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MOISTURE CONTROL IN OPERATIVE DENTISTRY

MOISTURE CONTROL IN OPERATIVE DENTISTRY. Definition. Refers to the exclusion of sulcular fluid, saliva and gingival bleeding from the operating field Additionally, also prevents handpiece spray and restorative debris being swallowed or aspirated by the patient. ADVANTAGES.

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MOISTURE CONTROL IN OPERATIVE DENTISTRY

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  1. MOISTURE CONTROL IN OPERATIVE DENTISTRY

  2. Definition • Refers to the exclusion of sulcular fluid, saliva and gingival bleeding from the operating field • Additionally, also prevents handpiece spray and restorative debris being swallowed or aspirated by the patient

  3. ADVANTAGES • Dry, clean operating field • Access & visibility • Preserving properties of dental materials • Protection of patient & operator • Better operation efficiency & productivity

  4. AIDS IN MOISTURE CONTROL: INDIRECT METHODS • Comfortable position of patient & relaxed surroundings • Local Anesthesia • Drugs- • Antisialogogues • Anti-anxiety drugs • Muscle relaxants

  5. AIDS IN MOISTURE CONTROL: DIRECT METHODS • Rubber Dam • Cotton Rolls & Cotton Roll Holder • Gauze Pieces • Absorbent Wafers • Suction Devices • Gingival Retraction Cord

  6. LOCAL ANESTHESIA • Reduces salivation • Patient is more comfortable, less anxious • Less sensitive to oral stimulation • ↓ salivary flow • Controls Hemorrhage • Presence of vasoconstrictor ↓ blood flow

  7. DRUGS • Rarely used • Atropine Sulfate • 0.25-1mg orally, 1-2 hrs before procedure • Contraindicated in Nursing Mothers, Patients with Glaucoma • Adverse effects- Dilatation of Pupils, Tachycardia, Urinary Retention • Methantheline bromide (Banthine) • 50mg 30 mins before procedure • Propantheline Bromide • 15-30mg 30 mins before procedure

  8. RUBBER DAM ISOLATION • Introduced- NY city dentist- Dr. Sanford Christie Barnum, March 1864 • Purpose: Isolate tooth/teeth from oral environment

  9. RUBBER DAM: PURPOSE • Define the operating field by ISOLATING one or more teeth from the oral environment • ELIMINATES SALIVA from the operating site • RETRACTS soft tissue • Prevention of CLOSED MOUTH SWALLOW • MINIMIZES PULPAL CONTAMINATION from oral fluids when excavating a deep carious lesion

  10. RUBBER DAM: ADVANTAGESSAFETY • Surgically clean area without residue from saliva • Protects patient from ASPIRATION / SWALLOWING of foreign body, root canal instruments • Oral Injuries from mechanical instrumentation and injurious chemicals (NaOCl) • Protects dentist from infection from diseased mouths: PHYSICAL BARRIER

  11. RUBBER DAM: ADVANTAGESPATIENT MANAGEMENT • Avoid need to rinse mouth • Improves access, vision • Gingival retraction • Reduction of Operating time

  12. RUBBER DAM: DISADVANTAGES • MINIMAL • Damage to marginal gingiva and cervical cementum (Select proper clamps) • Metal crown margins-microscopic defects • Ceramic crowns-fracture of porcelain at cervical margin • Contact allergy • TIME CONSUMING? Myth…

  13. RUBBER DAM: INDICATIONS • ALL OPERATIVE PROCEDURES • Mandatory • Root Canal Treatment • Pulp capping/ Deep carious lesions • Composite Restorations • Cohesive Gold Restorations • Additonally: • Isolation for Electric/Thermal Pulp tests

  14. RUBBER DAM: DIFFICULT SCENARIOS FOR PLACEMENT • Partially erupted teeth • Natural crowns with poor retentive shape • Extensive loss of coronal tissue • Fixed Partial Dentures/Orthodontic Appliances • Saliva Leakage • Extremely malposed teeth • Asthmatic patients & mouth breathers • Third molars

  15. RUBBER DAM KIT: COMPONENTS • Rubber Dam Sheet • Rubber Dam Frame/Holder • Rubber Dam Punch • Rubber Dam Clamp/Retainer • Rubber Dam Forceps • Rubber Dam Napkin • Template • Others

  16. RUBBER DAM MATERIAL • Continuous rolls in two widths (125mm or 150 mm) • Precut from these rolls into squares • 6” X 6” • 5” X 5” • Usually made from natural latex rubber

