Isolation of the Operative Field

Question 1

The major 3 goals of isolatin is to control the physical site of surgery so as to:

Answer 1

Exclude saliva
No intrusion by cheek/tongue
Maintain relative asepsis

Question 2

Operative field

Answer 2

The controlled (isolated) environment in which operative tx will be carried out

Question 3

Isolation is particularly cruicial ____

Answer 3

if the pulp might be exposed

Maximizes the chances of the pulp surviving

Question 4

Isolation of the operative field involves…

Answer 4

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

Question 5

7 methods of isolation

Answer 5

1. Cotton rolls w holders and saliva ejector
2. Driangle
3. Hygroformic - spiral low vol suction
4. HVE - need assistant
5. Svedopter - metal low vol - not used
6. Isovac - high vol suction attachment for retraction + bite block
7. Dam

Question 6

the thickness of the dental dam is called its ____

Answer 6

weight

We use extra heavy to prevent tearing

Question 7

Which tooth is the retainer placed on?”

Answer 7

the most posterior tooth in the operative field

Question 8

“A” retainers

Answer 8

A = apically
Used on teeth with little retentive axial contour
Grasp tooth more apically

Question 9

Dam retainers are sometimes used to retract the gingiva because…

Answer 9

retainers have a tendency to migrate apically

Question 10

“W” retainers

Answer 10

W = wingless

All rets at SOD are wingless

Question 11

You should not place dam retainers on_______ because they can damage delicate restorations

Answer 11

Teeth with full crowns

Cervical restorations

Question 12

Additional aids in retaining dental dam:

Answer 12

Wedges
Cut strips of dam
Floss

Question 13

What kind of dam frame do we use?

Answer 13

Metal Young’s frame

Question 14

What is the 1st step in dental dam application

Answer 14

Check proximal contacts

If contacts are so tight that they will not admit waxed floss without tearing, using a dam may be impractical

Question 15

What could prevent the use of a dental dam

Answer 15

Tight proximal contacts
Fixed bridges
Splinted teeth
Lingual rets
Single tight contacts can be lightened w a finishing strip

Question 16

When punching a dental dam, how many holes need to be punched in order to have enough teeth included in the isolated field?

Answer 16

1-2 teeth distal to tooth being restored - canine on opposite side of arch

Question 17

The dental dam punch has 5 different hole sizes. Which holes are used for which teeth?

Answer 17

1 - Md incisors, Mx laterals
2 - premolars, canines, Mx centrals
3 - molars
4 - rarely used
5 - tooth with retainer

Question 18

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

Answer 18

3.5 mm

Question 19

Incomplete holes punched in the dental dam result in:

Answer 19

Hanging chads

Tearing of dam during placement

Question 20

“A” retainers are used for deeper grip on:

Answer 20

Irretentive molars
Broken down molars
Partially erupted molars

Question 21

“D” retainers

Answer 21

D = distal extension of bow

Provides better access to distal surface of tooth receiving retainer

Question 22

Ivory brand 212 retainer

Answer 22

Used for tissue retraction, not dam retention
**Used for class V prep on #30

Question 23

Hygienic brand Brinker retainers

Answer 23

B1 - Md molars
B2 - Mx left molars
B3 - Mx right molars

2-3 have unequal jaws
bigger = buccal

Question 24

What is the purpose of ligating the retainer?

Answer 24

Safety - prevent pt from aspirating/swallowing ret

If ret breaks, floss will catch each half of it

Question 25

When ligating the retainer, begin on the _______ side, so that the floss tail is on the ______ of the retainer

Answer 25

Lingual

Facial

Question 26

When you pick up the retainer with the retainer forceps, it should be positioned so…

Answer 26

Prongs of forceps are in ret holes
Forceps engage ret from top side (bow up)
Bow is distal to forceps

Question 27

When seating the retainer, seat the _____ beaks first

Answer 27

lingual

Question 28

The lingual and facial beaks of the retainer should be _____

Answer 28

gingival to the COC

Question 29

When flossing the dam through the proximal contacts…

Answer 29

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

Question 30

Purpose of inverting the dam

Answer 30

to create a seal through which fluids cannot pass

Question 31

How to invert dam

Answer 31

Use cord packing instrument or explorer
Tip perpendicular to and resting on tooth
Drying area can help

Question 32

Steps of removing dam

Answer 32

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

Question 33

Dental dam left subgingivally can cause…

Answer 33

Gingival abcess

Irreversible damage to periodontium