2. INTRODUCTION
Good accessibility and visibility , adequate room for instrumentation is
necessary for easy manipulation and insertion of restorative materials
This control is attained through isolation
3. GOALS OF ISOLATION
Moisture control
Retraction and access
Protects soft tissues from damage
Safe and aseptic operating field
Prevent accidental swallowing of restorative materials and
instruments
4. METHODS OF ISOLATION
Direct method :
Rubber dam
Cotton rolls & cellulose wafers
Saliva ejectors
High volume evacuation
Throat shields
Gingival retraction cords
Mouth props
Mouth mirror
5. Indirect method:
1. Comfortable position of the patient and relaxed
surroundings
2. Local anesthesia
3. Drugs
-Atropine sulphate
-Propantheline bromide
6. RUBBER DAM
Use of rubber dam ensures absolute moisture control in the mouth
Introduced by S.C BARNUM in 1864
7. Advantages
Increases visibility & accessibility
Provides a dry field
Effectively retracts tongue, cheeks away from the field
of operation
Saves time
Improved properties of dental materials
Reduces the chances of injury to soft tissues
Produces calming effect in children
Protection of dentist- from infection like hepatitis B
Prevents any aspiration or ingestion of dental
instruments
8. Disadvantages
Takes time to apply and remove
Communication with the patient can be difficult
Some patient may object to the use of rubber dam due to
psychological reasons
Incorrect use may damage porcelain
crowns/gingival tissues
Insecure clamps can be swallowed or aspirated
10. 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
Extremely malpositioned teeth
11. Rubber dam equipments
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
12. 1. RUBBER DAM SHEET
The dam comes in different sizes(5” x 5” inches and 6” x 6” inches),
colors(light, blue, gray, and green), and thicknesses(special heavy, extra
heavy, heavy, medium, and thin).
GRADES THICKNESS
Thin 0.15 mm
Medium 0.20 mm
Heavy 0.25 mm
Extra-heavy 0.30 mm
Special heavy 0.35mm
13. The sheet has a dull and a shiny side
Dull side is less reflective. So placed facing the operator
Heavy thicknesss dam is most commonly used
For gingival retraction, extra heavy and special heavy dams are used
In case of allergy, nitrile or vinyl rubber dam can be used
14. 2. RUBBER DAM HOLDER/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
Example:
Plastic frame(Nygaard-Ostby frame) metal frame(Young frame)
15. 3. RUBBER DAM CLAMPS
Metal clips or retainers that fit the neck of the tooth and hold rubber
dam in position
2 types:-
1. Winged
2. Wingless
Winged clamps- can be attached to the dam before placement. One disadvantage is that it
interfers with the attachment of matrices and wedges
Wingless clamps- placed over the anchor tooth and then the dam is stretched over it
17. 4. Rubber dam punch
This is a precision instrument which has a rotating metal disc with six
holes of various sizes and a tapered sharp pointed plunger
The punch is used to cut holes on the rubber dam sheet.
Smaller holes for incisors, canines and premolars and larger holes for molars
18. 5. RUBBER DAM STAMP OR TEMPLATE
Helps in marking the dots on the rubber according to the average position of the teeth
Made of plastic
Marks for central incisor is placed 1 inch from the top edge of rubber sheet so that the
patients upper lip is covered when the dam is placed
19. 6. RUBBER DAM CLAMP FORCEPS
For placing, adjusting and removing clamps
7. RUBBER DAM NAPKIN
• Soft, absorbent and disposable napkin placed
under the rubber dam and patients skin.
• Reduce skin contact thereby reducing allergic
reaction in sensitive patients
• Also absorbs saliva from corner of the mouth
and act as cushion
20. 8. LUBRICANT
Applied in the area of punched holes on the rubber dam to allow easy
sliding of the sheet over the teeth and through the proximal contacts
9. DENTAL FLOSS
Tied to the bow of the clamps to facilitate retrieval of
retainer and to prevent accidental swallowing
21. RUBBER DAM PLACEMENT TECHNIQUES
FIRST METHOD:- CLAMP PLACED PRIOR TO RUBBER DAM
1. First select appropriate clamp and place it over the tooth using clamp
forceps
2. Stretch the dam over the clamp
22. SECOND METHOD:- CLAMP AND RUBBER DAM TOGETHER
1. The rubber sheet is punched with the
rubber dam punch. For easy placement of
rubber dam over the clamp, a larger hole is
punched
2. The rubber dam is stretched over the wings
of the selected clamp
23. 3. The dam and clamp are placed in position in the
patient’s mouth with the help of rubber dam clamp
forceps rubber dam clamp forceps
4. Frame is positioned to produce tension in the dam
5. Dental floss is used to force the dam through the
interproximal contacts.
24. THIRD METHOD:- CLAMP PLACEMENT AFTER RUBBER DAM
1. Position the dam directly around the tooth
to be treated.
2. Then position the clamp
3. Finally the frame and the napkin are fitted
25. REMOVAL OF DAM
1. First remove wedges or floss ligatures used on
the non-anchor tooth
2. Next cut the interdental dam by stretching
the rubber dam buccally using scissors
without injuring the soft tissues
3. Clamps removed
4. Finally rubber dam removed along with frame
26. COTTON ROLLS AND CELLULOSE WAFERS
Available in different size
Allow slight retraction of cheeks aiding in visibility & access
Precaution:
Moisten the cotton rolls & cellulose wafers while removing to prevent
inadvertent removal of epithelium from cheeks, floor of mouth or lips
27. SALIVA EJECTOR
• Aspirates saliva collected in the floor of the mouth
• Also removes water from airrotor durin cavity
preparation
• Plastic, bendable, disposable
SVEDOPTER – saliva ejector+tongue retractor
28. HIGH VOLUME EVACUATOR
• Speed of suction is high
• Tip is made up of stainless steel or plastic and
is autoclavable
THROAT SHEILD
• Gauze sponge(2*2 inch) unfolded and spread over
tongue and posterior mouth
• Used when rubber dam not used and there is risk of
aspiration
29. MOUTH PROPS
Keeps the mouth open
For patient- relieves muscle fatigue
For dentist- affords constant and sufficient opening to carry out
procedures