This document discusses methods for isolating the operating field in dental procedures. It begins with a brief history of rubber dam isolation, introduced in 1864. It then categorizes isolation methods as direct, including rubber dam, cotton rolls and gingival retraction cord, or indirect like local anesthesia. Various rubber dam application steps and armamentarium are outlined. Alternative isolation techniques like cotton rolls, throat shields and suction devices are also examined. The document concludes with recent advances in isolation products.

1. Good Morning…

2. Isolation
Of
Operating
Field
Presented by : Arpit Viradiya
Guided by : Dr. Sandeep Metgud
Dr. Deepali Agrawal

3. Contents
 Introduction
 History
 Classification – Isolation from moisture – Direct methods
- Indirect methods
- Isolation from soft tissues
Direct methods
• Rubber dam
• Cotton rolls & holder
• Throat shield/Gauze piece
• Absorbent wafers
• Suction devices
• Gingival retraction cord

4. Indirect methods
• Comfortable position of the patient & relaxed surroundings
• Local Anesthesia
• Drugs
 Isolation from Soft tissues
• Retraction of cheeks, lips and tongue
• Retraction of gingiva
 Advancements
 References
 Conclusion

5. Introduction
Isolation of operaring field is essential to the correct performances
of most operative procedures.
The term oral environment refers to the following items which
require proper control to prevent them from interfering with the
execution of any restorative procedures
•Saliva
•Moving organs, i.e. tongue
•Lips & Cheek
•The periodontium
•The contacting teeth and restoration
•The sulci, floor of the mouth and palate
•Respiratory moisture

6. History
•The rubber dam was first
described over 120 years ago when
in March 1864 Dr. Sanford
Barnum first explained its use at
meeting of Valley Dental Society in
New York.
•Rubber dam frames were
described in early 20th century as
Metal Fernauld’s design. More
recent designs have taken
advantages of developments in
plastics to produce frames which
are radiolucent.

7. Goals of isolation
Acc.to Sturdevant
1. Moisture control
 It refers to excluding sulcular fluid, saliva
& gingival bleeding from the operating field.
2. Retraction & Access
 retraction & access provides maximal
exposure of the operating site

8. 3. Harm prevention
• Small instruments and restorative debris can be aspirated or
swallowed.
•Soft tissue can be damaged accidentally.
•With moisture control and retraction, a rubber dam, suction
devices, absorbents, and occasional use of a mouth prop
prevents harm to the patient and improves operator
efficiency.

9. Local anesthesia
Use of these agents reduces salivation
apparently because the patient is
more comfortable, less anxious and
less sensitive to oral stimuli thus
reducing salivary flow.

10. Rubber Dam Isolation
 First introduced in 1864 by S.C.Barnum
•Reasons for using a Rubber dam
Safety
Moisture control
Patient management

11. Advantages of using a rubber dam
1. Dry, clean operating field
2. Access & Visibility
3. Improved properties of dental
materials
4. Protection to patient and operator
5. Increased operator efficiency

12. Disadvantages
• Asthmatics and mouth breathers
• Partially erupted and severely malpositioned teeth.
• Some 3rd Molars.
• Patients who are allergic to latex
• Psychological reasons
• Minor damage to marginal gingiva &cervical cementum
during clamp removal.
• Metal crown margins show microscopic defects
following clamp removal.
• Ceramic crowns could fracture if clamps are allowed
to grip the margins.
• Time consumption and patient objection.

13. Armamentarium
1. Rubber dam sheets
2. Rubber dam clamps
3. Rubber dam retainer forceps
4. Rubber dam holder
5. Rubber dam punch
6. Rubber dam template/stamp
7. Dental floss
8. Wedget
9. Lubricant
10. Modeling compound
11. Anchorage other than retainers

14. Rubber dam sheets
• Rubber dam is made from natural latex
rubber
• manufactured as continuous rolls in two
widths (5*5 inch or 6*6inch)
• Traditional rubber dam is black in color but it
is now made in at least four alternative color
green, blue, grey and natural (natural color is
translucent).
Thickness
Manufactured in range of five thicknesses:
Grade Thickness mm (inches)
Thin 0.15 (0.006)
Medium 0.20 (0.008)
Heavy 0.25 (0.010)
Extra heavy 0.30 (0.012)
Specia heavy 0.35 (0.014)

15. Rubber dam frame (Holder)
The rubber dam frame
maintains the borders of the
dam in position.
The young holder is a U shaped
metal frame with small
metal projections for
securing the borders of
rubber dam.

