Assalam Alekum Date: 11/09/2014

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Elements in isolation Advantages of isolation Methods of isolation

 MOISTURE CONTROL: It refers to excluding sulcular fluid , saliva, bleeding from operating site.  RETRACTION: It refers to temporarily displacing or depressing soft tissue like ,tongue , lips, & cheek from operating site.

 Protection from injuries: It refers to prevention of cross infection, soft tissue damage, Prevention of accidental aspiration of debris , small instruments & restorations

CONCEPTUAL ELEMENTS IN ISOLATION

MOISTURE CONTROL RETRACTION Protection from injuries

ADVANTAGES OF ISOLATION

 DRY ,CLEAN OPERATING FIELD  IMPROVED ACCESS & VISIBILITY  PROTECTION OF PATIENT & OPERATOR  OPEARTING EFFECIENCY  IMPROVED PROPERTIES OF DENTAL MATERIALS

Methods of ISOLATION

--RUBBER DAM (Recommended) --HIGH VOLUME EVACUATORS --SALIVA EJECTORS --COTTON ROLLS , GAUZE PIECES, cellulose wafers --THROAT SHEILDS --mouth MIRROR --RETRACTION CORD --MOUTH PROP --DRUGS-ANTISIALOGOUGES ,LOCAL ANAESTHETICS

RUBBER DAM

 Introduced in 1864 by S.C. BARNUM , New York city dentist.

Purpose: -provides absolute isolation of operating field from the surrounding. - Heavy rubber dams when used are capable of retracting the gingiva in addition to the isolation.  The rubber dam has been the most successful method of isolation till date and can be placed in 3-5 minutes

RUBBER DAM KIT

Rubber Dam Sheet  Made of latex rubber  Size: 5x5 inches/ 6x6 inches  Thickness: Thin: 0.15 mm Medium: 0.20 mm Heavy: 0.25 mm Extra heavy: 0.30 mm Special heavy: 0.35 mm  Has shiny and dull side  Dull side facing occlusal to the isolated teeth to prevent unnecessary light reflection  Thicker dam is more effective in retracting tissues and more resistant to tearing  Generally dark, heavy, 6x6 inch sheet are recommended.

Rubber Dam Napkin  Applied between pAtient’s mouth and dam sheet  Prevent saliva from drooling out  enhAnce pAtient’s comfort

Rubber dam FRAME Metal frame: Young’s frame Plastic frame: Nyggard Ostby PUNCH FORCEPS

PUNCH WITH ROTATING TABLE HOLE SIZE ON ROTATING TABLE (ideal distance between two holes: 6.3mm) TEMPLATE TO POSITION HOLES ON SHEET

Rubber dam RETAINERS/ Clamps

Wingless clamp Winged clamp

Optradam

      Partially erupted teeth Third molars Extremely malpositioned teeth Patients suffering from asthma Latex allergy Psychological problems

HIGH VOLUME EVACUATORS

- pick up solid debris --suction out water & liquids effectively --rapid & more effective than saliva ejectors --remove 0.5 liter(500ml) of water/liquid in 2 sec.

 It is the assistants responsibility to place the tip as close to the tooth being treated without obstructing access & view.

ADVANTAGES OF HIGH VOLUME EVACUATORS --cuttings of both tooth & restorative material are removed --a washed operating field improves access & visibility --precious metals are more easily salvaged --quadrant dentistry is facilitated --Pauses that are annoying & time consuming are eliminated

SALIVA EJECTOR

--It removes saliva that collects on floor of mouth --the tip should be sterile, non irritating, smooth --it is used in conjunction with cotton rolls & rubber dam --it should be placed in area not interfering with operator movements

Types:

1-metal tip (autoclavable) 2-plastic (disposable)

ABSORBENTS Cotton rolls , Cellulose wafers , Gauze sponges

--They are effectively used for short term isolation --Or when rubber dam isolation is not possible --Used with profound local anesthesia they produce acceptable dryness Cotton roll holders: --cotton rolls can be placed with cotton roll holders --they provide additional retraction for cheek & tongue

Maxillary teeth are isolated by placing medium sized cotton roll in adjacent vestibule

Mandibular teeth are isolated by placing one cotton roll in vestibule & larger one between teeth & tongue COTTON ROLL HOLDER WITHOUT HOLDER

THROAT SHIELDS

--are indicated when small instruments are being used or --indirect restorations are being inserted --especially for the maxillary arch --prevents or aspiration of instruments ,restorations  Gauze sponges 5cm x 5cm,unfolded , spread over the tongue & posterior part of the mouth act as throat shield

RETRACTION CORD

It is used for lateral displacement of gingival tissue whenever subgingival margins are involved It can be used prior to --impression making --facial veneering --treatment of cervical lesions --cementation of fixed restorations

 Retraction cord can be Single / double plain / along with styptic (ferric sulphate/ aluminum chloride)  Retraction cord is effective when used with saliva ejector& local anesthesia  A blunt edged instrument is used for placement  Any distortion or damage to gingival tissue should be avoided Cord packer

Recent methods of gingival retraction Expasyl

Mirror head & ejector tip can be used to retract lips ,cheek , tongue effectively

Mouth Prop

--aids to maintain sufficient mouth opening for time consuming procedures --relieves strain on muscles --increases operator efficiency Are available in different designs & materials & sizes Metal / plastic Small / large Block / ratchet Block type Ratchet type

Mouth prop in place Block type Ratchet type

IN POSITION

Cheek Retractors

CHEEK RETRACTOR

DRUGS

 Local anesthetics-with /without adrenaline --they reduce sensation so salivation is reduced --as pain is reduced ,patient co-operation & operator efficiency is increased --Adrenaline causes vasoconstriction & reduces bleeding  Antisialogouges --used to reduce salivation -- Example: Atropine, Scopolamine  Haemostatics --control bleeding along with retraction cord -- Examples: ferric sulphate 15.5%, Aluminum Chloride 15%

References: 1. Art and science of operative dentistry- sturdevent’s ,2006 2. Principles of Operative Dentistry- A.J.E. Qualtrough ,2005