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