16. Metal frames Fernauld’s
Fernauld’s Frame Young’s Frame

17. PLASTIC FRAMES
NYGARD-OSTBY FRAME SAUVEUR OVAL FRAME

18. Rubber dam clamps (Retainer)
• Consists of 4 prongs and 2
jaws connected by a bow
• Used to anchor the dam to
the most posterior teeth to
be isolated
• Also retract gingival tissues
• Winged & wingless retainers
are available.

20. •When positioned on a tooth, a
properly selected retainer
should contact the tooth in
four areas-two on the facial
surface and two on the lingual
surface.
•Retainer should not move on
the anchor tooth or it will
injure the gingiva and tooth,
resulting in postoperative
soreness or sensitivity.

21. Rubber dam punch
• A precision instrument having a
metal table and a tapered, sharp
pointed plunger which is used to
produce clean-cut holes in the
rubber dam sheet through which
the teeth can be isolated.
• 1. single hole punch
• 2. multi-hole punch
a. Ivory pattern
b. Ash or Ainsworth pattern

22. SINGLE HOLE PUNCH
AINSWORTH PATTERN
IVORY PATTERN

24. • INCORRECT CENTERING
• CORRECT CENTERING

25. Clean-cut Hole (right), Incomplete cut with Residual
tag of Dam (centre), and Irregular hole following
removal of the Residual tag (left)

26. Rubber dam forceps
• Forceps are needed to
stretch the jaws of the
clamp open in a controlled
manner during placement
and removal.
Three widely used designs
are
• Ash or stokes pattern
• Ivory pattern
• Washington pattern
LOCK
HANDLE
TIPS
HOLES OF THE CLAMP

27. Ash-or- Stokes Pattern Ivory Pattern

28. University Of
Washington Pattern
Brewer Forceps

29. Rubber dam stamp & template

30. Accessories
Dental floss
• Required for testing the
Interdental contacts
and for making ligatures
when they are needed.
• Also aid in flossing the
rubber dam through
tight contacts

31. Napkin :
• The rubber dam napkin is a
precut sheet of absorbent
material which can be placed
between the rubber sheet and
the oral soft tissues.

32. Lubricant:
A water-soluble lubricant
applied to both sides of
the dam in the area of
the punched holes
facilitates the passing of
the dam through the
proximal contacts.

33. Modeling compound
• Low fusing modeling compound is used
sometimes used to secure the retainer to the
tooth to prevent retainer movement during
the operator procedure.
• Wedget
This is an elastic cord generally used to secure
the dam around the teeth farthest from the
clamp.
It can also be used to push the dam through
the interproximal contact and also in some
places as a retainer instead of clamp.

34. Application of rubber dam

35. STEP 1 STEP 2
TESTING & LUBRICATING
PROXIMAL CONTACTS
PUNCHING THE HOLES

36. STEP 3 STEP 4
LUBRICATING THE DAM SELECTING THE CLAMP

37. STEP 5 STEP 6
TESTING THE CLAMP’S
STABILITY & RETENTION
POSITIONING THE DAM
OVER THE CLAMP

38. STEP 7 STEP 8
APPLYING THE NAPKIN POSITIONING THE
NAPKIN

39. STEP 9 STEP 10
ATTACHING THE FRAME ATTACHING THE NECK
STRAP [ OPTIONAL ]

40. STEP 11 STEP 12
PASSING THE DAM
THROUGH POSTERIOR
CONTACT
APPLYING THE
COMPOUND [ OPTIONAL]

41. STEP 13 STEP 14
APPLYING THE ANTERIOR
ANCHOR [ IF NEEDED ]
PASSING THE SEPTA THROUGH
THE CONTACTS WITHOUT
TAPE

42. STEP 15 STEP 16
PASSING THE SEPTA
THROUGH THE
CONTACTS WITH TAPE
TECHNIQUE FOR USING
TAPE [ OPTIONAL ]

43. STEP 17 STEP 18
INVERTING THE DAM
INTERPROXIMALLY
INVERTING THE DAM
FACIOLINGUALLY

44. STEP 19 STEP 20
USING A SALIVA
EJECTOR [ OPTIONAL ]
CONFIRMING A PROPERLY
APPLIED RUBBER DAM

45. STEP 21 STEP 22
CHECKING FOR ACCESS &
VISIBILITY
INSERTING THE WEDGES

46. Removal of rubber dam
STEP 1 STEP 2
CUTTING THE SEPTA REMOVING THE
RETAINER

47. STEP 3 STEP 4
REMOVING THE DAM WIPING THE LIPS

48. STEP 5 STEP 6
MASSAGING THE
TISSUES
EXAMINING THE DAM

49. APPLYING THE DAM & RETAINER SIMULTANEOUSLY

50. APPLYING THE DAM BEFORE THE RETAINER

51. CERVICAL RETAINER
PLACEMENT

52. CERVICAL RETAINER PLACEMENT

53. Fixed bridge isolation

54. Fixed bridge isolation

55. Substitution of a clamp with matrix band

56. Severely broken down tooth

57. Split dam technique

58. Errors in application of rubber dam
1. OFF-CENTRE ARCH FORM
2. INAPPROPRIATE DISTANCE BETWEEN THE HOLES
3. INAPPROPRIATE RETAINERS
4. RETAINER PINCHED TISSUE
5. SHREDDED –or- TORN DAM
6. INCORRECT LOCATION OF THE HOLE FOR CLASS-V
LESION
7. SHARP TIPS ON No.212 RETAINER
8. INCORRECT TECHNIQUE FOR CUTTING THE SEPTA

