Dental Dam

integral part of root canal treatment process
no direct evidence that dental dam enhances outcome of periapical healing but there is indirect evidence
OHS reasons to use
- Ahmad IEJ 2014
may improve tooth survival
- Lin et al J endo 2014
- Kwak et al J endo 2019
May improve periapical healing if prefabricated post is placed under dental dam
- Goldfein et al J endo 2013

advantages

improve visibility
protects patient and operator
- aspiration, swallowing, debris, medicaments, irrigants
- protect operator from infection pt mouth
- minimise aerosol risk
reduces bacterial contamination
- isolation from saliva, haemorrhage, other tissue fluids
operating efficiency
disadvantages
time consumption
additional cost
patient objection

Aseptic technique

infection control method and precautions taken during invasive clincial procedures to prevent transfer or micro organissm from healthcare work, procedure equipment or immediate environment to the patient
achieved via asepsis of key parts and key sites
key part (active)
- critical parts of procedure equipment that come in contact with key sites, liquid infusion or with other key parts connected to patient via medical device, if contaminated during procedure, key parts provide direct route for transmission of pathogen onto or into patient
key site
- open wounds, insertion or puncture site

Aspetic technique zoning for endo

tooth contaminated instruments which will become contaminated with root canal microorganisms on over patient bracket table
- open endo kit after rubber dam has been placed and tooth swabbed with NaOCl
- change gloves after dam and before open kit
sterile instruments which have not yet been contaminated with any microorganisms on nurse bracket table
asepctic tippes transfer tweezers
clean area on asistant side to mix sealer
designated clean (aseptic ) are for equipment
contaminated by saliva
heavily contaminated floor

Armamentarium

criteria to evaluate efficacy of RD isolation

stability of clamp
no saliva contamination leakge to access canal system
no leakage of irrigating solution to patient mouth
ultimately patient should not be at any discomfort because of using RD isolation

problems

allergy to latex
- use non latex
discomfort of gingivae
- block + infil or extra infil
loss of tooth stucture
- place clamp on adjacent tooth, may need to cuff multiple teeth
- use multiple clamps or wedget
- may require crown lengthening prior to RCT
- use stainless steel band
- restore tooth with composite (possibly)
ortho or fixed bridge
- clamp adjacent, multiple tooth iso
- floss ligature for retention

swab site before access after dental dam is placed