Restorative procedures require adequate isolation of the operating field for best results. ​ A clean and dry field is comfortable both for the patient and the operator. ​ It provides better access and visibility, improving the efficiency of the operator. ​ The properties of many dental materials are improved in the absence of moisture.​ Isolation collects the materials from operating site and also prevents their aspiration. ​ Isolation also often permits the dentist to carry out extended operations if desired.​ Goals of isolation: Moisture control ​ Retraction and access​ Harm prevention . Safe and aseptic operating field ​ Prevent accidental swallowing of restorative materials and instruments​

1. Isolation
- DR POOJA

2. Contents
Introduction
Goals of isolation
Advantage of isolation
Methods of isolation
Ø Direct methods
Ø Indirect methods
Conclusion

3. Introduction
Restorative procedures require adequate
isolation of the operating field for best results.
A clean and dry field is comfortable both for
the patient and the operator.
It provides better access and visibility,
improving the efficiency of the operator.
The properties of many dental materials are
improved in the absence of moisture.

4. Isolation collects the materials
from operating site and also
prevents their aspiration.
Isolation also often permits the
dentist to carry out extended
operations if desired.

5. Goals of
isolation
Moisture
control
Retraction and
access
Harm
prevention .
Safe and aseptic
operating field
Prevent
accidental
swallowing of
restorative
materials and
instruments
sturdevant

6. Advantages of isolation Patient related
A. Provides comfort
B. Protect from swallowing or aspirating foreign
bodies
C. Protect soft tissues by retracting them

7. Operator
related
A. dry clean
operative field
B. Infection
control
C. Increased
accessibility to
operative site
D. Improved
properties of
restorative
materials
E. Improved
visibility & less
fogging of
mirror
F. Prevents
contamination
of tooth
preparation
sturdevant

8. Methods of isolation
Direct method
Mouth
mirror
Mouth
props
Gingival
retraction
cords
Suction
devices
Gauze
piece
Dri-angle
Cotton
rolls &
cellulose
wafers
Rubber
dam
sturdevant

9. Rubber dam
 One of the most effective means of isolating teeth
 Developed by SC Barnum in 1864

10. Advantages
of rubber dam
Increases visibility & accessibility
Provides a dry field
Effectively retracts tongue, cheeks away from the field of
operation
Reduces the chances of injury to soft tissues
Protects against bad taste of the materials used
Prevents any aspiration or ingestion of dental instruments

11. Disadvantages
of rubber dam
Takes time to be applied
Communication with the patient can be
difficult
Incorrect use may damage porcelain
crowns/gingival tissues
Insecure clamps can be swallowed or aspirated

12. Contraindications
child with upper respiratory tract infection, congestion of
nasal passage or nasal obstruction
Presence of some fixed orthodontic appliances
recently erupted tooth
Patients with allergy to latex
grossly carious teeth

13. Armamentarium
Rubber dam
sheet
Rubber dam
template
Rubber dam
punch
Rubber dam
clamps
Rubber dam
forceps
Rubber dam
frame
Rubber dam
napkin
Waxed
dental floss
Scissors Lubricants

14. Rubber dam
sheet
 Made of latex or non-latex.
 Available in 2 sizes-
 ❶ 5”*5”
 ❷ 6”*6”
 Available in varying thickness
 Thin – 0.15 mm
 Medium – 0.20 mm
 Heavy – 0.25 mm
 Extra-heavy – 0.30 mm Special
heavy – 0.35mm
 Light and dark sheets are available,
may be flavored for the children
 Has a shiny and dull surface, dull side
will be facing the occlusal side
sturdevant

15. Rubber dam
template
 Have positions of the teeth marked on them and
are used to transfer them to the rubber dam sheet
for holes to be punched

16. Rubber
dam
punch
 Used to make the holes in the sheet through
which the teeth can be isolated
 Has a rotating metal disk with 5 to 6 holes of
varying sizes.
 The plunger must always be centered in the
cutting hole in order to create a clean cut.
 2 types of punch design available:
1) Single hole punch
2) Multi-hole punch
a. Ash or Ainsworth pattern
b. Ivory pattern