59. Cotton rolls and holder

60. Placement of cotton rolls

61. Throat shields/gauze pieces
• used when there is a danger of
aspirating or swallowing objects
• especially used when treating
teeth in the maxillary arch
• 2×2 inch (5×5 cm)

62. Absorbent pads and wafers
• made of cellulose, & hence
also called cellulose wafers
• available in different
shapes
• most commonly used inside
the cheeks to cover the
parotid ducts
• more absorbent than cotton
rolls & gauze pieces

63. Evacuation systems
• Are of two types:
1. High volume evacuators
2. Low volume evacuators

64. High volume saliva evacuators
• High volume evacuators are
preferred for suctioning
because saliva ejectors remove
water slowly
• Place tip of evacuator just
distal to the tooth to be
prepared
• Tip should be parallel to the
facial (lingual) surface of the
tooth acing prepared

65. Low volume saliva ejectors
• Meant to remove saliva that
collects at the floor of the
mouth
• When used with rubber dam
passed thro a hole in rubber
dam or beneath it.

66. Gingival retraction cord
Ready made cotton or synthetic
woven.
 available as
A. BRAIDED-or-NON-BRAIDED
B. PLAIN-or-IMPREGNATED
may be supplied impregnated with
chemical

67. Indirect methods
• Comfortable &
relaxed position of
the patient

68. Local anesthesia
• helps in reducing discomfort
associated with the
treatment.
• Makes the patient less
anxious and less sensitive to
stimuli.
• Vasoconstrictor in LA helps
to reduce salivary secretion
and controls hemorrhage

69. Drugs
• Antisiologogues:
• Atropine, Propantheine
bromide, Methantheline one
to two hour before
appointment
• Contraindicated is
– Patient with ocular pressure
– Cardiovascular problem
• Anti anxiety and
Barbiturates:
• Diazepam 5-10mg or
barbiturates 24 hours
before appointment
• Muscle relaxant can also be
tried

70. Isolation from soft tissues
• Retraction of
cheeks, lips &
tongue
1. Rubber dam
2. Cotton rolls and holder
3. Tongue holder
4. Tongue depressor
5. Cheek and lip retractors
6. Mouth mirrors

71. Mouth props
• For lengthy appointment
• Mouth props of different
designs and different
material are available i.e.
block type or ratchet types
• Benefits to patient as, it
relief them of maintaining
adequate mouth opening.
• For dentist prop ensure
constant and adequate
mouth opening

72. Retraction of gingiva
• Physio-mechanical means
• Chemical means
• Electrosurgical means
• Surgical means

73. Physiomechanical means
• Rubber dam
• Gingival retraction cord
• Wooden wedges
• Cotton twills combined with fast setting ZOE
• Guttapercha or eugenol packs.

74. Chemical means
• Vasoconstrictors
• Epinephrine/Nor epinephrine
• Contraindicated in pts with:
• Hypertension
• Diabetes
• Hyperthyroidism
• Heart pts

75. ASTRINGENTS AND STYPTICS
• Biological fluid coagulants
• coagulate blood & tissue fluids locally,
• creating surface layer that is an efficient
• sealant against blood & crevicular fluid
• seepage.
• they are safe with no systemic effects.
• 10% Alum
• 15-25% Aluminium chloride
• 10% Aluminium potassium sulfate
• 15-25% Tannic acid

76. Surface layer tissue coagulants
• coagulate surface layer of sulcular &
free gingival epithelium as well as the
seeped fluids, thus creating a temporary
impenetrable film for underlying fluids
• 8% ZINC CHLORIDE
• SILVER NITRATE

77. ELECTROSURGICAL MEANS
• 4 functions seen depending on amount of energy
produced
1. Cutting
2. Coagulation
3. Fulgeration
4. Dessication
Surgical means:
sharp knife is used to remove interfering gingiva

78. Advancements
1. Handi dam
2. Opti dam
3. Opal dam
4. Insti dam
5. Optra dam
6. Non-latex Flexi dam
7. Silicone Non-Latex rubber dam
8. Derma dam
9. Svedopter

79. HANDI DAM
• the latest addition to the DENTSPLY Ash®
Instruments
• Smaller than average rubber dam
material/frame: increases patient comfort as the
material and frame are less intrusive.
• Medical grade rubber latex used (vanilla
scented): provides flexibility and the good tensile
strength helps to minimize tearing.
• HandiDamTubes: used to keep the HandiDam
steady and are single use.

