ISOLATION OF THE OPERATING FIELD

Isolating the working area includes

1.Isolation from moisture like saliva, blood and gingival crevicular field 2. Isolation from soft tissues like lips, cheeks, gingiva and tongue

Isolation from moisture

Direct methods
1. Rubber dam 2. cotton rolls & cotton roll holder 3. gauze pieces 4. absorbent wafers 5. Suction devices. 6. Gingival retraction cord

Indirect methods 1.comfortable position of the pt. and relaxed surroundings 2. local anaesthesia 3.drugs anti sialogogues anti anxiety drugs muscle relaxants

Rubber dam
Introduced by Dr.S C .Barnum (1864) Purpose # Isolation of operating site from moisture Retraction of soft tissue Increases accessibility and visibility Improves efficiency of operator Protection of pt. and operator

Use of rubber dam should be avoided in Asthmatics and mouth breathers Partially erupted and malpositioned teeth Psychological reasons

Armamentarium
A. rubber dam sheets 5x5 or 6x6 square B. Rubber dam clamps (retainer) winged/wingless C. Rubber dam retainer forceps D. Rubber dam holder ( frame) U shaped and could be an adult or paedodontic one made of metal or plastic E. Rubber dam punch F. Rubber dam template/stamp G. Dental floss

Cotton rolls and cotton roll holder

Moisture absorbents and aid in minimally retracting soft tissues When used with LA provide acceptable dryness. loose cotton can be rolled into rolls prefabricated also available( small & medium sizes)

Gauze piece Available in 2x2 inch or larger sizes. Performed same function as cotton rolls. Can be used as throat screens when minute instruments are being used to avoid accidental aspiration.

Absorbent pads/wafers Available in different shapes Used inside the cheeks to cover the parotid ducts

Evacuation systems High volume evacuator

Adv: removes shavings of tooth and restorative material Toxic material readily removed Decreases treatment time

Low volume evacuator Basically saliva ejectors. Can be left in

mouth during operative procedure Available in disposable plastic tips, autoclavable metallic tips

Gingival retraction cord Ready made cotton or synthetic fibers woven in the form of cords Types :
Braided Non braided Plain Impregnated

Uses :
Provides access and visibility Protects gingiva from abrasion Restricts excess restorative material from pushing into the sulcus

Drugs: Anti sialogogues anti cholinergic agents( atropine) Anti anxiety drugs (barbiturate sadatives diazepam) Muscle relaxants

Isolation from soft tissues

1. Retraction of cheeks, lips and tongue

2.Retraction of the gingiva a. physico mechanical means b. chemical means c. electrochemical means d. surgical means

THANK YOU