Goals of Isolation of the Operating Field
-moisture control
-retraction
-harm prevention
Moisture Control
-saliva, blood, crevicular fluid, humidity
-necessary for proper restorative material applic
-bonding procedures need moissture controls for optimum results
Retraction
-access and visibility
-lips, cheek, tongue, gingival tissue
harm prevention
-prevents aspiration/swallowing of objects
-protexts tissues from instruments
-protects patients from irriating materials/ bad taste
-protexts operator from saliva + aerosol (infection control)
1-rubber
2-hole punch
1-1864, dr. sanford barnum
2-1882- SS White
Rubber Damn isolation
-protect patient
-patient comfort
-better visualization
-improve qualit of care
-inc. productivity
-improve retention of bonded restorations
-infection control
-for licensing exam
disadv of rubber damn
-may not be places where there is insuffiecient eruption of teeth so no clamp stability
-time consuming
-patient objection
Materials used for Rubber Dam
-non latex
-medium
-darker colors are preferable
1-young frame
2-plastic frame
3-clamp forceps
1-metal---U shaped w/ open end towards nose
2-endodontics, doesnt interfere w/ radiographs
3-placement/removal of clamb from abutment of tooth----open jaws of the clamp and carries clamp to tooth
1-wingless retainer
2-winged retainer
3-Retainers
1-positioned on tooth w/o rubber dam, damn goes over retainer...easier to see placement of retainer
2-damn is placed on wings of retainer and both applied at once
-one step application
-wings give additional retraction from rubber damn
3- 4 pts of retainers contact tooth at line angles
engage tooth cervical to height of contour
not extend past mesial & distal angles of tooth bc it would inferfere w/ matrix/wedge placement
may get gingival trauma
1- retainers with points directed gingivally
2-N27
3-13A
4-12A
5-14A
6- anterior retainer
1-placement on partially erupted teeth
2-small molars
3-lower left & upper right molars
4-lower right & upper left molars
5-partially erupted molars
6-retainer is placed after rubber damn, gives retraction of gingival tissue & protects gingival tissue
other methods to retain rubber damn
-wedgets
-rubber damn material
-ligation w/o floss
-usually w/ anterior of mouth
1-size 1
2-size 2
3-size 3
4-size 4
5-size 5
1-mand incisors
2-max incisors
3-canines & bicuspids
4-molars
5-molars
1-extension for the posterior teeth
2-extension for the incisors
3-extension for canine
4- minimum extension for restorative procedures
1- 1-2 teeth posterior to the treatment tooth to the contralateral canine
2-from 1st premolar to 1st premolar...may/may not need clamps
3-1st molar to contralateral canine
4-3 teeth: treatment tooth, 1 tooth anterior, 1 tooth posterior
Problems w/ holes
1-holes punched too close together
stretches the dam too much
causes gaps
2-holes punched too far apart
too much dam material between teeth
causes bunching
---double punch hole w/ the retainer
Placement of Retainer
-forceps open jaw of retainer and carry retainer to tooth
-bow is towards distal
-seal retainer from lingual then over buccal contour
Isolation of Teeth
-pull dam over bow
-after posterior tooth isolate, isolate anterior
-secure anterior w/ wedget or clamp or floss
-leave teeth in betwene until frame is in place
-isolate the rest of the teeth
Winged Clamp Technique
-dam is on retainer
-dam & retainer go at the same time
-winged retainer & damn are placed on posterior abutment at same time
Rubber dam removal
-remove debris
-cut septa
-remove wedgets
-remove clamps/ dam at same time
Other methods of Isolation
-cotton rolls
-dry angles
-super clamp---retracts & protects tongue and lip
-optra damn---3D, frame dam all in one
-optragate---retraction of lips and cheeks, doesnt isolate each tooth
-isoprep retractor---bleaching
-isolite system---retracts tissue, suction, & light
Enamel
-inorganic
-prisms are made of hydroxyapatite crystals
---parallel to one another
---from DEJ to outer surface in radial pattern
-in key hole like pattern
Etchants
-phosphoric acid
-gel so it stays in place
-removed via rinsing
Etching Enamel
-30-40% phosphoric
-15-30 s of demin of surface
-inc surface area for bonding
-inc surface roughness
-dec surface tensions
---frosty white appearance
-addition of bodnign resin makes resin tags in etched enamel= micromechanical retention
problems w/ etching
-over etching
-etching= decalcification to a big depth---no etch pattern
-dec ability to form resin tags
-lower bond strength
-clinically overetched enamel cant be distinguished
-outer 5 um of enamel= amorphous, if unprepared = more etching time
-if has fluorosis needs more etching time
-bond strength to enamel is reduced when etched enamel= contaminated (blood, saliva, oil) and then etch surface again for 10 s
1- enamel
2-dentin
1-more minerals than water, very little organic
2-50% minerals, and then 25% 25% for organic & water
Smear Layer
-cavity prep = smear layer
-debris from grinding & organic matter
-smear layer differs depending on instruments
-makes smear plugs in tubules
-loosely adheres to dentin
1-dentin
2-bonding to dentin
1-dentin is always wet
smear layer is present
when smear is removed, fluid seeps out of tubules
communicates w/ pulp
2-30-40% phosphoric, 15 s, removes smear, demineralizes surface dentin
1-bonding to enamel
2-enamel/dentin bonding systems
1-bonding system
-etchant (30-40% phos)
-adhesive----hydrophobic resin, works bc very little H20
2-etchant (37% phos)
-primer---hydrophillic in solvent (acetone, ethanol, H20)
-adhesive---hydrophobic resin
1-enamel bonding
2-dentin bonding
3- what happens when dentin is etched
1-inorganic
can be dried
hydrophobic resin can be applied to dried enamel and cured
2-organic
dentin is wet and stays wet
hydrophyllic primer is needed
3-smear layer is removed
dentin is demineralized
collagen layer remains
Dentin cant be dried...
-must be moist to prevent collapse of remaining collagen
-if dried, bond strength to dentin decreases
-if dried then must be rewet to rehydrate
-must be primed, priming removes residual H20 to allow for infiltration of hydrophobic adhesive resin
