Isolation Pallavi

8/13/2019 Isolation Pallavi

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Good morning..


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ISOLATION IN DENTISTRY

Presented by:

Dr. Pallavi B. Gopeshetti,

CODS, Dvg


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CONTENTS Introduction

Oral environment & goals of isolation

Isolation from moisture

-DIRECT METHODS RUBBER DAM

-history-advantages & disadvantages

-indications & contraindications

-additional uses

-materials & instruments-preparation of the dam

-selection & preparation of the clamp

-preparation of the mouth-a lication techni ues


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-Application of rubber dam in children

-Removal of the dam

-Errors in application & removal

-Special considerations-ADVANCES Optra dam

Opti dam

Handi dam Derma dam

Insti dam

Dry dam

Opal dam

Flexi dam

Isolation of the root canals

Isolation in periapical surgeries

Isolation in laser therapy


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Fluid absorbing materials

Debris & fluid evacuation equipments

Soft tissue isolationTissue retractors & protectors

-INDIRECT METHODS

Comfortable positioning ofpatient & relaxed surroundingsLocal anestheticsDrugs

Possible complications &corrective measures in isolationReferncesConclusion


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ORAL ENVIRONMENTSaliva

Moving organs

Lips & cheeks

Periodontium

Respiratory moistureDeposits


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GOALS OF ISOLATION

Moisture controlRetraction and access

Harm prevention


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ISOLATION FROM MOISTURE

Direct methods

*Rubber dam

*Cotton rolls & holder

*Gauge pieces

*Absorbent wafers*Suction devices

*Gingival retraction devices

Indirect methods*Comfortable position &relaxed surrounding to thepatient

*Local anesthetics*Drugs


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RUBBER DAMHISTORY:Dr. Sanford Christie Barnum on 15thmarch 1864,

Connecticut valley dental society, New York

1870, Dr. J.F.P. Hodson,7 types of clamps & no forceps used


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1878,Dr.Elliot design

1879, Ainsworth rubber dam punch

1880, Dr.Hickmanslipped clamps

1880, Dr.Tees festooned clamps


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ADVANTAGES

Dry and clean operating field

Access & visibilityImproved property of dental materials

Protects patient and operator

Operator efficiency

ABCDs of rubber dam

Adequate access and visibility in the operating field

Better patient protection and management

Control of moisture in the operating field

Decreased operating time


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DISADVANTAGES


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INDICATIONS

Endo, bleaching, caustic chemicals


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CONTRAINDICATIONS

o Allergieso Asthmatic patients

o Psychological reasons


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M l d


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Materials and instrumentsRUBBER DAM SHEET 55 & 66 Traditional dam- black Green, blue, natural

Surfaces

Shelf life

Thickness mm inch

Thin 0.15 0.006

Medium 0.20 0.008

Heavy 0.25 0.010

Extra heavy 0.30 0.012Special heavy 0.35 0.014


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Non latex rubber dam Synthetic/silicone, Powder free

Size & thickess

Shelf life

Tensile strength (N= 27.6 MPa)


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RUBBER DAM PUNCHESTypes:

Sterilization

Single hole

2 sizes

Multiple

hole

Ivorypattern

Ash/ainsworthpattern

T i bl


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Two main problems:a) Blunting of the sharp cutting edges.b) Damage to the punch point & anvil.


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RUBBER DAM FORCEPS

Parts.

Sterilization..

Working life.

Sliding ring

Forceps handles

HingeForceps arms

Pointed tips


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Ivory pattern

University ofWashington

pattern

Ash/ strokespattern


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The tips of the rubber dam forcepsmodified for ease of use.

The second groove for

removal of the rubberdam clamp


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RUBBER DAM FRAMESFernaulds frame

Metallic

Youngs frame

Endon frame


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HARNESSES Advantages

Advantages of frames over harnesses

Types: Woodburry

Wizzard

RUBBER DAM CLAMPS /


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RUBBER DAM CLAMPS /RETAINERS

Parts

Shelf life

Sterilization

Types:


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Types:

Winged

WinglessBland

Winged

WinglessRetentive

4 pointcontact

Circumferentialcontact

Anchoringclamps


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Single

bow

Doublebow

Metallic

Plastic

Carbon steel plated

Stainless steel


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Sizes:

