Isolation

CONTENT
 Introduction
 Goals of isolation
 Methods of isolation
 RUBBER DAM ISOLATION
 OTHER ISOLATION TECHNIQUES
SALIVA EJECTORS
COTTON ROLLS AND CELLULOSE WAFERS
• Recent advances
• Summary
• Reference
3

INTRODUCTION
 Isolation of teeth is mandatory during all restorative procedures in
order to achieve the best possible result.
 Cotton rolls ,saliva ejectors and rubber dam may be employed.
4

GOALS OF ISOLATION
 MOISTURE CONTROL
It refers to excluding sulcular fluids, saliva and gingival
bleeding from the operative field.
The rubber dam , suction device and absorbents are
various aids effective in moisture control.
Generally rubber dam is the recommended technique for
moisture control.
6

ISOLATION FROM MOISTURE
DIRECT METHOD
• Rubber dam
• Cotton rolls and holders
• Suage pieces
• Absorbent wafers
• Suction devices
• Gingival retraction devices
INDIRECT METHOD
• Comfortable position and relaxed
surrounding to the patient
• Local anesthetics
• Drugs
 Anti-sialagogues
 Anti-anxiety drugs and muscle
relaxant
7

RETRACTION AND ACCESSS
It provides maximal exposure of operating site and usually
involves having the patient maintain an open mouth.
Rubber dam, high-volume evacuator, absorbents , retraction cord ,
mouth prop and other isolating devices such as the Isolite are used.
8

HARM PREVENTION
The same devices as that of moisture control and retraction are
used for harm prevention as well as for comfort of patient and
operator efficiency.
9

METHODS OF ISOLATION
 RUBBER DAM ISOLATION
Developed by SC Barnum,1864.
It eliminates saliva and retracts the soft tissue.
10

ADVANTAGES
 It provides a dry and clean operative field.
 Improves access and visibility.
 It potentially improved properties of restorative material.
 It protects the patient from aspirating or swallowing small
instrument or debris associated with operative procedure.
 It increases the quality and quantity of restorative service.
11

DISADVANTAGES
 It is time consuming and patients objection are most
often.
12

INDICATIONS
 In endodontic procedure to prevent aspiration or swallowing small
instruments and to avoid soft tissue contact with irrigants like sodium
hypochlorite.
 During evacuation of deep caries.
 During etching and bonding to ensure complete dryness.
 To prevent damage to adjacent tissue during bleaching.
 To control gingival hemorrhage and provide good retraction to gingival tissue
 For high risk patients infected with HIV and Hepatitis B.
13

CONTRAINDICATION
 Teeth that has not erupted sufficiently
 Some third molars
 Extremely malpositioned teeth
 Asthmatic patients with breathing problem
 Patients with latex allergy
 Non-latex rubber dam are available
polyvinyl and nitrile rubber
14

ARMAMEMTARIUM
 Rubber dam sheet
 Rubber dam clamp
 Rubber dam retainer forceps
 Rubber dam holder
 Rubber dam punch
 Rubber dam template/stamp
 Dental floss
 Lubricant
 Wedges
 Modelling compound
16

RUBBER DAM EQUIPMENTS
 RUBBER DAM MATERIAL
Available in various size and thickness
SIZE:
i. 5*5 Inch sheets
ii. 6*6 inch sheets
 THICKNESS:
i. Thin(0.006 inch)
ii. Medium(0.008 inch)
iii. Heavy(0.010inch)
iv. Extra heavy(0.012 inch)
18

• Light and darker dam material are available among which darker
color are generally preferred for contrast.
• A thicker dam is more useful in retracting tissue and more
resistant to tearing recommended for isolating class V lesions
in conjunction with certain retainer
• Thinner dam has advantage of passing through the contacts
easier , which is particularly helpful when contacts are tight.
19

 RUBBER DAM FRAME
It maintains borders of the dam in position.
It can be of two types:
Metallic: young holder
Non-metallic:
The Young holder is a U-shaped metal frame with small
metal projectors for securing the borders of the rubber dam.
20

 RUBBER DAM RETAINER
PARTS OF A RETAINER
Prong
Jaws
Bow
The rubber dam retainer consist of four prongs, two jaws connected
by a bow.
23

