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MOISTURE CONTROL AND INTRAORAL BARRIER TECHNIQUES

MOISTURE CONTROL AND INTRAORAL BARRIER TECHNIQUES. UNCLASSIFIED//REL TO NATO/ISAF. OVERVIEW. Restorative procedures are performed with superior results when the field of operation is clearly visible and completely dry.

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MOISTURE CONTROL AND INTRAORAL BARRIER TECHNIQUES

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  1. MOISTURE CONTROL AND INTRAORAL BARRIER TECHNIQUES UNCLASSIFIED//REL TO NATO/ISAF

  2. OVERVIEW • Restorative procedures are performed with superior results when the field of operation is clearly visible and completely dry. • An operator can work more efficiently and the properties of the restorative materials are enhanced by being placed in a dry field. • To obtain the best restorative result a rubber dam should be used. AFAMS Dental Advisor Team

  3. OVERVIEW • If you cant install a rubber dam to restore a tooth, maybe this is not the best treatment and you must review your treatment plan AFAMS Dental Advisor Team

  4. OVERVIEW • The problems of infection control and the spread of disease when operating in the oral cavity must also be considered • Isolation and maintenance of a dry field can reduce the production and spread of harmful aerosols. AFAMS Dental Advisor Team

  5. HIGH-VOLUME EVACUATION • High-volume evacuation (HVE) is another component of the AVS. • It is essential when using high- speed handpieces with water coolant or spraying a tooth with water because saliva ejectors and absorbents cannot remove moisture fast enough. AFAMS Dental Advisor Team

  6. HIGH-VOLUME EVACUATION • HVE tips may be made of metal or plastic and are available as large-diameter operative tips or small- diameter surgical tips. AFAMS Dental Advisor Team

  7. HIGH-VOLUME EVACUATION • The tip must be placed in the proper area to rapidly evacuate the water while maintaining the operator’s visibility. AFAMS Dental Advisor Team

  8. HIGH-VOLUME EVACUATION • It should be positioned: • as close as possible to the tooth being prepared, without injuring soft tissue, with the bevel parallel to the facial or lingual surface of the tooth; •  with the edge of the HVE tip even with the occlusal surface of the tooth being prepared AFAMS Dental Advisor Team

  9. RUBBER DAM • Rubber dam is a thin sheet of natural latex rubber used in dentistry to isolate teeth. It comes in adult and child sizes. • Non-latex rubber dam is available for use on patients with latex rubber allergies or sensitivity. AFAMS Dental Advisor Team

  10. RUBBER DAM AFAMS Dental Advisor Team

  11. RUBBER DAM • The use of the rubber dam ensures the best possible results for a given dental treatment. It is the ultimate barrier technique to control moisture, create a dry field and maintain a suitable surgical environment. AFAMS Dental Advisor Team

  12. RUBBER DAM Standard of care is the minimum acceptable level of care. • Routine use of the rubber dam is considered a standard for the health and safety of all that are in the dental operatory. AFAMS Dental Advisor Team

  13. RUBBER DAM The advantages of its use are: • Moisture Control • Increased Access, Visibility and Operating Efficiency • Patient Protection • Infection Control • Patient Management • Saves Time • Operator Protection AFAMS Dental Advisor Team

  14. RUBBER DAM The advantages: • Moisture Control • Most dental materials such as amalgam, cements, tooth conditioners, composite resins and pit and fissure sealants are adversely affected by water, blood, saliva, moisture and debris. • To achieve the best results with these materials, they must be placed in a dry, clean field. AFAMS Dental Advisor Team

  15. RUBBER DAM The advantages: • Increased Access, Visibility and Operating Efficiency • The rubber dam retracts the tongue, cheeks, and gingiva, improving the operator’s access to the area. • This allows for better visibility, often resulting in improved quality and efficiency of dental treatment. AFAMS Dental Advisor Team

  16. RUBBER DAM The advantages: Increased Access, Visibility and Operating Efficiency • More precise preparations can be prepared and superior restorations placed in less time. • It also provides a color contrast which greatly aids to increase visibility. AFAMS Dental Advisor Team

  17. RUBBER DAM The advantages: Patient Protection : • The rubber dam provides protection from debris, dental materials and from small treatment devices falling back into the patient’s throat and being accidentally swallowed or inhaled. AFAMS Dental Advisor Team

  18. RUBBER DAM The advantages: Patient Protection : Endodontic file ingestion AFAMS Dental Advisor Team

  19. RUBBER DAM The advantages: • Infection Control – Rubber dam provides excellent protection against infectious diseases. • Studies have clearly shown the reduction of bacteria in the operatory when using a rubber dam. AFAMS Dental Advisor Team

