Isolation of the
Operating Field
Sammayak Hiwale
Shrikant Magar
Goals Of Isolation:
• 1;Moisture Control
• >Refers to sulcular fluid,saliva,bleeding,etc.
• >generally Rubber dam is recommend for moisture control
• 2;Retraction and access
• >provides maximum exposure of the operating site and involve
maintaining the open mouth.
• >Rubber dam,High volume evacuator,Absorbent,Reyraction Chord.
• 3;Harm prevention
• > Ecxess saliva and handpiece spray alarms the patient
• >Aspiration intom small debries
• >damage to soft tissues
Advantages of Isolation
• 1)Patient related
• >Provide comfort
• >prevent swolloeing of thw debries
• >protect soft tissues
• 2)Operator related
• >Dry clear field
• >Infection conteol
• >Accesecibility icreased to operating site
• >Prevent contaminationof tooth preparation
Methods of Isolation
• Direct methods
• 1)Rubber dam
• 2)Cotton roll and cellulose wafrs
• 3)Gauze piece
• 5)suctipn device
• 6)Gingival retraction cgord
• 7)Mouth propos
• 8)Mouth mirror
Rubber Dam Isolation
• 1864 SC Barnum a New York
Dentist introduced Rubber Dam
into Dentistry.
• Efficient method of isolationg of
teeth
Advantages of Rubber Dam
• Increased visibility and accesibility
• Provide dry field
• Effectively Retract tongue,cheek,away from the operating field.
• saves time
• prevent aspiration/ingestion of dental instruments.
Disadvantages of Rubber dam
• Takes time to apply
• communication with the patient becomes difficult
• clamps can be swallowed/aspirated.
Armamenterium
• Rubber Dam sheet
• Rubber dam template
• Rubbeer dam punch
• Rubber dam clamp
• Rubber dam forceps
• Rubber dam frame
• Rubber dam napkin
• Waxed dental floss
• Scissors
• Lubrikants
Rubber dam sheet
• made of latex or non latex
• varying thickness
• thin 0.15
• medium 0.25
• heavy 0.30
• special heavy 0.35
• dull side faces occlusal side.
Rubber dam template
• position teeth is marked on
them
• use to gtrensfer them to rubber
dam sheet for holes to be
piunched
Rubber dam punch
• se to make holes in sheet thrugh
which teethcan be isolated.
Rubber dam clamps
• made of shiny and dull stainless
steel
• consist of bow and 2 jaws
• aids to anchor dam to the tooth
and sovt tissue retraction
• TYPES:1)Winged
2) Wingless
Dental floss
• After selecting clasmp 1w inch
piece of dental floss on the bow
of the clamp to aid in etreval of
the clamp if dislodged from the
tooth and falls into the
pposterior pharngeal area.
Rubber dsam clamp Forceps
• Used placement and removal of
retainer from the tooth.
Rubber Dam frame
• >maintains the border of the
dam in position
• >Support the edged of the ruber
dam
• >Retract the soft tissues
Lubricants
• on the inner surface,vaseline ir
soap appied so it will slide over
the contours of the teeth more
easily overcome the contact
areas and closely tightly around
cervix.
Rubber Dam Napkins
• Prevent direct contact between
rubber dsm sheet and patient
cheek
• Absorb saliva that accumukate
beneath the dam by cappilary
action
• indicated in cases of allergy of
rubber dam.
Preparing Patient for Rubber Dam(rubber
dam isolation)
• Step1:Testing and lubricating he proximal contacts
>Dental floss is used to test inter proximal contact and remove
debries from the tooth o be isplated
>Identify the sharp edges to be smoothened
>Usingb waxed dental tape may lubricate tight contact to facilitae dam
placement.
Step 2: Punching the Holes
Step 3:Lubricating the Dam
• Lubricating both he sides of rubber dam in area of puncged hole,using
cotton role or gloved finger to apply lubricant
• Lips and corners of the mouth may be lubricated with he petrolium
jelly.
Step 4:Selecting the Clamp
>Rubber dam retainer forceps with selected retainer and floss tie in he
position
>FRee end should exit from the cheek
>care sbould be tasken ,notb to open retainer more thsn neccessary to
secure it in forceps.
Step 5:Tesing the retaoiner stability amd
Retension
> done by lifting gently in an occlusal direction wth finger tip under the
bow of the retsiner
> An improperly fitted retainer easily dislodged.
Step6: Positioning of teh dam over the
Retainer.
• Before applying dam floss tie may be threded through anchor hole or
mayn left on underside of the dam.
• the lip of the hole must be pass completely under jaw
• the septal dam always pass through its rspective contacts in single
thickness.
Step 7:Applying the Napkin
• operator gathers the rubber dam in left hand while the assistant
insert finger and thumb to right hand through he napkin’s opening
and grasp the bunched dam held by the operator.
Step 8:Poaitioning the Napkin
• assistnt pulla the the bunched dam through the napkin and position it
o the patients face.
• operator helps by positioning the napkins on patients right side.
• napkin reduce skin contact with dam
Step 9:Attaching the frame
• Operator unfold the dam
• assistant aids in unfoding he dam
• simultaneously operator stretch and attach the dam on the right siide
• curvature of the frame should be concentric with with patients face
• free ends of the floss tie are secured to the frame.
step 10: Attaching the neck strap
• it i optional
Step 11:Passing the dam through Posterior
contact
• when the tooth is present to retainer distally the distal hole sould
pass through contact
Step 12:Applying Compound
• when the stability of the retainer is questionable then,low fusing
impression compound may be applied.
Step 13:Applying the anterior anchpr(if
needed)
• dam passes through anterior anchor which anchor the anterior teeth.
• Dam passes easily through the mesial and distal contact if it is passed
in single thicknessstarting with lip of he hole.
Step 14:Passing the Septa through the contact
without tape/with tapes
• Dental tapes used by stretching the septal dam faciolingually and
linguogingivallyeith foredfingers.
• septa is not allowed to fold.
• wedging may be appied if there is tight contact
• waxed dental tapes pass the dam through reamainin contacts.
• waxed variety makes passage easier and decrease the chances of
holes in he septaor tearing edges of holes.
Step 15: Techniques for using tape(Optional)
• previously passed tape should be left in gingiva embressure until the
septum has placed placed successfully with subsequent passage of
tapes.
• this p[revent prtially passed septum from being removed from facial
embrassure.
• the doubble stranded tape is removed from the facial embressure.
