1. ISOLATION OF THE OPERATIVE & ENDODONTIC FIELD

2. Operative dentistry can not be expressed properly unless the moisture in the mouth is properly controlled

3. The goals of operative field isolation are
Moisture control
Infection control
Retraction
Harm prevention
Increase the concentration of dentist

4. Following components of oral environment need to be controlled during operative procedure
Saliva
Tongue
Mandible
Lips & cheek
Gingival tissue
Buccal & lingual vestibule
Floor of the mouth
Adjacent teeth and restoration
Respiratory moisture

5. Advantages Patient related: Provides comfort to the patient
Protect patients from swallowing or aspirating foreign bodies
Protect patients soft tissues by retracting them.
Operator related:
A dry clean operative field
Infection control
Increased accessibility to operative site
Improved properties of dental materials
Improved visibility & less fogging of mirror
Prevents contamination of tooth preparation.

6. Materials can be used Rubber Dam Cotton rolls & cellulose wafers
High volume evacuators & saliva ejector
Mirror & evacuator tip retractor
Mouth props
Air Water syringe
Cheek retractor
Medicine Atropine / Antihistamin

8. Rubber Dam Isolation
It is a flat thin sheet of latex/non-latex that is held by a clamp and a frame, that is preferred to allow the tooth/teeth to protrude through the perforations, while all other teeth are covered.

9. Rubber Dam Isolation Advantage Disadvantage Takes time to be applied.
Act as a raincoat for the tooth.
Complete, long term moisture control.
Maximizes access and visibility.
Clean dry field while working.
Protect lips, cheeks & tongue by keeping them aside.
Prevents accidental swallowing or aspiration of foreign bodies.
Improves the properties of dental materials
Takes time to be applied.
Communication with the patient can be difficult.
Incorrect use may damage porcelain crowns/gingival tissues.
Insecure clamps can be swallowed or aspirated.

10. Rubber Dam Isolation Contraindication Asthmatic patients.
Allergic to latex
Mouth breathers
Extremely malpositioned teeth
Third molar (in some cases)

11. Armamentarium Rubber dam sheet. Rubber dam clamps.
Rubber dam forceps clamp holder.
Rubber dam frame.
Rubber dam punch.
Accessories
Lubricant/Petroleum jelly.
Dental floss.
Rubber dam Napkin.

12. Rubber Dam Sheet It is made of latex or non-latex.
Available in 2 sizes- ❶ 5”*5”
❷ 6”*6”
New material should be used.
Available in varying thickness heavy-medium & thin.
Light and dark sheets are available for colour contrast.
Has a shiny & dull side, dull side will be facing the occlusal side.

13. Rubber Dam Frame
The rubber dam frame maintains the border of the dam in position.
Support the edges of the rubber dam.
Retract the soft tissues.
Available in metal and plastic.

14. Rubber Dam Punch
Rubber dam punch is used to make the holes in the sheet through which the teeth can be isolated.
The working end is designed with a plunger on one side and a wheel on other side.
This wheel has holes of different sizes on the flat surface facing the plunger.
The punch must produce a clean cut every time.

15. Rubber Dam Punch

16. Rubber Dam Clamps
These are used to fix the dam to the teeth, that are to be isolated.
These also minimally retract the gingiva
Subdivided into >Winged
>Wingless

17. Rubber Dam Clamps
Clamps without wings
Clamps with wings

18. Rubber Dam Template
It is an inked rubber stamp which helps in marking the dots on the sheet according to position of the tooth.
Holes should be punched according to arch and missing teeth.

19. Rubber Dam Template

20. Accessories
Dental Floss: It is used as flossing agent for rubber dam in tight contact areas.
Rubber Dam napkin: This is a sheet of absorbent material placed between the rubber dam and skin.
Lubricant: A lubricant is applied in the area of punch holes facilitates the passing of dam septa through proximal contacts.

21. Disposable rubber dam
For single use

22. Application of Rubber Dam

23. 1. Testing & lubricating the proximal contacts

24. 2.Punching the holes

25. 3.Lubricating the dam

26. 4.Selecting the retainer

27. 5.Testing the retainers stability & retention
The clamp and reamer should be hold with dental floss to be removed in case of aspiration or inhalation

28. 6.Positioning the dam over the retainer

29. 7.Applying the napkin

30. 8.Attaching the frame

31. 9.Applying the anterior anchor

32. 10.Passing the septa through the contacts

33. 11.Invert the dam interproximally

34. 12.Inverting the dam Faciolingually

35. 13.Confirming a properly placed rubber dam

36. 14.Checking for access & visibility

37. 15.Inserting the wedges(optional)

38. Removal of Rubber Dam

39. 1.Cutting the septa

40. 2.Remove the clamps

41. 3.Remove the dam

42. 4.Wiping the lips

43. 5.Massage the tissue

44. 6.Examining the dam

45. Cotton rolls
Cotton rolls, gauze & cellulose wafers absorbents are helpful for short period of isolation of the teeth especially where rubber dam application is not possible.
Usually placed in buccal & lingual sulcus specially where salivary gland ducts exit, to as to absorb saliva.

46. High volume evacuators & saliva ejector
It is used to remove water from airrotor with high suction speed.
Also helps in retracting the soft tissues.

47. Mirror & evacuator tip retractor
A secondary function of the mirror and evacuator tip is to retract the cheek, lip & tongue

48. Mouth prop
Mouth prop is also used to establish & maintain a suitable mouth opening, thus help in tooth preparation of posterior tooth.
It is placed on the opposite to treatment side.
Provides sufficient mouth opening for longer times.

49. Cheek retractor They are used to expand the mouth opening.
This is usually use when working on the gingival border of upper & lower front teeth and for the adjustment of orthodontic bands.

50. Air water syringe
By air water syringe an air blast can be useful to dry tooth and soft tissue during examination or used during procedure.

51. Drugs
The use of drugs to control salivation is rarely indicated in restorative therapy, and is generally limited to atropine.
Contraindicated for nursing mothers, and patients with glaucoma.

52. THANK YOU