Isolation: Other Methods
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This document discusses various direct and indirect methods for dental isolation and moisture control. Direct methods include rubber dams, cotton rolls, saliva ejectors, gingival retraction cords, and mouth props. Indirect methods involve patient comfort, local anesthesia, and drugs like anti-sialogogues and muscle relaxants. Specific techniques using cotton rolls, evacuation systems, saliva ejectors, tongue retractors, cheek and lip retractors are described. Gingival retraction can be achieved through physico-mechanical, chemico-mechanical, electrochemical or surgical means. Newer retraction materials like magic foam cord and Expasyl are also mentioned.
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Isolation: Other Methods
- 1. Isolation: Part 2 Presented by: Aaron Sarwal MDS 3rd Prof
- 2. Contents: Part 2 A. Direct methods 1. Rubber Dam 2. Cotton Rolls and cellulose wafers 3. Saliva Ejectors and Evacuator systems 4. Gingival Retraction Cord 5. Mouth Props B. Indirect methods 1. Patient Comfort and relaxation 2. Local Anesthesia 3. Drugs - Anti-sialogouges - Anti- anxiety drugs - Muscle relaxants CONCLUSION
- 3. Cotton Rolls and Holders Cotton Rolls Manually rolled Prefabricated SmoothWoven • Moisture absorbents • Aid in minimally retracting soft tissues • Alternative when rubber dam application is not practical or possible. • When used in association with profound anaesthesia, cotton rolls provide acceptable dryness for procedures like: ▫ Examination ▫ Sealant placement ▫ Impression taking ▫ Topical fluoride application ▫ Cementation
- 4. HOLDERS Cotton rolls can be placed into position and stabilized with commercial holding devices known as Cotton roll holders.
- 5. Application Techniques • For isolation in maxillary anterior area. • Small sized rolls are placed on either side of labial frenum.
- 6. Application Techniques • For isolation in mandibular anterior area small sized rolls are placed on either side of mandibular labial frenum along with in lingual sulcus.
- 7. ABSORBENT PADS/ CELLULOSE WAFERS
- 8. Silver Dri-Aid – Absorbent Wafers and Bisques
- 9. GAUZE PIECES/ THROAT SHIELDS • 2˝× 2˝ (5 ×5 cm) • Same function as cotton rolls • Better tolerated by delicate tissues • Less chances of adhesion to dry tissues
- 10. Isolite System
- 13. Isolite System
- 14. EVACUATION SYSTEMS High vaccum evacuation system Low vaccum evacuation system
- 15. DEBRIS AND FLUID EVACUATION EQUIPMENTS High Volume Evacuation TRK-O-VAC™ (Plasdent) • Apprx. 150ml water in 1 sec • More efficient • Tips: Metallic autoclavable tips Disposable plastic
- 17. Saliva Ejector
- 18. ADVANCES IN SALIVA EJECTORS SwevelFlex Saliva Ejector Hygoformic Saliva Ejector
- 19. INDIRECT METHODS Comfortable Position Of Patient And Relaxed Surroundings
- 20. Local Anesthesia • Reducing discomfort • Less anxious • Less sensitive to stimuli • Less salivation
- 21. DRUGS • Antisailogouges • Antianxiety drugs • Barbiturates • Sedatives • Muscle relaxants
- 23. SOFT TISSUE ISOLATION- TISSUE RETRACTION & PROTECTION • TONGUE RETRACTORS: Guards and depressors Svedopter
- 24. Svedopter • Introduced by Dr E C Moore • It is a metallic saliva ejector with a tongue depressor
- 25. CHEEK AND LIP RETRACTORS • Pulls cheeks & lips backwards & outwards • Photographic purposes • Working on anterior teeth
- 26. LIP RETRACTORS Simple lip retractor, 11cm 4 ½ " Wire lip retractor Oringer lip retractor Plastic lip retractors, adult 12cm 4 ¾
- 27. CHEEK AND TONGUE RETRACTORSDISPOSABLE SPAND- EZZ EXPANDERS
- 28. DRY FIELD SYSTEM
- 29. FAST DAM
- 31. Mouth props For the patient: • Relief of responsibility of maintaining adequate mouth opening • Relief of muscle fatigue and muscle pain For the dentist • The prop ensures constant and adequate mouth opening and permits extended and multiple operations if desired. Mouth props Rubber Latex Non Latex Molt Ratchet Type
- 32. RUBBER MOUTH PROPS MOLT MOUTH PROPS
- 33. GINGIVAL RETRACTION AIDS • Gingival retraction collars • Retraction cords • Collars : ▫ Physical retraction ▫ Better tissue control ▫ Less chance of recession ▫ Margins fully visible (subgingival)
- 34. Retraction of Gingiva Physico mechanical means Chemico mechanical means Electrochemical means Surgical means • There are four means of accomplishing gingival retraction and are frequently used in combination.