18. Common hole
placement
problems
Holes punched too
close together –
holes pull away
from teeth causing
leakage
01
Holes punched too
far apart– dam
bunches up
between teeth
02
Holes position too
low on the dam –
dam covers
patient’s eyes or
nose
03
Holes position too
high on dam – dam
does not extend
over upper lip
04
sturdevant

19. Rubber dam clamps
 Made of shiny & dull stainless steel
 consists of
 4 prongs , 2 jaws , 1 bow
 Aid in anchoring the dam to the tooth & in
soft tissue retraction
 2 types :
 Winged
 Wingless

21. CLAMP
SELECTION
Select a clamp that will maintain four-point
contact with the tooth’s proximal surfaces.
• If a clamp is too large, it will impinge on the
soft tissues.
• If it is too small, it will not properly grasp the
tooth’s surface, and will be unstable.
sturdevant

22. sturdevant

23. Anterior teeth
 A small group of clamps
have two bows ,one on each
end of the jaw, and due to
their shape is called butterfly
clamps
Butterfly clamps

26. Bland
and retentive
clamps
 Bland clamps have jaws which are flat, directed
towards each other.They grasp the tooth at or above
the gingival margin & cause minimal gingival damage.
 Retentive clamps have jaws directed more gingivaly
and grasp the teeth below the gingival margin.
 Both bland and retentive can be further sub divided
into winged and wingless type

27. CERVICAL RETRACTINGCLAMP
 These can be single bowed or double bowed but
the jaws with their blades are movable even after
attaching the clamp to the tooth.
 By moving the blade apically the gingiva can be
retracted apically.
•Disadvantages of Brinker’s tissue retractors
•These have little gripping power and so retention
are provided mainly by impression compound.
•They have limited life.

28. CLAMPS
WITH LONG
GUARD
EXTENSION
 These retract and protect the cheek and tongue .
 Some of them have tube like perforated
extensions which hold cotton roll in the sulci.

29. Specialized
Clamps
 The Dentsply HW pattern or the Ash AD
patterns are special clamps (extended bow
clamps) in which the bow lies more distally
than that of a standard clamp.
 This is especially helpful if the preparation
of the distal surface of a clamped tooth is
necessary.

30. S-G (SILKER-
GLICKMAN )
CLAMP
 Anterior extension in this clamp allows for
retraction of dam around severely broken down teeth
while the clamp itself is placed on a tooth proximal to
one being treated.

31. RUBBER
DAM
FORCEPS
 Forceps are needed to stretch the jaws of the clamp open
in a controlled manner during placement and removal.
•Three widely used designs are:
 Ash or stokes pattern
 Ivory pattern
 Washington pattern

32. It has notches near the tips of their beaks in which
to locate the holes of a rubber dam clamp.
It allows a range of rotation for the clamp so that it
may be positioned on teeth that are mesially or
distally angled.
It has stabilizers that prevent the clamp
from rotating on the beaks.
It limits the use of these forceps to teeth
that are within a range of normal
angulation.
Ash-or- Stokes Pattern Ivory Pattern

33. University Of
Washington Pattern
It used to hold and place
rubber dam clamps around
teeth in any area of the
mouth.

34. RUBBER
DAM FRAME
 Maintains borders of rubber dam in position
 Supports edges of rubber dam sheet.
 Retracts soft tissues
 Improves access
 Two types:
 1. Plastic 2. Stainless steel
sturdevant

35. StainlessSteel
Rubber Dam
frames
Fernauld’s frame Young’s Frame

36. Plastic Rubber
Dam Frames
Starlite Visi Frame Nygaard-Ostby frame
Hygenic Frame Sauveur Oval Frame

37.  It is composed ofTwo hinged
frames members whose snap sheet
locking mechanism securely clamp
the rubber dam sheet in place.
 Offers a secure
fit without stretching the rubber
dam sheet.
 Held in this manner the dam sheet
is a under less tension, and hence
exerts less tugging on clamp.
SafeT Frame

38. Quick dam
 Comes with an attached flexible plastic
frame or rim that supports dam intraorally.
 Effective in saliva control anterior part of
the mouth than posterior part .
 Has a pliable plastic frame around
perimeter of the rubber dam
Instidam (Zirc company)
Simple & effective isolation system.
It is a pre punched rubber dam mounted
on a frame .
Compact design fits outside patient lips

