Isolation of the Op Field - Sturdevant's, Ch 7 Flashcards
What are the goals of operating field isolation? (3 goals)
Moisture control
Retraction
Harm prevention
What might contribute to moisture in the mouth?
Sulcar fluid
Saliva
Gingival Bleeding
**note: local anesthesia can incorporate a vasoconstrictor and reduce blood flow
What main devices are used for retraction?
Rubber Dam
High-volume Evacuator
Absorbents
Retraction Cord
Mouth Prop
Isolite Systems, etc
What are the main benefits of the rubber dam?
1) a dry, clean operating field
(2) improved access and visibility
(3) potentially improved properties of dental materials
(4) protection of the patient and the operator
(5) operating efficiency.
Why is it so important to operate in a dry operating field?
Prevent contamination from oral fluids
Allow amalgam restorative material to achieve its optimum physical properties
Fluids may inhibit bonding to enamel and dentin
How does the rubber dam protect the patient?
Protects:
From aspirating or swallowing small instruments/debris
Soft tissue from irritating or distasteful medicaments
Soft tissue from rotating burs and stones
What are the listed disadvantages of rubber dams?
Time consumption
Patient objection
When is it not advisable to use a rubber dam?
In situations where:
(1) teeth have not erupted sufficiently to support a retainer,
(2) some third molars
(3) extremely malpositioned teeth.
(4) Patient can’t breath through nose
Rubber Dam Specifications: What weight/thickness are rubber dams available? Why have different weight options?
Thin (0.15 mm)
Medium (0.20 mm)
Heavy (0.25 mm)
Extra Heavy (0.30 mm)
A thicker dam is more effective at retracting tissue (class V lesions!). A thinner dam passes between contacts more easily.
Rubber Dam Specifications: Which color dam is generally preferred and which side is usually facing the operator?
Darker colors provide more contrast.
There is a dull side and a shiny side - usually the dull, less reflective side faces outward toward the operator.
What is the name of this, and what is it used for?
Young Holder (frame) –a rubber dam holder (frame) that maintains the borders of the rubber dam
–U-shaped metal frame with small metal projections (tines)
What is the general name of this, and what is its purpose?:
A rubber dam retainer.
–Used to anchor the dam to the most posterior tooth to be isolated.
–May also be used to retract gingival tissue.
Name the different parts of this image?
A. bow
B. hole
C. jaw
D. prong
Four prongs, two jaws!
What is the proper position of a retainer? What occurs if improperly placed?
A retainer should contact the tooth in its 4 line angles.
4 pt contact prevents rocking or tilting. Movement can injure the gingiva and the tooth.
Why use a retainer with prongs that are gingivally directed (inverted)?
Inverted prongs are helpful when the anchor tooth is only partially erupted or when additional soft tissue retraction is necessary.
What two main types of retainers are available? Why choose one over the other?
Wingless and winged.
–Wings provide extra retraction of the rubber dam from the operating field
For which teeth is the W2 retainer best used?
Small premolar anchor teeth
For which teeth is the W4 retainer best used?
Most premolar anchor teeth
For which teeth is the W56 retainer best used?
Most molar anchor teeth
For which teeth is the W7 retainer best used?
Mandibular molar anchor teeth
For which teeth is the W27 retainer best used?
Mandibular molar anchor teeth requiring preparations involving the distal surface
For which teeth is the W8 retainer best used?
Maxillary molar anchor teeth
Where and why is dental floss used with the retainer?
Tie dental floss to the bow before the retainer is placed in the mouth. (around the bow, through the holes, both, etc)
–allows retrieval of the retainer or its broken parts if they are accidentally swallowed or aspirated.
What is this called and why use it? What are the different parts called?
Rubber dam punch. Punch the tooth holes in the rubber dam. Rotating metal table (disk) & Tapered, sharp-pointed plunger
What are the retainer forceps used for?
Placement and removal of the retainer from the tooth.
What is a rubber dam napkin? Why use it?
A napkin placed btw the rubber dam and the patient’s skin.
Benefits:
- Improves patient comfort by reducing direct contact of dam with skin.
- It absorbs any saliva seeping at the corners of the mouth.
- It acts as a cushion.
What may be used to anchor the dam at the proximal side of the isolation other than a retainer?
Waxed dental floss
Small piece of dam material
Rubber Wedjet
Is the size of the hole punched in the rubber dam important?
Yes. Successful isolation/maintenance of a dry environment depend on it.
What teeth the largest hole punch use for?
The posterior anchor tooth (has to go over the retainer).
What teeth are isolated when operating on incisors and mesial surfaces of canines? Is a retainer necessary?
Isolate from 1st premolar to 1st premolar. Two full teeth surrounding the operating zone. Usually don’t need retainers to anchor the dam, but a retainer may be used to retract the gingival from the lesion, if necessary.
What teeth are isolated when operating on canines?
Isolate form the 1st molar to the opposite lateral incisor. Three teeth surrounding operation site.
What teeth are isolated when operating on molars?
Isolate anteriorly to inclue the lateral incisor on the opposite side of the arch from the operating site.
What teeth are isolated when operating on premolars?
Isolate by punching holes to include 2 teeth distally & extend anteriorly to include the opposite lateral incisor.
