ISOLATION OF THE OPERATIVE
Operative dentistry can not be
expressed properly unless the
moisture in the mouth is properly
The goals of operative field
Following components of oral environment
need to be controlled during operative procedure
Lips & cheek
Buccal & lingual vestibule
Floor of the mouth
Adjacent teeth and restoration
A. Provides comfort to the
B. Protect patients from
swallowing or aspirating
C. Protect patients soft
tissues by retracting them.
A. A dry clean operative field
B. Infection control
C. Increased accessibility to
D. Improved properties of
E. Improved visibility & less
fogging of mirror
F. Prevents contamination of
Materials can be used
1. Rubber Dam
2. Cotton rolls & cellulose wafers
3. Throat shields
4. High volume evacuators & saliva ejector
5. Mirror & evacuator tip retractor
6. Mouth props
7. Air Water syringe
8. Cheek retractor
Rubber Dam Isolation
In 1864, S.C.Barnum, a NY city dentist
introduced the rubber dam.
It is a flat thin sheet of latex/non-latex that is
held by a clamp and a frame, that is preferred
to allow the tooth/teeth to protrude through
the perforations, while all other teeth are
Rubber Dam Isolation
Act as a raincoat for the tooth.
Complete,long term moisture
Maximizes access and visibility.
Clean dry field while working.
Protect lips,cheeks & tongue by
keeping them aside.
Reduces risk of cross contamination
esp. to root canal system
Prevents accidental swallowing or
aspiration of foreign bodies.
Improves the properties of dental
A. Takes time to be applied.
B. Communication with the patient
can be difficult.
C. Incorrect use may damage
D. Insecure clamps can be
swallowed or aspirated.
Epilepsy and other motor disabilities.
Allergic to latex
Presence of some fixed ortho app.
A recently erupted tooth that does not retain
Extremely malpositioned teeth
Third molar (in some cases)
Rubber dam sheet.
Rubber dam clamps.
Rubber dam forceps.
Rubber dam frame.
Rubber dam punch.
Rubber dam Napkin.
Rubber Dam Sheet
It is made of latex or non-latex.
Available in 2 sizes- ❶ 5”*5”
New material should be used.
Available in varying thickness.
Light and dark sheets are available for colour contrast.
Has a shiny & dull side, dull side will be facing the
Rubber Dam Frame
The rubber dam frame maintains the border
of the dam in position.
Support the edges of the rubber dam.
Retract the soft tissues.
Available in metal and plastic.
Rubber Dam Punch
Rubber dam punch is used to make the holes in
the sheet through which the teeth can be
The working end is designed with a plunger on
one side and a wheel on other side.
This wheel has holes of different sizes on the flat
surface facing the plunger.
The punch must produce a clean cut every time.
• Dental Floss: It is used as flossing agent for
rubber dam in tight contact areas.
• Rubber Dam napkin: This is a sheet of absorbent
material placed between the rubber dam and
• Lubricant: A lubricant is applied in the area of
punch holes facilitates the passing of dam septa
through proximal contacts.
RUBBER DAM APPLICATION TECHNIQUES.
Clamp first technique.
Rubber first technique
CLAMP FIRST TECHNIQUE
It is two handed procedureore
It can be implemented with molar and premolar(single bracket), winged or wingless clamp
Excellent operative field visibility during placement
Inserting the clamp into the mouth before the dam is dangerous since it might be displaced (fasten
it with ligature)
The clamp is severely strained during placement
It cannot be used with double bracket clamps
It is two handed procedure
It is safe procedure for the clamp engaged within the sheet hole; if it gets disengaged from the
plier there is no risk of falling into the oral cavity (swallowing or inhaling)
It is minimally invasive technique ; the patient does not feel the dentist’s hands in his/her mouth
It can be implemented with winged clamps only
Limited visibility on the target tooth
RUBBER FIRST TECHNIQUE
It is a clamp safe procedure when oral cavity is protected by the rubber sheet(no risk of
swallowing or inhaling)
Suitable for every clamp type
Invasive for the patient especially in posterior region
Limited visibility of the tooth to be clamped
It is two handed procedure
it is safe; the clamp is engaged within the sheet hole and it won’t fall into oral cavity should it
unfasten from the plier(swallowing or inhaling)
Compatible with winged or wingless (wingless is better) premolar and molar (single bracket
Excellent field visibility during clamping
Not compatible with anterior clamps(double bracket).
• Cotton rolls, gauze & cellulose wafers
absorbents are helpful for short period
isolation of the teeth especially where
rubber dam application is not possible.
• Usually placed in buccal & lingual sulcus
specially where salivary gland ducts exit, to as
to absorb saliva.
• Throat shield is important specially when the
maxillary tooth is being treated.
• An unfold gauze is stretched over the tongue
and posterior part of the mouth.
• Avoid aspiration of restorations.
High volume evacuators & saliva ejector
• It is used to remove water from airrotor with
high suction speed.
• Also helps in retracting the soft tissues.
17 suction holes along the perimeter
Retraction,protection, aspiration, illumination
Size: pediatric, adult small, medium, large
Mirror & evacuator tip retractor
• A secondary function of the mirror and
evacuator tip is to retract the cheek, lip &
• Mouth prop is also used to establish &
maintain a suitable mouth opening, thus help
in tooth preparation of posterior tooth.
• It is placed on the opposite to treatment
• Provides sufficient mouth opening for
• They are used to expand the mouth opening.
• This is usually use when working on the
gingival border of upper & lower front teeth
and for the adjustment of orthodontic bands.
Air water syringe
• By air water syringe an air blast can be useful
to dry tooth and soft tissue during
examination or used during procedure.
• The use of drugs to control salivation is rarely
indicated in restorative therapy, and is
generally limited to atropine.
• Contraindicated for nursing mothers, and
patients with glaucoma.
By all these we can achieve a moisture
free mouth for better operative and
Sturdevant’s Art and Science of Operative
Isolation game of styleitaliano
Textbook of Operative Dentistry
Pickard’s manual of Operative Dentistry
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