39.  DENTAL FLOSS
• Required for testing the interdental contacts and for making ligatures when they
are needed.
• Also aid in flossing the rubber dam through tight contacts.
 RUBBER DAM WEDJETS
• This is an elastic cord generally used to secure the dam around the teeth
farthest from the clamp.
• It can also be used to push the dam through the interproximal contact and also
in some places as a retainer instead of clamp.
 MODELLING COMPOUND
• Low fusing modelling compound is used sometimes to secure the retainer to
the tooth to prevent retainer movement during the operative procedure.
sturdevant

40.  RUBBER DAM NAPKIN
 It is a disposable paper which is placed between the patients skin and
the rubber dam sheet.
 Uses:
a) Prevents contact of rubber dam sheet to the skin thus preventing any
possible allergic reaction.
b) It absorbs saliva seeping through the corners of the mouth.
c) It acts as a cushion.
 LUBRICANT
 In the area of the punched holes facilitates the passing of the dam
through the proximal contacts. Dam lubricants are commercially
available but other lubricants such as soap slurry are also satisfactory.
 Petroleum based lubricants should be avoided with rubber dam as they
are difficult to remove after application and can impede bonding
procedures and make inversion of dam difficult, & so a water soluble
lubricant is preferred.
 Petroleum jelly is often used at the corners of the patients mouth to
prevent irritation
sturdevant

41. STEPSOF
RUBBER DAM
APPLICATION
sturdevant

44. sturdevant

47. sturdevant

49. sturdevant

51. sturdevant

53. METHODSOF RUBBER DAMAPPLICATION
1. Dam FirstTechnique
2. Clamp FirstTechnique
3. Clamp And DamTogetherTechnique

54. Assistant’s hands position
the dam directly around the
tooth to be treated
Dam FirstTechnique
Finger tip is introduced in
the dam opening to better
illustrate the patient,the
functions of this rubber
sheet
The dentist positions the
clamp.
With assistance dentist
positions Young’s frame

55. Clamp FirstTechnique
Clamp positioned on the tooth.
Rubber sheet has been slide below
the clamp, already in place

56. Clamp And DamTogetherTechnique
Rubber sheet is punched
with a rubber dam punch
Rubber dam is stretched over
the wings of selected clamp
Dam & clamp placed in
position in patient’s mouth,
with the help of an assistant
Young’s frame is positioned
to produce tension in the dam
Using an instrument dam is
slipped beneath the clamp wings

58. Cutting the Septa Removing the Retainer
Removal of
rubber dam
sturdevant

59. Removing the Rubber Dam Wiping the Lips

60. Rinsing the Mouth and
Massaging theTissue
Examining the
Rubber dam
sturdevant

61. Cleaning –
o Clamps should be rinsed & cleaned immediately after the procedure
o Failure to clean will decrease the life of the clamp & can result in staining & corroding
o Rinse & remove excess material before ultrasonic cleaning
o Allow clamps to dry
 Sterilization –
o Important to remove excess restorative material from the clamp before sterilization as it may damage
the clamp
o Autoclave – 15 min at 130°C/266°F •
Inspection –
o Inspect the clamp for wear, distortion or damage.
o Discard if distorted
Cleaning of clamps after use

62. Errors in application & removal of rubber dam
Off center arch form
May not adequately shield the patient’s
oral cavity, allowing foreign matter to
escape down patient’s throat
May result in an excess dam material
superiorly that may occlude patient’s
nasal airway
Superior border of dam may me folded
or cut from around patient’s nose
sturdevant

63. Inappropriate
retainer
May be :
Too small
resulting in
occasional
breakage when
the jaws are
overspread
Unstable on the
anchor tooth
Impinge on soft
tissues
An appropriate
retainer should
maintain a stable
four point
contact with the
anchor tooth

64. Incorrect
technique for
cutting the septa
Stretching the septa away from gingiva,
protecting the lip & cheek with an index finger,
using curved beak scissors decreases the risk
May result in cutting soft tissues or tearing of
septa
sturdevant

65. Retainer
pinched tissue
Jaws & prongs of the retainer
usually slightly depress the tissues
but should never pinch or impinge
on it
Shredded or
torn dam
care should be taken to prevent
tearing the dam during hole
punching or passing the septa
through contact