 FUNCTIONS OF A RETAINER
It is used to anchor the dam to the most posterior
tooth to be isolated
It is used to retract the gingival tissue.
25

 TYPES OF RETAINER
 Based on application
W56 Most molar anchor teeth
W7 Mandibular molar anchor teeth
W8 maxillary molar anchor teeth
W4 Most premolar anchor teeth
W2 smaller premolar anchor teeth
W27 Terminal mandibular molar anchor teeth
26

 Based on clamps
Wingless
Winged
Its has anterior and lateral wings.
Clamps have traditionally been made from tempered carbon to
the recently stainless steel.
Non metallic clamps are now available which are made of
polycarbonate plastic.
28

 The jaws of the retainer should not extend beyond the
mesial and distal line angle of the tooth.
 The bows of the retainer should be tied with dental
floss approx. 12 inches
30

 RUBBER DAM PUNCH
It is a precision instrument used to create precise
area of opening in the rubber dam material.
31

 RUBBER DAM TEMPLATE
A useful way to determine exactly where to punch the rubber dam
hole according to the position of the tooth
33

HOLE SIZE AND POSITION
 Holes should be punched by following the arch form
 Smaller holes are used for incisors, canine and premolar
 Larger holes for posterior tooth
34

• RUBBER DAM FORCEPS:
It is used for placement and removal of the
retainer from the tooth.
36

 NAPKINS
It is placed between the rubber dam and the patients skin.
Improves patients comfort.
Acts as a cushion
Absorbs saliva seeping to corner of mouth
Convenient method of wiping patients lip
38

 LUBRICANTS
Facilitates easy passing of the dam through the proximal
contact area.
40

 ANCHORS
Used where retainers are contraindicated.
Materials such as:
Waxed dental tape(floss)
Small piece of rubber dam material
Rubber wedjet
42

APPLICATION OF RUBBER DAM
ISOLATION
 Testing and lubricating the proximal contact
 Punching holes
 Lubricating the dam
 Selecting the retainer
 Testing the stability of retainer
 Applying napkin
 Attaching the frame
 Passing dam over posterior contact
 Passing the septa through the contact with tape
 Inverting dam interproximally
 Check for access and visibility
 Inserting wedges
43

REMOVAL OF RUBBER DAM
 Remove wedges or floss
 Cut the inter dental dam by stretching buccally
 Clamp and other retention aids are removed
 Finally rubber dam along with frame is removed
44

COTTON ROLL ISOLATION
 Used as alternative when rubber dam application is
impractical or impossible.
 Placing it in lingual vestibule for maxillary teeth and
placing it in vestibule and between the teeth and
tongue in mandibular teeth.
45

OTHER ISOLATION TECHNIQUES
 THROAT SHIELDS
Prevents aspirating or swallowing small objects is
present
It is important particularly when treating maxillary arch.
47

 HIGH VOLUME EVACUATORS AND SALIVA EJECTORS
Preferred for suction of both water and debris from
mouth.
48

 RETRACTION CORD
For accessibility to gingival and sub gingival area.
Controls sulcular seepage,hemorrhage
Resist excess restoration material into the gingival
sulcus.
50

 MOUTH PROP
It should maintain suitable mouth opening , relieving the
muscles.
52

 DRUGS
Rarely indicated in restorative dentistry.
It is limited to atropine.
53

RECENT ADVANCES
 Handidam
 Optidam
 Lingua fix(saliva ejector)
54

 LINGUA FIX
Unique disposable saliva ejectors that isolates and
protects the tongue and evacuates fluid while maintaining a dry
work area.
Comfortable , no sharp edges or corners . Useful when
the assistant is not present.
55

SUMMARY
 Isolation is necessary in operative dentistry to get the best result
in the restorative procedure
 Maintaining optimal moisture control is a necessary component
in the delivery of high quality operative dentistry.
56

REFERENCE
 Sturdivant's Arts and Science of Operative Dentistry
 Clinical Operative Dentistry Principles And Practice- Ramya Raghu
Raghu Srinivasan
57

Isolation

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Isolation