Dental Isolation Techniques

• Field isolation ensures favorable oral conditions for hard tissue intervention and subsequent restoration
• Mastering field isolation is necessary and mandatory for dentists to get appropriate results

Specific Objectives

• Isolation of saliva protects the tooth
• Blocking gingival sulcus secretion is important
• Tooth isolation of humidity prevents air aspiration
• Allows a clear view of the tooth
• Protects soft tissue
• Facilitates tooth medication application
• Isolates buccal micro-flora for aseptic work
• Separates/contains soft tissues surrounding the tooth
• Ensures a clean and dry work area

Types of Isolation

• Relative isolation uses absorbent elements and aspiration to eliminate saliva and liquids within the mouth
• Absolute isolation uses a rubber dam with perforations for teeth, held on the patient's face, to separate teeth from saliva

Absolute Isolation Tools

• Include rubber dams, protectors/napkins, frame holders, clamps and instrumental

Isolation Tools: Protectors/Napkins

• Absorbent, disposable napkins protect the patient's face

Isolation Tools: Frame Holders

• Frame holders have a U shape and can be plastic or metallic
• They have pins to hold the rubber
• Different types of frame holders include Young frame, Ostby frame, and pre-attached frame

Isolation Tools: Punch

• The punch is a large-sized clamp with a steel punch and a small wheel or platen with perforations adapted to the shape of the punch

Isolation Tools: Clamp Forceps

• Clamp forceps are spring-loaded and locking long clamping pliers
• Examples include Ivory and Brewer

Isolation Tools: Dental Floss

• Dental floss is used in situations where the rubber dam tends to slip out of place
• It helps to fix the rubber dam around a tooth

Isolation Tools: Clamps

• Steel retainers come in different shapes and sizes to adapt to different tooth sizes, providing excellent stability
• Parts of a clamp:
  • Bow provides elasticity and ensures pressure on the tooth
  • Jaws hug the tooth
  • Points are the ends of the jaws that contact the tooth
  • Holes act as clamp holders for placement and removal
  • Wings are small lateral platforms that hold the rubber dam in position

Clamps Available

• 0
• 1
• 5
• 7
• W8A
• 212

Rubber Dam Functions

• Absolute isolation of the operating field and patient
• Separation of lips and cheeks
• Protection of tongue and mucous membranes
• Prevents accidental swallowing of small instruments
• Reduction of environmental contamination and infection risk
• Improved access and visibility for operative procedures
• Protection of patient's airway
• Prevents gag reflex
• Saves time

Isolation Tools - Rubber Dam

• Types available as rolls or sheets
• Thickness options include thin (not recommended), medium, and thicker
• Sizes available: 12.5 x 12.5 cm, 15 x 15 cm, 15 x 20 cm
• Colors:
  • Light increases visibility by reflecting light
  • Dark provides better contrast between the tooth and rubber dam

Placement techniques

• Preview:
  • Evaluate the operative field
  • Clean and dry the mouth and tooth surfaces
  • Verify contact points
  • Use dental floss
  • Evaluate sharp edges and bad-shaped restorations
• The rubber dam should cover from the base of the nose to the edge of the chin, and crosswise to the middle of both cheeks
• Punching techniques:
  • Place a WET rubber dam in the tooth holder, pressing toward the inside of the mouth until it touches the tooth
  • Perforate based on the place where it touches
  • Perforated templates can be used
• Mc Geltee Technique:
  • Divides the rubber dam into 4 equal parts using 2 perpendicular lines

Placement Techniques: First Clamp & Then Rubber Dam (Stibbs Technique)

• Place the clamp on the tooth
• Take the dam with fingers and bring it inside the mouth to deepen the rubber
• Stretch orifices and pass them through the clamp
• Rubber dam loose or in the holder for step 4

Placement Techniques: First Rubber Dam & Then Clamp

• Most common for anterior teeth
• Place the rubber dam through the teeth
• Place the Young frame and then the clamp
• A variation includes carrying the rubber dam already attached to the dam holder

Placement Techniques: clamp and rubber dam together

• Lift the rubber dam to reveal clamp holes
• Place the jaws of the rubber clamp holder in the holes
• Unfold the clamp using pliers
• Fold the rest of the rubber dam into a napkin shape
• Place the clamp on the indicated tooth
• Pass the rubber dam under flaps and position the dam holder
• Alternately, take the dam holder with it

Placement Techniques: Anterior Zone

• Isolate the 6 anterior teeth
• Steps:
  • Create holes for each tooth on the rubber dam
  • Start with the rubber dam over the canine
  • Place wedjets between canines and premolars to keep the dam tense and flexible
  • Use dental floss through the teeth to correctly position and tie up each tooth

Placement Techniques: Posterior Zone Technique

• Posterior teeth: one tooth distal to the contralateral
• Premolar: two distal teeth to the contralateral
• Molar: one distal tooth to the contralateral

Difficult Isolation Situations

• Few or not enough dental structure
• Huge caries, radicular caries
• Unusual tooth position and shape
• Bridges or ortho brackets
• Ceramic restorations
• Clamp cervical
• Class V
• 212 (standard or modified)
• Increase of about 1 mm between the tooth distal holes

Difficult Isolation Situations (Young Patients)

• Small arch sizes
• Small rubber dam sizes
• Clamp interference with gingival tissue
• Presence of ortho ligature between proximal areas
• Short or small crowns