66. Cotton rolls & cellulose wafers
1
Available in
different
diameters, cut to
variant lengths &
have plain or
woven surfaces .
2
Stabilized & held
sublingually with
specific holders or
with an anchoring
rubber dam clamp
.
3
Can be applied
without holders,
over or lateral to
salivary gland
orifices .
4
Cellulose wafers
provide additional
absorbency
5
Advantage –
6
Slight retraction
of cheeks aiding in
visibility & access
7
Precaution:
8
Moisten the
cotton rolls &
cellulose wafers
while removing to
prevent
inadvertent
removal of
epithelium from
cheeks, floor of
mouth or lips
sturdevant

67. Gauze piece
or throat
shields
Indicated when there is danger
of aspirating or swallowing
small objects, when rubber
dam is not being used
Used in pieces of 2”x2” or
larger
Particularly important when
treating teeth in maxillary arch
Gauze sponge unfolded &
spread over the tongue&
posterior part of the mouth is
helpful in recovering a small
object should it be dropped
Advantage –
Better tolerated by delicate
tissues
Less adherence to dry tissues
compared to cotton
sturdevant

68.  A thin, absorbent, cellulose triangle
 Unique replacement on the cotton roll in the parotid
area
 Covers the parotid or Stensen's duct and effectively
restricts the flow of saliva
 Provides the required Dri-Field for
 Composites
 Bonding
 Cementing
 Comes in two types: plain and silver coated
Dri – angle

69. Saliva
ejector &
high volume
evacuating
equipment
 Saliva ejector prevent pooling of saliva in the floor of the mouth
 High volume evacuating equipment removes solid debris along
with water Saliva ejector High volume evacuator
 Types of saliva ejectors :
 Metallic –
 Autoclavable
 Rubber tip to avoid irritating delicate tissues on floor of the mouth
 Plastic –
 Disposable & inexpensive
 Metallic saliva ejector Plastic saliva ejector

70.  Requirements
 Tip should always be molded to face backwards with a slight
upward curvature
 Floor of the mouth under the tip should be covered with gauze to
prevent injury to soft tissues
 Should not interfere with instrumentation
 Advantages
 Provides an adequate dry field
 No dehydration of oral tissues
 Precautions
 Should be disinfected after each use
 Child patient- cautioned not to close his mouth
sturdevant

71. Retraction cords
Used for isolation &
retraction in direct
procedures of treatment of
accessible sub gingival area
Diameter of cord should be
selected such that it is gently
inserted into gingival sulcus,
producing lateral
displacement of the free
gingiva without blanching
Cord may be moistened with
a non caustic styptic before
insertion (Hemodent)

72. Advantages –
May help restrict excessive
restorative materials from
entering the gingival sulcus
Provide better access for
contouring & finishing the
restorative material
Prevent abrasion of gingival
tissue during tooth
preparation
Used primarily to push the
gum tissue away from the
prepared margins of the
tooth, in order to create an
accurate impression of the
teeth

73. Mouth props
 Can be potential aid for lengthy appointment on posterior teeth
 Should maintain suitable mouth opening
 Types – Block AND Ratchet
 Block type Ratchet type
sturdevant

74. 
Ideal characteristics-
 Should be adaptable to all mouths
 Should be easily positioned & removed with no patient discomfort
 Should be stable once applied
 Should be either sterilizable or disposable
Secondary function -- Helps to
retract cheeks, lip & tongue in the
absence of rubber dam
Mouth mirror
sturdevant

75. Indirect
methods
Local anaesthesia
Drugs –
Anti sialogogues (Atropine)
Anti anxiety ( Diazepam)
sturdevant

76. Conclusion
 A thorough knowledge of the
preliminary procedures reduces the
physical strain on the dental team
associated with the daily dental
treatment, reduces patient’s anxiety
associated with dental procedures &
enhance moisture control thereby
improving the quality of operative
dentistry

77. References
Sturdevant’s
Art and
Science of
Operative
Dentistry
Grossman’s
Endodontic
practice
Shobha
tandon.
Textbook of
Peadodontics
Vimal K Sikri.
Textbook of
operative
dentistry

78. THANKYOU!