Isolation & File ID Flashcards
The rubber dam protects the patient from
swallowing or
aspirating instruments and materials
DENTAL DAM
(3)
- ESSENTIAL FOR ENDODONTICS
- Defined as the “STANDARD OF CARE”
- ANYTIME YOU DO NOT USE DAM YOU ARE
SIMPLY LIABLE WITHOUT DEFENSE
Effective Isolation Crucial to:
(3)
- RCT Success
- Patient Protection
- Provider Protection
NEVER place anything small
enough to be swallowed or
aspirated into the mouth without
the
protection of an effective dental
dam
— is one of the basic objectives of successful
contemporary RCT
The elimination of Micro-organisms within the pulpal
spaces
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
Salivary Contamination turns out to be a major factor in
controlling
Aerosol danger of droplet contamination in dental
treatment. (COVID-19
Failure to eliminate salivary leakage by proper placement of the rubber dam
creates — contamination which has the potential of turning a simple,
routine, uncomplicated RCT into life threatening cellulitis by
salivary
introducing
additional micro-organisms which can greatly complicate the infection
This is precisely WHY we never leave a tooth open to
salivary contamination
— is commonly used for
flushing out debris and cleaning the
prepared canal system.
8.3% NaOCl
If saliva is not effectively sealed by
your dam placement, you can be
assured that
NaOCl will leak into the
mouth as you irrigate
— Dam is available in Black White, Blue or Green color in various weights & thickness
— is available in the Clinic and is necessary to prevent
problems arising from latex allergies
Latex
Non-latex Nitrile Dam
Examples of Rubber dam frames:
There are many types available.
Select one which is — and
leave it in place when taking radiographs
radiolucent
Isolate ONLY the tooth to be treated IF POSSIBLE*
(Exception:
some Regional Board Exams where multiple isolation is required.)
Whatever approach you take, Leave Rubber Dam & Frame ON when
taking Radiographs
You may find the “—” Labial
Clamp useful for most anterior teeth
and even for some premolars. This part
to the facial.
Butterfly
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.
Rubber dam clamp #— is
designed for an anterior tooth.
212
The use of a winged clamp allows clamp and dam to be safely placed as a — unit.
single
Once the Dam is securely placed below the height of contour of the tooth, 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.
Here’s where the Clamp should 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.
Here the dam has not been released from the wings
of the clamp. This is not acceptable:
Leaks
Even after the Dam is released from the wings of the clamp, it may be necessary to use some type of
sealing
agent to caulk around the tooth to insure isolation.
Here Oraseal® by Ultradent (available in dispensary) is being used to caulk around the tooth to eliminate salivary
contamination.
Not Possible to Place a Dam?
* If unable to achieve 100% effective isolation of the
tooth to be treated:
(3)
– Provisionally restore tooth to obtain isolation base*
– Clinical Crown lengthening procedure
– Refer to endodontic specialis
skipped
* If still unable to isolate tooth:
– Consider alternate treatment modality
(3)
- Restorability?
- TE and implant?
- TE and fixed prosthesis?
If you cannot place an effective rubber dam,
you cannot do a RCT on the tooth.
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.
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.
If you can’t isolate —, you can’t do a
successful RCT
saliva
If patient is a copious saliva producer, you
might consider
Rx Pro-banthine 15 mg.
(propantholine) ½-1 hour before appointment
to control extraordinary salivary flow if not
otherwise contraindicated by
patient’s med. histo
Why different types of Files?
(3)
- Each file type has unique attributes
- Each file type can benefit us in a specific
way when used correctly - Each type is important to consistent RCT
success