- 35. Physico-mechanical Means • This involves mechanically forcing the gingiva away from the tooth surface both in the lateral and apical direction. • It should be used only when gingiva is healthy with a very good vascular supply and there is a definite zone of attached gingiva apical to the free gingiva. • Bone support should be sufficient without signs of resorption. • Rubber dam • Gingival retraction cord • Rolled cotton twills with or without fast setting ZOE cement • Wooden wedges • Gutta percha or eugenol packs • Copper band • Oversized temporary crown Any one of following techniques can be used:
- 36. Chemico-Mechanical means • The most popular technique for gingival retraction - Vasoconstrictor - Astringent and styptics • Biologic fluid coagulant ▫ Alum 100% ▫ Aluminium potassium sulphate 10% ▫ Aluminium chloride 15-25% ▫ Tannic acid 15-25% • Tissue coagulant ▫ Zinc chloride 8% ▫ Silver nitrate 2% • This chemicals can be carried to the operating site by following means: ▫ Cords ▫ Cotton rolls ▫ Cotton pellets
- 37. Gingival Retraction Cords • Gingival retraction agents (GRAs) are used in clinical practice in the form of - Gingival retraction fluids (GRFs) - Gingival retraction gels (GRGs) (Nowakowska and Panek, 2007) • With respect to the pharmacological effects of the active substance, they belong either to - Class 1 (vasoconstrictors, adrenergics) - Class 2 (haemostatics, astringents) (Nowakowska, 2008)
- 38. Types of retraction chords Retraction chords Material Cotton Synthetic Make Twisted Woven Braided Size Coarse Fine Chemi- impregnated Impregnated Non impregnated
- 39. Application of Gingival Retraction
- 40. Application of Gingival Retraction
- 41. Newer Materials • Magic foam cord • Expasyl • Retrac • Merocel • Laser
- 42. Magic Foam Cord First expanding material designed for easy & fast retraction of sulcus without potentially traumatic packing or pressure.
Editor's Notes
- • Disadvantage -They have to be removed from the mouth for changing cotton rolls -Relatively time consuming
- Also known as parotid blockers
- Size- adult small -adult medium -adult large -pediatric
- Advantages of High Volume Evacuators • Removes shavings of tooth and restorative material as well as other debris from the working site. • Toxic material is readily removed. • Decreases treatment time as intermittent rinsing and washing is avoided.
- Placement Saliva ejectors should be placed with their tips on the floor of the mouth, directed backwards and not directly in contact with the tissues.
- Sealants, ortho bonding, posterior restorations High heat plastic/ silicone construction Autoclavable at 2800F Red-pedo White- adult
- 17 suction holes along the perimeter When applying sealants (Practicon)
- Upper suction inlet relieves tissue grab and ensures anti-fog acrylic mirror stays clear—even under direct exhalation Ideal for sealants, air abrasion, bonding and other dry field procedures