Topic to read:

Isolation techniques in operative dentistry

Clinical scenario:
Patient reports with a complaint of decay in tooth #14. On examination, a class 1 carious
lesion (ICDAS 5) was diagnosed. Patient had no complaints of pain. Rubber dam was placed,
tooth preparation was done, followed by a composite restoration.
1) What are the isolation techniques used in dentistry?
Direct methods
 Rubber dam
 Absorbent materials (Cotton rolls and cellulose wafers)
 Low-volume evacuator
 High-volume evacuator
 Air-water syringe
 Throat shield
 Check retractor
 Mouth prop
Pharmacological methods
 Antisialogogues
 Antianxiety drugs
 Muscle relaxants
Methods used for gingival tissue management
 Physicomechanical
 Chemical
 Chemomechanical
 Rotary curettage
 Electrochemical
 Surgical.

2) Highlight the parts of a rubber dam assembly.

Rubber Dam Equipment
 Rubber dam sheet
 Rubber dam clamps
 Rubber dam forceps
 Rubber dam frame
 Rubber dam punch.
Rubber Dam Accessories
• Lubricant/petroleum jelly
• Dental floss
• Rubber dam napkin.

3)
3) Give indications/ contraindications of rubber dam application.
Indication
i. During root canal treatment/endodontic procedures: To prevent swallowing of foreign
bodies and contamination of root canal space
ii. Excavation of deep caries: To prevent contamination of pulp in case of pulpal exposure
iii. Subgingival restorations: To provide gingival retraction and control gingival fluid
iv. During adhesive restorations: To prevent salivary contamination and ensure complete
dryness of operating field
v. In high-risk patients: In patients with hepatits B or HIV, isolation prevents spread of
oral fluids
vi. Bleaching of teeth: To prevent damage of adjacent soft tissues by bleaching agents.

Contraindication
i. Asthmatic patients
ii. Allergy to latex
iii. Mouth breathers
iv. Extremely malpositioned tooth
v. Third molar (in some cases).

4) What is a split dam rubber dam placement technique?

This method in which rubber dam is placed to isolate the tooth without the use of rubber dam
clamp. In this technique, two overlapping holes are punched in the dam. The dam is stretched
over the tooth to be treated and over the adjacent tooth on each side. Edge of rubber dam is
carefully teased through the contacts of distal side of adjacent teeth.
Indications of split dam technique:
• To isolate anterior teeth
• When there is insufficient crown structure
• When isolation of teeth with porcelain crown is required. In such cases placement of rubber
dam clamp over the crown margins can damage the cervical porcelain.
Advantage
• Easy to apply for anterior teeth.