endo files and isolation Flashcards
how does the dam protect pts
The rubber dam protects the patient from swallowing or
aspirating instruments and materials
dental dam
essential?
standard?
anytime not used?
*ESSENTIAL FOR ENDODONTICS
*Defined as the “STANDARD OF CARE”
*ANYTIME YOU DO NOT USE DAM YOU ARE SIMPLY LIABLE WITHOUT DEFENSE Precedent:
Kansas State Supreme Court 1973
Effective Isolation Crucial to:
*RCT Success
*Patient Protection
*Provider Protection
NEVER place anything small
enough to be swallowed or
aspirated into the mouth
without:
NEVER place anything small
enough to be swallowed or
aspirated into the mouth
without the protection of an
effective dental dam
why and how should there be no microbes when performing endo
*The elimination of Micro organisms within the
pulpal spaces is one of the basic objectives of
successful contemporary RCT
*It is simply impossible to eliminate micro-
organisms in the presence of saliva with its
multitude of micro-organisms
*ONLY a properly applied Dental Dam can insure the absence of saliva in the surgical field
failure to elim salivary leakage with dam can result in:
*Failure to eliminate salivary leakage by proper placement of the rubber dam creates salivary contamination which has the potential of turning a simple, routine, uncomplicated RCT into life threatening cellulitis by introducing additional micro-organisms which can greatly complicate the infection.
*This is precisely WHY we never leave a tooth open to salivary contamination
leakage of irrigants
*8.3% NaOCl is commonly used for flushing out debris and cleaning the prepared canal system.
*If saliva is not effectively sealed by your dam placement, you can be assured that NaOCl will
leak into the mouth as you irrigate.
dental dam saves time/trouble?
yes
what should be placed on all dam clamps
safety ligature (floss) to avoid accidental loss of the clamp into the airway/esphogus
forms of the dam available
latex Dam is available in Black White, Blue or Green color in various weights & thickness
Non-latex Nitrile Dam is available in the Clinic and is necessary to prevent problems arising from latex allergies
Examples of Rubber dam frames:
which to select? why?
There are many types available.
Select one which is radiolucent and leave it in place when taking radiographs
how many teeth to isolate with dam
Isolate ONLY the tooth to be treated IF POSSIBLE*
(Exception: some Regional Board Exams where multiple isolation is required.)
dam and radiographs
leave on
dam clamp for anterior teeth/ PMs
You may find the “Butterfly” Labial Clamp useful for most anterior teeth and even for some
premolars.
types of dam clamps
can be winged or unwinged
unwinged clamps
Clamps without wings are also available and are designed to first be placed on the tooth with the RD later stretched over the clamp
and tooth.
clamp #212
designed for ant
winged clamps allow the dam to be placed as:
single unit
once dam is below HOC, what should be done when placing dam as single unit?
it is necessary to push the dam off the wings of the clamp using an instrument so that the dam is free to seal around the tooth cervical to the clamp. (spoon excavator used)
dif with?
where should dam clamp rest on teeth
rest at the cervical line below the height of contour to be adequately retained.
This is difficult but necessary with young or partially erupted teeth.
when might you isolate more than one tooth
when interprox caries are present
what if dam not released from the wings
leakage
selaing agents
may be used to ensure no leakage/salivary contamination once dam is properly placed, we use oraseal
Oraseal procedure
Get it if you have any idea that leakage might occur with your dam placement/ Ask for faculty help.
Not Possible to Place a Dam?
If unable to achieve 100% effective isolation of the tooth to be treated:
–Provisionally restore tooth to obtain isolation base*
–Clinical Crown lengthening procedure
–Refer to endodontic specialist
still unable to isolate a tooth? next steps?
–Consider alternate treatment modality
*Restorability?
*TE and implant?
*TE and fixed prosthesis?
If you cannot place an effective rubber dam, you cannot do:
If you cannot place an effective rubber dam, you cannot do a RCT on the tooth.
badly broken down teeth and isolation
A badly broken down tooth often cannot be isolated following complete caries removal.
In this case, it was necessary to first do a build-up before RCT.
An orthodontic band was added as a matrix, for strength and to protect against fracture.
isolation with badly broken down tooth covered with hyperplastic gingiva
Sometimes a badly broken down tooth requiring RCT is covered over with hyperplastic gingiva
It may be possible to excise the gingiva with
electrosurgery, laser, or conventional surgery
This procedure may expose sufficient tooth structure to be able to place a clamp and isolate with dental dam thereby allowing RCT.
split dam technique
not possible to place a clamp/ no solution to this so dam stretched over adjacent teeth and sealed using oraseal