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Methods of Isolation and Rubber Dam

The document discusses various methods of isolation used in dentistry, with a focus on the rubber dam. It describes the goals and importance of isolation, then covers different direct and indirect isolation methods like cotton rolls, saliva ejectors, and drugs. Rubber dams are discussed in depth, including their history, indications, advantages, disadvantages and application techniques. Other isolation tools like clamps, templates and throat shields are also outlined. The conclusion emphasizes the importance of isolation, especially rubber dams, for endodontic treatment and operative procedures.

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Sakshi Thakur
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163 views

Methods of Isolation and Rubber Dam

The document discusses various methods of isolation used in dentistry, with a focus on the rubber dam. It describes the goals and importance of isolation, then covers different direct and indirect isolation methods like cotton rolls, saliva ejectors, and drugs. Rubber dams are discussed in depth, including their history, indications, advantages, disadvantages and application techniques. Other isolation tools like clamps, templates and throat shields are also outlined. The conclusion emphasizes the importance of isolation, especially rubber dams, for endodontic treatment and operative procedures.

Uploaded by

Sakshi Thakur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Methods of Isolation and

Rubber Dam

-Dr.Meghna Punjabi
2nd Year Post Graduate Student
Department of Pediatric & Preventive Dentistry
Nair Hospital Dental College,Mumbai
Introduction
• Isolation of the operating area in dentistry is the separation of a tooth or a group of
teeth from other oral tissues, saliva and blood. 

• The idea of dental isolation was first put forward by Sanford Christie Barnum, an
American dentist from New York in 1864.

• It is mainly done to improve the access, visibility and reduce the contamination.
Goals of isolation

1.Moisture control

2.Tissue Retraction

3.Prevent accidental swallowing of restorative materials and instruments

4.Prevent bacterial contamination from saliva

5.Protection

6.Improved quality of treatment


Methods of Isolation
Isolation from moisture
a) Direct methods-

1) Cotton rolls and cellulose wafers

2) Rubberdam

3)Saliva ejector and evacuator systems

4)Gingival retraction cord

5)Throat shield
b) Indirect methods-

1)Patient comfort and relaxation

2)Local anaesthesia

3)Drugs- a)Anti-Sialagogues
b)Anti - Anxiety
COTTON ROLLS AND CELLULOSE WAFERS

• They provide satisfactory dryness for most


clinical procedures especially if used along
with saliva ejectors.
RUBBER DAM

-Introduced by S.C.Barnum in 1864


Grossman has stated that “in the eyes of the court, when an endodontic
instrument escapes from the dentist’s fingers and is ingested or aspirated,
expert opinion is unnecessary to justify claims of negligence.”
Indications-

• All the restorative and endodontic


procedures .

• Its use is imperative for reducing


bacterial contamination in pulpal
therapy.

• Bleaching

• High risk patients


Contra indications-

• Partially erupted teeth (serrated clamps/split dam)

• Latex allergies

• Asthma patients (airway obstruction)

• Severely malpositioned teeth


Advantages –

1.Improves the physical properties of restorations due to moisture control.

2. Rubber dam shields the child from any sensations of debris or tastes of
materials /prevents aspiration

3. More comfortable for child as well as dentist

4. Improved visibility and greater efficiency

5. Prevents soft tissue damage


Disadvantages-

1. Low usage amongst private practitioners


2. Claustrophobic feeling
3. Patient objection
4. Sensitive for some hours after clamp removal
ARMAMENTARIUM
Rubber Dam Sheet

a)Size of Rubber dam sheets - 5 inch by 5


inch( 12.5 cm by 12.5 cm) or 6 inch by 6 inch
(15cm by 15cm)

b)Sides- glossy and matte

c)Latex/non latex sheets

d)Thickness of the sheets-


Rubber Dam Punch -
• There are two main types: a
single-hole punch of one
size (1.63 mm or 1.93 mm)
or a five-hole punch which
can create five different-
sized holes (0.5–2.5 mm)
• Holes for quadrant isolation
is punched 3-4 mms apart
The largest hole for molars and the second-
smallest hole for all other teeth being clamped. The
second-largest hole may be used for other molar
teeth being isolated, but not clamped
Rubber Dam Clamp
Rubber Dam Holder /Frame
Retracts and holds the edges of the dental dam sheet in place

Foldable frame Youngs Frame Nygaard-Ostby frame


Rubber Dam Clamp Forceps
Instrument for placing,
adjusting and removing
clamps
Rubber Dam Template

• It is an inked rubber stamp that helps


in marking the dots on the rubber
dam sheet according to the average
position of the teeth
Accessories

Dental floss Rubber dam napkins

Wedjets Rubber dam lubricants


Methods of Rubber Dam application

1. Clamp first technique

2. Dam first technique

3. Clamp and dam together technique

4. Split dam technique


Clamp first followed by sheet
Sheet first followed by clamp
Clamp and sheet together
No Clamp Technique
Retraction with Floss
Split Stitch Technique
Single tooth isolation Multiple teeth isolation
SALIVA EJECTOR & HIGH VOLUME
EVACUATOR

• Saliva ejector aspirates saliva collected in the floor of


the mouth and to suction out water spray of airotor
(Much slower rate than the high volume evacuator)

• Svedopter is a combination of saliva ejector and


tongue retractor

• High volume evacuator used to suction out water


spray of airotor
(Speed of suction is high)
THROAT SHIELD

• This is a gauze sponge ( 2 x 2 inch) which is unfolded and spread over the tongue
and posterior part of the mouth

• Used when there is danger of aspirating or swallowing small objects


DRUGS

Anti - Sialagogues - medications which reduce salivation like atropine


Anti - Anxiety drugs- medications that reduce apprehension and anxiety levels in
patients
CONCLUSION

• In order to practice the highest standards of operative dentistry,proper control of the operating field is
mandatory

• The use of dental dam has an important role in reducing aerosol contamination as well as increasing
the success and efficiency of the treatment workflow, in addition to reducing overall treatment time. 

• Current guidelines have re emphasised that rubber dam should be universally employed for all
endodontic treatment. Endodontic treatment carried out without use of rubber dam has implications
both from a safety and medico-legal standpoint.
REFERENCES

• Ramya Raghu Clinical Operative Dentistry 2nd Edition


• Grossman’s Endodontic Practice 13th Edition
• Sturdevants Art and Science of Operative Dentistry 7th Edition
• Patel S, Hamer S, A simple guide to using dental dam. Br Dent J,230,644-
650(2021)
• Patel, Shanon & Chong, Bun & Bhuva, Bhavin. (2008). Rubber Dam in Clinical
Practice. Endodontic Practice.
• Rubber Dam for Restorative Dentistry,Australian Dental Association Guidelines

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