  20. RUBBER DAM The advantages: Patient Management: • The rubber dam appears to produce a feeling in the patient of “separation” from the work being done, which has a relaxing effect. • The patient does not experience discomfort from the accumulation of water and debris, and can swallow normally with the rubber dam in place. AFAMS Dental Advisor Team

  21. RUBBER DAM The advantages: • Saves Time – Unnecessary talking, rinsing and spitting are eliminated with the use of rubber dam. • Operator Protection – It isolates most of the oral cavity, therefore, helps to protect the operator from oral fluids and aerosol. • . AFAMS Dental Advisor Team

  22. RUBBER DAM Care and Storage of Rubber Dam • Rubber dam is a perishable substance. • Old rubber dam will tear more readily as it is stretched. • For a longer shelf life, rubber dam must be stored in a refrigerator or a freezer. • Storing rubber dam near a source of heat or in a warm area will affect the material adversely and shorten its shelf life. • Therefore rubber dam should not be overstocked. AFAMS Dental Advisor Team

  23. RUBBER DAM Care and Storage of Rubber Dam • Rubber dam is a perishable substance. • Old rubber dam will tear more readily as it is stretched. • For a longer shelf life, rubber dam must be stored in a refrigerator or a freezer. • Storing rubber dam near a source of heat or in a warm area will affect the material adversely and shorten its shelf life. • Therefore rubber dam should not be overstocked. AFAMS Dental Advisor Team

  24. RUBBER DAM Armamentarium for Rubber Dam Application • In addition to the basic instruments – mirror, explorer and cotton pliers, rubber dam application requires the following additional items: AFAMS Dental Advisor Team

  25. RUBBER DAM Armamentarium for Rubber Dam Application AFAMS Dental Advisor Team

  26. RUBBER DAM Armamentarium for Rubber Dam Application • Rubber Dam Material – size 6”x 6” square is commonly used. This is the adult size. A dark shade of grey or green provides color contrast for increased visibility. AFAMS Dental Advisor Team

  27. RUBBER DAM Armamentarium for Rubber Dam Application: Rubber Dam Punch – is used to make a series of small holes in a piece of rubber dam. AFAMS Dental Advisor Team

  28. RUBBER DAM Armamentarium for Rubber Dam Application: Rubber Dam Retainers/Retractors : • are used to stabilize or anchor the rubber dam on the most posterior tooth to be isolated. • Each retainer consists of two holes, two jaws, four prongs and a bow. • They may be winged or wingless. AFAMS Dental Advisor Team

  29. RUBBER DAM Armamentarium for Rubber Dam Application: Rubber Dam Retainers/Retractors : • The retainer’s jaws must fit below the height of contour of the tooth. Molar retainer in correct position. Molar retainer too high on tooth AFAMS Dental Advisor Team

  30. RUBBER DAM Armamentarium for Rubber Dam Application: Rubber Dam Retainers/Retractors : • The shape of the retainer’s jaws identifies the tooth that it is designed to fit. AFAMS Dental Advisor Team

  31. RUBBER DAM Rubber Dam Retainers/Retractors : • Jaws should not extend beyond the mesial and distal line angles of the tooth because: • wedges will be difficult to place • a complete seal of rubber dam around the anchor tooth will not be possible • soft tissue trauma is likely to occur AFAMS Dental Advisor Team

  32. RUBBER DAM Rubber Dam Retainers/Retractors : • The properly selected retainer should contact the tooth in four areas. Correct prong and jaw alignment results in proper fitting of a premolar retainer. Prongs are too close together for such a large tooth. This retainer will likely rotate on the tooth. Prongs securely grasp the tooth at its four corners. AFAMS Dental Advisor Team

  33. RUBBER DAM Rubber Dam Retainers/Retractors : • The prongs on some retainers are directed in a pronounced gingival direction to grasp partially erupted teeth to provide extra retraction of soft tissue or tooth with lower height of contour . • Flat jawed retractors are usually placed on fully erupted teeth. AFAMS Dental Advisor Team

  34. RUBBER DAM Armamentarium for Rubber Dam Application: • Rubber Dam Retainer Forceps – are used to hold a retainer and place it on the tooth. AFAMS Dental Advisor Team

  35. RUBBER DAM Armamentarium for Rubber Dam Application: • Rubber Dam Frame – attaches to the rubber dam to stretch and secure it. It also provides cheek and lip retraction. AFAMS Dental Advisor Team

