Isolation of the Operative Field Flashcards
The major 3 goals of isolatin is to control the physical site of surgery so as to:
Exclude saliva
No intrusion by cheek/tongue
Maintain relative asepsis
Operative field
The controlled (isolated) environment in which operative tx will be carried out
Isolation is particularly cruicial ____
if the pulp might be exposed
Maximizes the chances of the pulp surviving
Isolation of the operative field involves…
Protect lips, cheek tongue
Prevent obscured view
Keep saliva and tissue fuilds out
Prevent aerosols of pt’s oral microorgs
Prevent swallowing/aspiration of materials
Prevent moisture contamination by patient’s breath
High contrast - enhanced visibility
7 methods of isolation
- Cotton rolls w holders and saliva ejector
- Driangle
- Hygroformic - spiral low vol suction
- HVE - need assistant
- Svedopter - metal low vol - not used
- Isovac - high vol suction attachment for retraction + bite block
- Dam
the thickness of the dental dam is called its ____
weight
We use extra heavy to prevent tearing
Which tooth is the retainer placed on?”
the most posterior tooth in the operative field
“A” retainers
A = apically
Used on teeth with little retentive axial contour
Grasp tooth more apically
Dam retainers are sometimes used to retract the gingiva because…
retainers have a tendency to migrate apically
“W” retainers
W = wingless
All rets at SOD are wingless
You should not place dam retainers on_______ because they can damage delicate restorations
Teeth with full crowns
Cervical restorations
Additional aids in retaining dental dam:
Wedges
Cut strips of dam
Floss
What kind of dam frame do we use?
Metal Young’s frame
What is the 1st step in dental dam application
Check proximal contacts
If contacts are so tight that they will not admit waxed floss without tearing, using a dam may be impractical
What could prevent the use of a dental dam
Tight proximal contacts Fixed bridges Splinted teeth Lingual rets Single tight contacts can be lightened w a finishing strip
When punching a dental dam, how many holes need to be punched in order to have enough teeth included in the isolated field?
1-2 teeth distal to tooth being restored - canine on opposite side of arch
The dental dam punch has 5 different hole sizes. Which holes are used for which teeth?
1 - Md incisors, Mx laterals 2 - premolars, canines, Mx centrals 3 - molars 4 - rarely used 5 - tooth with retainer
There should be _____ mm of dam material between the punched holes in order to completely cover the gingival papilla and to not have excess material forces between the teeth
3.5 mm
Incomplete holes punched in the dental dam result in:
Hanging chads
Tearing of dam during placement
“A” retainers are used for deeper grip on:
Irretentive molars
Broken down molars
Partially erupted molars
“D” retainers
D = distal extension of bow
Provides better access to distal surface of tooth receiving retainer
Ivory brand 212 retainer
Used for tissue retraction, not dam retention **Used for class V prep on #30
Hygienic brand Brinker retainers
B1 - Md molars
B2 - Mx left molars
B3 - Mx right molars
2-3 have unequal jaws
bigger = buccal
What is the purpose of ligating the retainer?
Safety - prevent pt from aspirating/swallowing ret
If ret breaks, floss will catch each half of it
When ligating the retainer, begin on the _______ side, so that the floss tail is on the ______ of the retainer
Lingual
Facial
When you pick up the retainer with the retainer forceps, it should be positioned so…
Prongs of forceps are in ret holes
Forceps engage ret from top side (bow up)
Bow is distal to forceps
When seating the retainer, seat the _____ beaks first
lingual
The lingual and facial beaks of the retainer should be _____
gingival to the COC
When flossing the dam through the proximal contacts…
Pass dam material through as single sheet
Do not place floss on septum itself
Do not thread out a long piece of floss
Always bring floss through contact along same path as 1st pass - will fold
Purpose of inverting the dam
to create a seal through which fluids cannot pass
How to invert dam
Use cord packing instrument or explorer
Tip perpendicular to and resting on tooth
Drying area can help
Steps of removing dam
clean debris
stretch dam facially - cut each interproximal septum
Remove retainer
Remove rest of dam
Lay dam on bench to check for any pieces left behind
Dental dam left subgingivally can cause…
Gingival abcess
Irreversible damage to periodontium