Maxillary teeth Clamps

Maxillary molar 6, 9, 210, 212

Central incisor 6, 9, 210, 00

Canine 6, 9, 210

Premolars 0, 2, 2A, W2A

Molars 3, W3, W8A, 14,14A

Mandibular teeth Clamps

Incisors 6, 9, 210, 212

Canine 6, 9, 210

Premolars 0, 00, 2, W2A

Molars 3, W3, W8A, 14, 14A

SPECIALIZED CLAMPS


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SPECIALIZED CLAMPS

Extended bows

Modified bow clamps Cervical retainers

Tiger clamps

S-G (Silker Glickman) clamps Fit Cervical Clamp 214

ANCHORS/ OTHER RETAINERS


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ANCHORS/ OTHER RETAINERS

Dental floss(waxed)/ dental tape

Cut rubber dam sheet Wedjet Stabilizing cords Wedges Elastic rings

Modeling compound


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NAPKINS


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LUBRICANTS Hygienic or KY jelly or topical LA

Cocoa butter/ petroleum jelly


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TEMPLATES AND STAMPS

PREPARATION OF THE DAM


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PREPARATION OF THE DAMSelection

Position of the holes-Single tooth isolation

-Multiple tooth isolation

Heavy

Thin

Dark

Light/translucent Medium

GUIDELINES FOR MAKING THE HOLES


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GUIDELINES FOR MAKING THE HOLES


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PUNCHING OF THE DAM


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PUNCHING OF THE DAM

PUNCHING THE HOLES

LUBRICATING THE DAM

SELECTION OF THE CLAMP


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SELECTION OF THE CLAMPAnchor teeth..

Endo treatment and cervical lesions

Anterior teeth

Most distal tooth

Acid etching

Maximal coronal diameter

four point contact

Length of the clamp jaw = MD width of the root Criterion:..

E E E


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CORRECT CLAMP PLACEMENT

TESTING THE CLAMPS

STABILITY & RETENTION

CUSTOMIZATION OF THE CLAMPS


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CUSTOMIZATION OF THE CLAMPSS.S clamps- cold working, carbon plated- heat working


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Dentsply pattern C, Hygenic Ferrier 212, Ash No. 6


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FLOSS TYING


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FLOSS TYING

PREPARATION OF THE MOUTH


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PREPARATION OF THE MOUTH Deposits

Contacts

Rinse mouth Shade selection

Anesthesia

Mark the tooth

Endodontic access

Post application rinsing TESTING & LUBRICATINGPROXIMAL CONTACTS

APPLICATION TECHNIQUES


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APPLICATION TECHNIQUES

DOUBLE MOTION TECHNIQUES:

Clamp placement prior to the rubber dam

TESTING THE CLAMPS

STABILITY & RETENTION

POSITIONING THE DAM

OVER THE CLAMP


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APPLYING THE NAPKIN POSITIONING THENAPKIN


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ATTACHING THE FRAME ATTACHING THE NECKSTRAP [ OPTIONAL ]


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PASSING THE DAMTHROUGH POSTERIOR

CONTACT

APPLYING THECOMPOUND [ OPTIONAL]


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APPLYING THE ANTERIORANCHOR [ IF NEEDED ]

PASSING THE SEPTA THROUGHTHE CONTACTS WITHOUT

TAPE


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PASSING THE SEPTATHROUGH THE

CONTACTS WITH TAPE

TECHNIQUE FOR USINGTAPE [ OPTIONAL ]


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INSERTING THE WEDGES

Cl l d ft th bb d


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Clamp placed after the rubber dam

SINGLE MOTION TECHNIQUE


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SINGLE MOTION TECHNIQUEClamp & rubber dam placed together ( endodontics)

Application of dam in children


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Application of dam in children Sheet55"

Frame5 Youngs pattern Clamps S.S White No. 27 for primary and Ivory No. W14 for young

permanent teeth, retentive type

Tell-show-do tech.

Euphemisms like rubber rain coat

REMOVAL OF THE RUBBER


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REMOVAL OF THE RUBBERDAM

CUTTING THE SEPTA REMOVING THERETAINER


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REMOVING THE DAM WIPING THE LIPS


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MASSAGING THETISSUES

EXAMINING THE DAM

ERRORS IN APPLICATION &


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ERRORS IN APPLICATION &REMOVAL

Off-center arch form

Inappropriate dist. between the holes Incorrect arch form of the holes

Inappropriate retainer

Shredded/ torn dam

Sharp tips on No. 212 retainer

Incorrect technique of cutting septa

SPECIAL CONSIDERATIONS


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SPECIAL CONSIDERATIONS

EVACUATION OF THE FLUID FROM DAM:

Modified saliva ejectors (Lambert)

Wash field apparatus


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Wash field apparatusChilders and Marshall

Benavides and Herrera


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Endon frames

SUBSTITUTION OF THE RETAINER


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WITH MATRIX

SEALING OF THE ROOT CONCAVITY/


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GAPS


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RADIOGRAPHIC TECHNIQUES


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RADIOGRAPHIC TECHNIQUES

Hemostats & Rinn Eezee- grip


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Tongue spatula Masel Precision endodontic holder

CALCIFIED CANALS


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CALCIFIED CANALS

UNUSUAL SHAPES AND POSITIONS

BLEACHING


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BLEACHING

Use of opal dam..

