspiration More comfortable for child as well as dentist Improved visibility and greater efficiency Prevents soft tissue damage

13. Disadvantages- Low usage amongst private practitioners Claustrophobic feeling Patient objection Sensitive for some hours after clamp removal

14. ARMAMENTARIUM

15. Rubber Dam Sheet a) Size of Rubber dam sheets - 5 inch by 5 inch( 12.5 cm by 12.5 cm) or 6 inch by 6 inch (15cm by 15cm) b) Sides - glossy and matte c) Latex /non latex sheets d)T hickness of the sheets-

16. Rubber Dam P unch - There are two main types: a single-hole punch of one size (1.63 mm or 1.93 mm) or a five-hole punch which can create five different-sized holes (0.5–2.5 mm) H oles for quadrant isolation is punched 3-4 mms apart

17. The largest hole for molars and the second- smallest hole for all other teeth being clamped. The second-largest hole may be used for other molar teeth being isolated, but not clamped

18. Rubber Dam Clamp

19. Youngs Frame Nygaard-Ostby frame Rubber Dam Holder /Frame Foldable frame Retracts and holds the edges of the dental dam sheet in place

20. Rubber Dam Clamp Forceps Instrument for placing, adjusting and removing clamps

21. It is an inked rubber stamp that helps in marking the dots on the rubber dam sheet according to the average position of the teeth Rubber Dam Template

22. Accessories Dental floss Wedjets Rubber dam lubricants Rubber dam napkins

23. Methods of Rubber Dam application Clamp first technique Dam first technique Clamp and dam together technique 4. Split dam technique

24. Clamp first followed by sheet

25. Sheet first followed by clamp

26. Clamp and sheet together

27. No Clamp Technique

28. Retraction with Floss

29. Split Stitch Technique

30. Single tooth isolation Multiple teeth isolation

31. SALIVA EJECTOR & HIGH VOLUME EVACUATOR Saliva ejector aspirates saliva collected in the floor of the mouth and to suction out water spray of airotor (Much slower rate than the high volume evacuator) Svedopter is a combination of saliva ejector and tongue retractor High volume evacuator used to suction out water spray of airotor (Speed of suction is high)

32. THROAT SHIELD This is a gauze sponge ( 2 x 2 inch) which is unfolded and spread over the tongue and posterior part of the mouth Used when there is danger of aspirating or swallowing small objects

33. DRUGS Anti - Sialagogues - medications which reduce salivation like atropine Anti - Anxiety drugs- medications that reduce apprehension and anxiety levels in patients

34. CONCLUSION In order to practice the highest standards of operative dentistry,proper control of the operating field is mandatory The use of dental dam has an important role in reducing aerosol contamination as well as increasing the success and efficiency of the treatment workflow, in addition to reducing overall treatment time.  Current guidelines have re emphasised that rubber dam should be universally employed for all endodontic treatment. Endodontic treatment carried out without use of rubber dam has implications both from a safety and medico-legal standpoint.

35. REFERENCES Ramya Raghu Clinical Operative Dentistry 2nd Edition Grossman’s Endodontic Practice 13th Edition Sturdevants Art and Science of Operative Dentistry 7th Edition Patel S, Hamer S, A simple guide to using dental dam. Br Dent J,230,644-650(2021) Patel, Shanon & Chong, Bun & Bhuva, Bhavin. (2008). Rubber Dam in Clinical Practice. Endodontic Practice. Rubber Dam for Restorative Dentistry,Australian Dental Association Guidelines