What is the minimum of teeth that should be isolated?
Three, unless endodontic therapy is necessary - then isolating only the tooth operated on is necessary.
Is the posterior tooth ever anesthetized if it is not the one with the lesion?
It may be anesthetized if far from the operating site to eliminate discomfort from applying the posterior retainer.
How is the appropriate seal of each tooth by the rubber dam guaranteed? How is this done?
By inversion of the rubber material in the gingival direction. Use floss first, then a blunt instrument to push it.
Which direction is the frame oriented when attached to the rubber dam?
The open edge opens toward the nose. The curvature follows the curvature of the chin.
Where are the free ends of the floss ties attached?
They are secured to the frame.
What is the best way to remove the dam?
Stretch the dam facially, use a finger under the dam to protect the gingiva, and snip each rubber dam septum between the teeth. Then remove the posterior retainer and the dam.
Make sure no remnant of dam is left behind.
What is the main benefit of applying the posterior retainer and then the stretching the dam over it, instead of applying the dam and posterior retainer together?
Reduced visibility may cause the placement of the retainer to impinge on gingival tissue.
What is the 212 cervical retainer recommended for? How does this affect the hole punches?
For Class V tooth preparations. Place the hole in the dam for the tooth with the Class V lesion more facial to account for this retainer.
How are cervical retainers inserted?
Lingual side first, then facial side. Slide the jaws gingivally to depress the dam and soft tissue on first the lingual side and then the facial side. On the facial side, the jaws should be at least 0.5 mm gingival to the tooth preparation.
What is the range of isolation for posterior primary teeth?
Usually from the most posterior tooth to the canine on the same side.
When might you tie a surgeon’s knot around a tooth?
When the isolated teeth have short clinical crowns (such as primary teeth) use a ligature (a tie to bind tightly) to hold the dam in position.
Is this bad rubber dam placement?
Yep. No breathing = bad.
Can cotton roll isolation be as effective as rubber dam isolation?
Yes, in selected situations, if done correctly.
If used with profound anesthesia, they can provide acceptable moisture control for most clinical procedures.
What is this & what are its benefits:
Cotton rolls + a cotton roll holder. Creates effective isolation and slightly retracts the cheeks and tongue from the teeth
What is a throat shield?
A piece of gauze spread over the tongue and posterior portion of the mouth. Use when there is a risk of aspiration (especially easy when working on the maxillary arch), such as when trying on an indirect restoration.
Why use water spray and a high-volume evacuator during cutting procedures?
- Cuttings of tooth and restorative material and other debris are removed
- Cleans & improves access and visibility.
- Dehydration of oral tissues does not occur.
- Precious metals can be more readily salvaged if desired.
What is retraction cord? What does it do? What is a brand name often used?
Used for isolation and retraction. Used when a rubber dam is impractical or inappropriate. Placed in the gingival sulcus (1st moistened with noncaustic hemostatic agent) to control sulcular seepage, hemorrhage, etc.
Ultrapak Cord (from Ultradent)
- braided cord
- sizes 000 to 2
- Dampen with water or hemodent
What are the benefits of retraction cord?
Improves access and visibility Isolates from fluids
Helps prevent abrasion of gingival tissue during prep
Restricts excess restorative material from entering gingival sulcus
Better access for finishing the restorative material
Is it good if the retraction cord blanches the free gingiva when inserted?
No. Insert it into the sulcus so that it does not blanch the free gingiva.
What types of mouth props are available?
Block type
Ratchet type - adjustable (but large and costly)
Why are mouth props used?
They are used to aid in procedures on posterior teeth when the appointment is lengthy. They relieve the patient’s muscles = less pain. The maintain proper mouth opening.
What is the main drug (rarely used) used in restorative dentistry to control salivation? Who can not take it?
Atropine. Not for nursing mothers or patients with glaucoma.
From the lecture:
What is an alternative compound that can be used to create a barrier?
Light-cured resin barriers, such as OpalDam. Lay over the gingiva, light-cure, and it hardens into a protective barrier.
From the lecture:
What is this?
An Expandex Oral Retractor - retracts the lips & cheeks
From the lecture:
What is this?
OptraGate - another retractor.
Note: not as convenient on Class II lesions or for lesions on posterior teeth.
From the lecture:
What are the characteristics of Hemodent (from Premier)?
Good Hemostasis
Buffered aluminum chloride
Used with cord or as direct liquid application
Localized action
From the lecture:
What are the characteristics of Viscostat (from Ultradent)?
Excellent hemostasis
20% ferric sulfate
Scrub with it and then rinse
Can stain restorations!!
From the lecture:
What are the characteristics of Viscostat Clear (from Ultradent)?
Good hemostasis
25% aluminum chloride
Does not stain
Less effective than Viscostat
Scrub it on and then rinse
From the lecture:
What are the characteristics of Expa-Syl (from Kerr)?
Excellent Hemostasis
Kaolin & Aluminum Chloride
Selective Uses
Expensive
Minimizes tissue trauma
Harder to use
From the lecture:
What are the steps to rebond after contamination?
Just etch and rebond!
1st: Control the field
2nd: rinse and dry
3rd: apply etchant and rinse
4th: apply primer
5th: apply adhesive and polymerize
6th: Apply and polymerize resin