  17. RUBBER DAM MATERIAL: COLOR • Traditionally Black. • Now in 4 colors • Light: Preferred in Endodontics • Dark: Good Color Contrast • Green: Pleasant. Mint scented, good patient acceptance • Fiesta: 3 colored assortment (Pink, Blue, Purple) in fruit scent

  18. RUBBER DAM MATERIAL: GAUGE

  19. RUBBER DAM MATERIAL: SURFACES • SHINY • Reflective, tiring to the eyes (strain) • Should face the tooth side • DULL • Less reflective and should face the operator

  20. RUBBER DAM FRAME/HOLDER • Positions and holds the borders of the rubber dam sheet • Examples: • Fernald’s frame • Strap Holders or Harness Type- Woodbury holder • Young’s frame • Nygard Ostby Frame • Le Articulaire Frame

  21. RUBBER DAM FRAME/HOLDER • Most widely used: YOUNG’s FRAME • U shaped metal/plastic • Small projections from sides to secure borders of sheet • Optional Necktsrap- Snugs dam & frame to face • If metallic- applied over the sheet; if plastic- either way • NYGARD OSTBY • Holds sheet away from face-ease for patients breathing

  22. RUBBER DAM FRAME/HOLDER • LE ARTICULAIRE FRAME: HINGED in the middle • Used in endodontics • PRE ATTACHED FRAMES: • Quick Dam (Ivoclar Vivadent)-flexible plastic rim attached to a sheet. Effective anteriorly • Handidam(Aseptico) • Dry Dam- Rubber sheet set in center of absorbent paper sheet with elastics on either side to pass over the ears

  23. RUBBER DAM PUNCH • Produce clear cut holes in rubber dam sheet through which teeth can be isolated • TYPES • SINGLE HOLE- 2 sizes • MULTIPLE HOLE- Size ranges 0.5-2.5mm by rotation of the anvil • 2 designs of the Multihole punch ASH / AINSWORTH IVORY PATTERN

  24. RUBBER DAM PUNCH • Multi Hole Punch: • 1st hole: Mandibular Incisors • 2nd hole: Maxillary Incisors • 3rd hole: Canines & Premolars • 4th hole: Large premolars/small molars • 5th hole: Molars • 6th hole: Large Molars/Macrodonts

  25. RUBBER DAM CLAMPS/RETAINERS • Anchors Dam sheet to the tooth • Rubber dam sheet usually anchored onto the tooth using at least 1 clamp (Usually posterior most tooth) • Other means of anchoring sheet onto teeth • Wedgets • Dental Tape • Small Piece of rubber Dam

  26. RUBBER DAM CLAMPS: PARTS • Bow • Clamp Forcep Locating Holes • Jaws • Prongs • Wings (or their absence)

  27. BOW HOLE JAWS PRONGS

  28. WINGS

  29. RUBBER DAM CLAMPS:CLASSIFICATION • BLAND • Winged • Wingless • RETENTIVE • Winged • Wingless

  30. RETENTIVE

  31. BLAND

  32. RUBBER DAM CLAMPS • BLAND CLAMPS • Grasp tooth at or above gingival margin • Minimal Gingival Damage • Provide circumferential contact • Indicated when axial angles are lost or don’t co-incide

  33. RUBBER DAM CLAMPS • WINGS: Small flanges on outer edges of the clamp jaws, directed anteriorly or laterally, and can engage the dam sheet during placement. Provides additional gingival tissue retraction Interferes with placing matrix bands/retainers

  34. RUBBER DAM CLAMPS:CONTACTS • 4 POINT CONTACT • Retainer contacts only in 4 areas- 2 lingual & 2 labial • Prevents rocking or tilting of the clamp • JAWS not to extend beyond M & D line angles of tooth • Interferes in wedge placement • Precludes complete seal around tooth • Gingival trauma more likely • FLOSS

  35. RUBBER DAM FORCEPS • Placement & Removal of Clamp from the tooth: Stretch the jaws of the clamp • 3 WIDELY USED DESIGNS: • Ash or Stokes • Ivory Pattern • University of Washington Pattern • Differ in tip design • Presence of sliding ring

  36. RUBBER DAM NAPKIN • Precut sheet of absorbent placed between the skin and the rubber dam sheet • USES • Reduces skin contact of sheet • Absorbs saliva at corners of mouth • Acts as cushion • Wiping patient lip on dam removal

  37. RUBBER DAM TEMPLATE • Aids in positioning of Rubber Dam • Available as a stamp bearing the pattern of the maxillary and mandibular dentitions • Both deciduous and permanent dentitions

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