Assalam Alekum

MOISTURE CONTROL
Excluding sulcular fluid
, saliva, bleeding from operating site.
RETRACTION
Temporarily displacing or depressing soft tissue like tongue , lips, & cheek from operating site.
Protection from injuries prevention of cross infection, soft tissue damage, accidental aspiration of debris , small instruments & restorations


Dry ,Clean operating field

Improved Access & Visibility
 Protection of Patient & Operator

Improved Operator's Efficiency

Improved Properties of Dental Materials

--RUBBER DAM (recommended)
--High volume evacuators
--Saliva ejectors
--Cotton rolls , Gauze pieces, Cellulose wafers
--Throat shields
--Mouth mirror
--Retraction cord
--Mouth prop
--Drugs- Antisialogouges , Local anesthetics

 Introduced in 1864 by S.C. BARNUM , New York city dentist.
Purpose:
-Provides absolute isolation of operating field from the surrounding.
- Heavy rubber dams when used are capable of retracting the gingiva in addition to the isolation.

It is the most successful method of isolation till date and can be placed in 3-5 minutes


Made of latex rubber

Size: 5x5 inches/ 6x6 inches
Rubber Dam Sheet

Thickness:
Thin: 0.15 mm
Medium: 0.20 mm
Heavy: 0.25 mm
Extra heavy: 0.30 mm
Special heavy: 0.35 mm

Has shiny and dull side
 Dull side facing occlusal to the isolated teeth to prevent unnecessary light reflection

Thicker dam is more effective in retracting tissues and more resistant to tearing

Generally dark, heavy, 6x6 inch sheet are recommended.

Rubber Dam Napkin
 Applied between patient’s mouth and dam sheet

Prevent saliva from drooling out
 Enhance patient’s comfort

Rubber dam FRAME
Metal frame: Young’s frame
Plastic frame: Nyggard Ostby
PUNCH
FORCEPS

PUNCH WITH ROTATING TABLE
HOLE SIZE ON ROTATING TABLE
(ideal distance between two holes: 6.3mm)
TEMPLATE TO
POSITION HOLES ON
SHEET

Rubber dam RETAINERS/ Clamps

Wingless clamp Winged clamp

Optradam

 Partially erupted teeth
 Third molars
 Extremely malpositioned teeth
 Patients suffering from asthma
 Latex allergy
 Psychological problems

--Pick up solid debris
--Suction out water & liquids effectively
--Rapid & more effective than saliva ejectors
--Remove 0.5 liter(500ml) of water/liquid in 2 seconds

It is the assistants responsibility to place the tip as close to the tooth being treated without obstructing access & view.

ADVANTAGES
OF HIGH VOLUME EVACUATORS
 Cuttings of both tooth & restorative material are removed

Improves access & visibility
 Precious metals are more easily retrieved if dislodged

Quadrant dentistry is facilitated

Pauses that are annoying & time consuming are eliminated

--It removes saliva that collects on floor of mouth
--the tip should be sterile, non irritating, smooth
--it is used in conjunction with cotton rolls & rubber dam
--it should be placed in area not interfering with operator movements
Types:
1-metal tip (autoclavable)
2-plastic (disposable)

Cotton rolls , Cellulose wafers , Gauze sponges
--They are effectively used for short term isolation
--Or when rubber dam isolation is not possible
--Used with profound local anesthesia they produce acceptable dryness
Cotton roll holders:
--cotton rolls can be placed with cotton roll holders
--they provide additional retraction for cheek & tongue

Mandibular teeth are isolated by placing one cotton roll in vestibule & larger one between teeth & tongue
COTTON ROLL HOLDER WITHOUT HOLDER


Indicated when small instruments are being used or

Indirect restorations are being inserted especially for the maxillary arch

Prevents or aspiration of instruments
,restorations

Gauze sponges 5cm x 5cm,unfolded , spread over the tongue & posterior part of the mouth act as throat shield


It is used for lateral displacement of gingival tissue whenever subgingival margins are involved
It can be used prior to
--Impression making
--Facial veneering
--Treatment of cervical lesions
--Cementation of fixed restorations

 RETRACTION CORD CAN BE
Single / double plain / along with styptic (ferric sulphate/ aluminum chloride)

Retraction cord is effective when used with saliva ejector & local anesthesia

A blunt edged instrument (Cord packer) is used for placement

Any distortion or damage to gingival tissue should be avoided
Cord packer

Recent methods of gingival retraction
Expasyl

--maintain sufficient mouth opening for time consuming procedures
--relieves strain on muscles
--increases operator efficiency
Are available in different designs & materials & sizes
Metal / plastic
Small / large
Block / ratchet
Block type
Ratchet type

Mouth prop in place
Block type Ratchet type

IN POSITION
CHEEK RETRACTOR

 Local anesthetics-with /without adrenaline
--they reduce sensation so salivation is reduced
--as pain is reduced ,patient co-operation & operator efficiency is increased
--Adrenaline causes vasoconstriction & reduces bleeding
 Antisialogouges
-Drugs used to reduce salivation
-- Example: Atropine ( single doses in adults is 0.5 mg to 1 mg) , Scopolamine (1.5 mg)
 Haemostatics
--control bleeding along with retraction cord
-- Examples: Ferric sulphate 15.5%, Aluminum Chloride 15%

References:
1. Art and science of operative dentistry- Sturdevent’S ,2000
2. Principles of Operative Dentistry- A.J.E. Qualtrough ,2005