80. Opti dam

81. Assembling Opti dam
1.Stretch the ergonomic
rubber dam over the
3-dimensional frame.
2. Cut off the appropriate
rubber nipples
3. Insert the winged
clamp into the
opening.

82. FOR ANTERIOR TEETH
1. Insert OptiDam 2. Use dental floss to push
the dam through the mesial
contact. Starting with the
central incisors.
3. Slip the rubber dam over
the remaining teeth to be
isolated.

83. FOR POSTERIOR TEETH
1. Position the clamp
with OptiDam
Posterior in one step.
2. Place the rubber dam
behind the wings of the
clamp.
3. Slip the rubber dam
over the remaining teeth
to be isolated.

84. Optra dam
By ivoclar vivadent
Advantages:
Easy application because of integrated frame and prepunched arch template.
High patient comfort because of flexible 3 dimensional design.
Simultaneous isolation of both arches.

85. Opal dam
It is a methacrylate based light cured resin barrier used for isolating tissue
adjacent to teeth.

86. Vital Bleaching with OpalDam
Apply a barrier of OpalDam 4-6mm wide on the
gingiva. Seal interproximal spaces. Overlap resin
approximately 0.5mm onto dry enamel to seal.
Extend resin one tooth beyond the last tooth to be
bleached. Visually check that all gingival tissues at resin
margin are covered and seal is established.

87. Light cure resin 20 seconds per light guide
width.
Note reflective properties of OpalDam!
After applying gel and light activating
according to
instructions, remove gel using suction to
avoid splattering.

88. Rinse and suction to evaluate color
change and
determine if additional whitening is
necessary.
Cured OpalDam resin is quickly and easily removed in
one or a few large pieces. Check interproximally for retained
resin.
OpalDam is designed to easily remove from
embrasures and undercuts.

89. Insti dam
Advantages:
• Compact design fits outside patients
mouth.
• Built-in flexible frame, with pre-punched
hole off-center 1/2”
• Pre-punched hole helps eliminate
tearing (additional holes may be
punched)
• Made with translucent natural latex
that is very stretchable, tear-resistant
and provides easy visibility
• Radiographs may be taken without
removing the Insti-Dam™, by bending
Insti-Dam™ to the side

90. • INSTI-DAM™ Dispenser
Features:
• Can be mounted to wall or cabinet or can sit
on a counter
• Holds 35 Insti-Dams
• Non-slip rubber bottom
• Available in White (A) - for latex or Neon
Blue (N) - for latex-free
• 4-7/8" x 4-7/8" x 6-1/8“
INSTI-CLAMP
Advantages:
• Single use only
• Can be adapted with a carbide bur
• Available in 2 sizes to fit most applications
• When removing, simply cut with a carbide
bur, no need for a Rubber Dam forceps

91. DERMA DAM
• The most pure latex rubber dam available
• Reduces the possibility of latex reactions.
• Quality processing ensures the lowest known
content of surface proteins (1.92 mg/g latex vs
up to 440 mg/g latex for some competitors).
• DermaDam Synthetic contains 0mg of
sensitizing proteins. Powder-free to eliminate
allergic reactions to powder and contamination
to preparation.
• Shelf Life: 24 months.

92. Non-Latex Flexi Dam
• Flexi Dam has an ultra-convenient, built-in-
frame.
• The flexible frame is designed with a
convenient working size of 100 mm x 105
mm to ensure for easy placement without
getting in the way.
• The smooth surface of the plastic frame
helps to maximize patient comfort when
positioned on their skin.
• Features :
• Convenient built-in-frame – saves time
• Highly elastic Flexi Dam material – tear
resistant and easy placement
• Latex free – allergy free
• Odorless – patient comfort

93. Silicone non latex Dental Dam
• Roeko, Coltene
Whaledent
• For patients, doctors and
assistants with latex
allergies and those who
are sensitized to latex.
Autoclavable up to 134°
C.

94. Svedopter

95. Summary
•A thorough knowledge of preliminary isolation procedures
reduces the physical strain on the dental team associated with daily
dental practice.
•Maintaining optimal moisture control is necessary component in
the delivery of high quality operative dentistry.

96. REFERENCES:
•Sturdevent – Art and Science of Operative Dentistry, 5th edition
•Ingle – Fifth edition
•Cohen – Pathways of Pulp, 8th edition

97. Thank You