  36. RUBBER DAM Armamentarium for Rubber Dam Application: • Rubber Dam Lubricant (shaving cream) – is used as an aid to slip the rubber dam over the teeth. • Contact with the patient’s own saliva during rubber dam application can also act as a lubricant. • This lubricant is, therefore, used more when working on mannequins. AFAMS Dental Advisor Team

  37. RUBBER DAM Armamentarium for Rubber Dam Application: Rubber Dam Ligatures – • used to stabilize the rubber dam in the anterior region. Items that can be used to anchor the dam include a small strip of rubber dam, a piece of dental floss, a wooden wedge or an additional retainer. • Ligatures need only be used if the rubber dam is slipping off the teeth. AFAMS Dental Advisor Team

  38. RUBBER DAM Armamentarium for Rubber Dam Application: • Dental Floss : • To pass the rubber dam through the interproximal contact and to attach to the clamp to avoid the ingestion or aspiration • Scissors : • are used to cut the interseptal rubber dam material before removing it. AFAMS Dental Advisor Team

  39. RUBBER DAM Rubber Dam Retainer Selection • The following information will give you some guidance to retainer selection; however, the actual shape of the patient’s tooth will determine the final retainer selection: • Rubber dam retainer #9 – used as a cervical retainer on anteriors and premolars to retract the gingiva and permit access and visibility to Class 5 cavities on facial surfaces • Rubber dam retainer #00 – used for small premolars, primary first molars and anterior teeth • Rubber dam retainer #2A – used for small permanent molars, large premolars and primary first molars AFAMS Dental Advisor Team

  40. RUBBER DAM • Rubber Dam Retainer Selection • Rubber dam retainer #4 – used for small permanent molars and primary second molars • Rubber dam retainer #8A – used for partially erupted or irregularly-shaped smaller permanent molars or primary second molars • Rubber dam retainer #14 – used for partially erupted permanent molars • Rubber dam retainer #14A – used for large partially erupted permanent molars AFAMS Dental Advisor Team

  41. RUBBER DAM • Rubber Dam Retainer Selection • Rubber dam retainer #56 – universal retainer used for fully erupted permanent molars • Rubber dam retainer #13A – universal retainer for fully erupted upper right and lower left molars. • Rubber dam retainer #12A – universal retainer for fully erupted upper left and lower right molars. AFAMS Dental Advisor Team

  42. RUBBER DAM Rubber Dam Retainer Selection • Proper selection of a retainer is based on: • the size of the tooth it is placed on. • the function of the retainer (as an anchor for the rubber dam or to further expose a carious lesion as in a Class 5). • its’ soft tissue relationship (flat jaws vs. apically directed jaws). • its’ stability on the tooth it is placed. AFAMS Dental Advisor Team

  43. Punching the Rubber Dam • Successful isolation of the teeth and maintenance of a dry operating field largely depend on the positioning and size of the holes in the rubber dam AFAMS Dental Advisor Team

  44. Punching the Rubber Dam • Consider the shape of the dental arch, spacing and alignment of the teeth when punching holes (i.e., crooked teeth and missing teeth). • Attach frame to rubber dam before punching. AFAMS Dental Advisor Team

  45. Punching the Rubber Dam When punching the rubber dam prior to placement, it is important that: • the holes placed resembles the positions of the teeth in the quadrant (this is why we don't use templates.). • the size of the holes reflects the size of the teeth (smallest holes for lower incisors, etc.). AFAMS Dental Advisor Team

  46. Punching the Rubber Dam • there is enough rubber dam between adjacent holes so that it completely encompasses the interdental papilla bringing about its retraction (approximately 4 mm between holes). AFAMS Dental Advisor Team

  47. Punching the Rubber Dam • NOTE: Insufficient spacing between holes forces the narrower dimensions of the dam to slip to the mesial or distal of the papilla therefore allowing the gingival papilla to protrude. This results in leakage and damage to the papilla. AFAMS Dental Advisor Team

  48. Punching the Rubber Dam • Excessive rubber dam between holes causes the rubber to bunch between the teeth and causes difficulty when trying to pass the rubber dam between the proximal contacts. • Templates should not be used due to variations in arch size and form, tooth size and position. AFAMS Dental Advisor Team

  49. Punching the Rubber Dam AFAMS Dental Advisor Team

  50. Punching the Rubber Dam • For the maxillary arch, punch central incisor holes at rubber dam’s midline, 1 inch from rubber dam’s edge. Punch additional holes according to the dental arch (see previous diagram). AFAMS Dental Advisor Team

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