LOSS OF TOOTH/ PORCELAIN CROWNS/VENEERS


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VENEERS

SPLIT DAM TECHNIQUE

FIXED BRIDGE ISOLATION


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FIXED BRIDGE ISOLATION Slit tech.

Large hole technique(Antrium)

EXTENSIVE LOSS OF TOOTHE


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STRUCTURE Periodontal procedures

Orthodontic procedures Restorative procedures: Canal projection

MEDICAL PROBLEMS


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MEDICAL PROBLEMS

Mouth breathing

Allergies


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High risk patients

ADVANCES


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DERMA DAMADVANCES

INSTI DAM


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FLEXI DAM


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FLEXI DAM

OPTI DAM


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HANDI DAM


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HANDI DAM

DRY DAM


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DRY DAM

(Svenska)

OPTRA DAM


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OPTRA DAM

OPAL DAM


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OPAL DAM

ISOLATION OF THE ROOT CANALS


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FROM MOISTURE-Absorbent points-Needle of the syringe in the canal andwithdrawing the plunger slowly.-Stropko drier

Stropko irrigator / drier with

ultradent microtip

Isolation in periapical surgeries


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Isolation in periapical surgeries Profound anesthesia

Micro mirrors and retractors Preoperative considerations

Localized haemeostasis Suction tips


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Suction tips

Wire styletFraser suction tip

Stropko irrigator / drier with

ultradent microtip

ISOLATION IN LASER THERAPY


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Ventilation, evacuation, respiratory protection

Adequate suction Protection of non target tissues

FLUID ABSORBING MATERIALS


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COTTON ROLLS AND HOLDERS

Holders


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Application techniques


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pp q

Application techniques


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pp q

ABSORBENT PADS/ CELLULOSEWAFERS


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WAFERS

DRI AID

(Young dental)


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GAUZE PIECES/ THROAT SHIELDS


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2 2 (5 5 cm)


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DEBRIS AND FLUID EVACUATIONEQUIPMENTS


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HIGH VOLUME EVACUATION

-0.5 l of water in 2 sec-75%-95% water & 100% debris

Metallicautoclavable tips

Disposable plastic

TRK-O-VAC (Plasdent)

EQ MEN


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SALIVA EJECTORS


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Metallicautoclavable tips

Disposableplastic

Placement


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MODIFIED SALIVA


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EJECTORS

WASH FIELD APPARATUS


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WASH FIELD APPARATUS

SWEFLEX SALIVA EJECTORS


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SVEDOPTER


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E. C Moore


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HYGOFORMIC SALIVA EJECTORS


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FAST DAM


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17 suction holes along the perimeter

(Practicon)

MIRRO-VAC SALIVA EJECTORMIRRORS


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MIRRORS

DRY FIELD SYSTEM


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SOFT TISSUE ISOLATION- TISSUERETRACTION & PROTECTION


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TONGUE RETRACTORS:

Guards and depressors

Svedopter


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LIP RETRACTORSSi l li t t 11 4 "


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Simple lip retractor, 11cm 4 "

Wire lip retractorOringer lip retractor

Plastic lip retractors, adult 12cm 4 "

CHEEK AND TONGUE RETRACTORSDISPOSABLE SPAND EZZ EXPANDERS


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DISPOSABLE SPAND- EZZ EXPANDERS

Sizes: small (green)

medium (blue)large (red)


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GINGIVAL RETRACTION AIDS


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Gingival retraction collars

Retraction cords


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MOUTH PROPS


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Mouth

props

Rubber

LatexNonlatex

Molt

Ratchettype

MIRROR AND EVACUATOR TIPS


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ISOLITE


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Size- adult small

-adult medium-adult large

-pediatric


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Attach mouthpiece to Isolite tube

Align Bite Block at 1st or 2nd bicuspid area keeping Cheek Shield outside the mouth.


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Place Isthmus behind maxillary tuberosity. Position Cheek Shield in buccal vestibule


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INDIRECT METHODS


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COMFORTABLE POSITION OF PATIENT

AND RELAXED SURROUNDINGS

LOCAL ANESTHESIA


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DRUGS


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Antisailogouges

Antianxiety drugs and barbiturates sedatives Muscle relaxants


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Swallowing/ aspiration of the foreign bodies


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CONCLUSION


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THANK YOU.


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Documents

Isolation Pallavi