Isolation of the operative & endodontic field

ISOLATION OF THE OPERATIVE
&
ENDODONTIC FIELD

Presentedby,
KallolPramanik, Final yr

Operative dentistry can not be
expressed properly unless the
moisture in the mouth is properly
controlled

The goals of operative field
isolation are

Moisture control
Retraction
Harm prevention

Following components of oral environment
need to be controlled during operative
procedure
 Saliva
 Tongue
 Mandible
 Lips & cheek
 Gingival tissue
 Buccal & lingual vestibule
 Floor of the mouth
 Adjacent teeth and restoration
 Respiratory moisture

Advantages
Patient related: Operator related:
A. Provides comfort to the A. A dry clean operative field
patient B. Infection control
B. Protect patients from C. Increased accessibility to
swallowing or aspirating operative site
foreign bodies D. Improved properties of
C. Protect patients soft dental materials
tissues by retracting them. E. Improved visibility & less
fogging of mirror
F. Prevents contamination of
tooth preparation.

Materials can be used
1. Rubber Dam
2. Cotton rolls & cellulose wafers
3. Throat shields
4. High volume evacuators & saliva ejector
5. Mirror & evacuator tip retractor
6. Mouth props
7. Air Water syringe
8. Cheek retractor
9. Drugs

Rubber Dam Isolation
In 1864, S.C.Barnum, a NY city dentist
introduced the rubber dam.
It is a flat thin sheet of latex/non-latex that is
held by a clamp and a frame, that is preferred
to allow the tooth/teeth to protrude through
the perforations, while all other teeth are
covered.

Advantage Disadvantage
A. Act as a raincoat for the tooth. A. Takes time to be applied.
B. Complete,long term moisture B. Communication with the patient
control. can be difficult.
C. Maximizes access and visibility.
C. Incorrect use may damage
D. Clean dry field while working. porcelain crowns/gingival
E. Protect lips,cheeks & tongue by tissues.
keeping them aside.
D. Insecure clamps can be
F. Prevents accidental swallowing or
swallowed or aspirated.
aspiration of foreign bodies.
G. Improves the properties of dental
materials

Contraindication
 Asthmatic patients.
 Allergic to latex
 Mouth breathers
 Extremely malpositioned teeth
 Third molar (in some cases)

Armamentarium
 Rubber dam sheet.
 Rubber dam clamps.
 Rubber dam forceps.
 Rubber dam frame.
 Rubber dam punch.
Accessories
 Lubricant/Petroleum jelly.
 Dental floss.
 Rubber dam Napkin.

Rubber Dam Sheet
 It is made of latex or non-latex.
 Available in 2 sizes- ❶ 5”*5”
❷ 6”*6”
 New material should be used.
 Available in varying thickness.
 Light and dark sheets are available for colour contrast.
 Has a shiny & dull side, dull side will be facing the
occlusal side.

Rubber Dam Frame
The rubber dam frame maintains the border
of the dam in position.
Support the edges of the rubber dam.
Retract the soft tissues.
Available in metal and plastic.

Rubber Dam Punch
 Rubber dam punch is used to make the holes in
the sheet through which the teeth can be
isolated.
 The working end is designed with a plunger on
one side and a wheel on other side.
 This wheel has holes of different sizes on the flat
surface facing the plunger.
 The punch must produce a clean cut every time.

Rubber Dam Clamps
These are used to secure the dam to the
teeth, that are to be isolated.
These also minimally retract the gingiva
Subdivided into >Winged
>Wingless

Rubber Dam Clamps

Clamps without wings Clamps with wings

Rubber Dam Template
It is an inked rubber stamp which helps in
marking the dots on the sheet according to
position of the tooth.
Holes should be punched according to arch
and missing teeth.

Accessories
• Dental Floss: It is used as flossing agent for
rubber dam in tight contact areas.
• Rubber Dam napkin: This is a sheet of absorbent
material placed between the rubber dam and
skin.
• Lubricant: A lubricant is applied in the area of
punch holes facilitates the passing of dam septa
through proximal contacts.

1. Testing & lubricating the proximal
contacts

5.Testing the retainers stability &
retaintion

6.Positioning the dam over the
retainer

9.Applying the anterior anchor

10.Passing the septa through the
contacts

11.Invert the dam interproximally

12.Inverting the dam Faciolingually

13.Confirming a properly placed
rubber dam

14.Checking for access & visibility

15.Inserting the wedges(optional)

Cotton rolls
• Cotton rolls, gauze & cellulose wafers
absorbents are helpful for short period of
isolation of the teeth especially where rubber
dam application is not possible.
• Usually placed in buccal & lingual sulcus
specially where salivary gland ducts exit, to as
to absorb saliva.

Throat Shield
• Throat shield is important specially when the
maxillary tooth is being treated.
• An unfold gauze is stretched over the tongue
and posterior part of the mouth.
• Avoid aspiration of restorations.

High volume evacuators & saliva
ejector
• It is used to remove water from airrotor with
high suction speed.
• Also helps in retracting the soft tissues.

Mirror & evacuator tip retractor
• A secondary function of the mirror and
evacuator tip is to retract the cheek, lip &
tongue

Mouth prop
• Mouth prop is also used to establish &
maintain a suitable mouth opening, thus help
in tooth preparation of posterior tooth.
• It is placed on the opposite to treatment side.
• Provides sufficient mouth opening for longer
times.

Cheek retractor
• They are used to expand the mouth opening.
• This is usually use when working on the
gingival border of upper & lower front teeth
and for the adjustment of orthodontic bands.

Air water syringe
• By air water syringe an air blast can be useful
to dry tooth and soft tissue during
examination or used during procedure.

Drugs
• The use of drugs to control salivation is rarely
indicated in restorative therapy, and is
generally limited to atropine.
• Contraindicated for nursing mothers, and
patients with glaucoma.

By all these we can achieve a moisture
free mouth for better operative and
endodontic procedure.

References:
Sturdevant’s Art and Science of Operative
Dentistry
Grossman’s Endodontic practice
Textbook of Operative Dentistry
Pickard’s manual of Operative Dentistry
Internet

A special thanks to Department of Operative
Dentistry & Endodontics, HIDSAR for
providing me the opportunity of giving
seminar.

Isolation of the operative & endodontic field

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