Isolation in dentistry is important for visualization, efficiency, and preventing contamination. The main goals of isolation are moisture control, retraction and access, preventing harm, and avoiding accidental swallowing of materials. Rubber dam is the gold standard isolation method providing a dry, clear operating field, but alternatives include cotton rolls and saliva ejectors. While rubber dam placement takes skill and patients can object, its benefits include protection and a controlled environment for restorative procedures.

1. ISOLATION
• AHMED TAREQ DDS.BDS.ORTHODONTIC FELLOW. NBDE
BOARD CERTIFIED

2. INTRODUCTION
• ISOLATION IS FOR BETTER VISUALIZATION INCREASES THE EFFICIENCY OF THE
OPERATOR & VICE VERSA
• ISOLATION IS A TECHNIQUE TO PROTECT TOOTH AGAINST CONTAMINATION
FROM ORAL FLUIDS DURING SURGICAL OR RESTORATIVE PROCEDURE, USUALLY
THROUGH THE APPLICATION OF RUBBER DAM OR VARIOUS OTHER MEASURES
• GOOD ACCESSIBILITY AND VISIBILITY , ADEQUATE ROOM FOR
INSTRUMENTATION IS NECESSARY FOR EASY MANIPULATION AND INSERTION OF
RESTORATIVE MATERIALS THIS CONTROL IS ATTAINED THROUGH ISOLATION
ADVANCES IN OPERATIVE DENTISTRY VOLUME 1: CONTEMPORARY CLINICAL PRACTICE
STURDEVANT'S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION

3. GOALS OF
ISOLATIO
N
• MOISTURE CONTROL
• RETRACTION AND ACCESS
• HARM PREVENTION (SAFE AND ASEPTIC OPERATING
FIELD)
• PREVENT ACCIDENTAL SWALLOWING OF
RESTORATIVE MATERIALS AND INSTRUMENTS
• STURDEVANT'S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION

4. METHOD
S OF
ISOLATIO
N
DIRECT METHOD
• RUBBER DAM
• COTTON ROLLS
• SALIVA SUCTION UNIT( SALIVA EJECTOR,
DRYSHIELD ISOLATION SYSTEM)
• LIP AND CHEEK RETRACTOR
• THROAT SHIELDS ?
• COPPER BAND, CELLULOSE PADS
• GINGIVAL RETRACTION CORDS
• MOUTH MIRROR

5. INDIRECT METHOD:
• COMFORTABLE POSITION OF THE PATIENT AND RELAXED
SURROUNDINGS
• LOCAL ANESTHESIA
• DRUGS:
(ATROPINE SULPHATE -PROPANTHELINE BROMIDE) ; BOTH HAVE
CHRONOTROPIC EFFECT ON THE HEART RATE AND A MORE
PRONOUNCED MOUTH DRYING ACTION.@
@ METHYL ATROPINE BROMIDE VERSUS ATROPINE SULPHATE. A
CLINICAL COMPARISON PMID: 6369862

7. RUBBER
DAM
• RD IS FLAT THIN SHEET OF (LATEX, OR NON-
LATEX) THAT’S HELD BY A CLAMP AND FRAME
WHICH IS PERFORATED TO ALLOW TOOTH OR
TEETH TO PROTRUDE THROUGH THE
PERFORATION FIELD WHILE ALL OTHER TEETH
ARE COVERED AND PROTECTED BY THE SHEET.@
@QUINTESSENZ VERLAGS GMBH, BERLIN 2006-JOHANNES MULLER, NORMAN TISCHER

8. HISTORY
OF RD
• THE TECHNOLOGY TO ISOLATE TEETH UNDER
RUBBER DAM AND THEREBY ELIMINATE ADVERSE
EFFECTS OF MOUTH HUMIDITY WAS FIRST APPLIED
IN 1864 BY THE NEW YORK DENTIST S.C. BARNUM.
@
@ADVANCES IN OPERATIVE DENTISTRY VOLUME 1: CONTEMPORARY CLINICAL PRACTICE

9. MAIN
ARGUMENT
S FOR THE
USE OF
RUBBER
DAM
• PROTECTION OF THE PATIENT FROM ASPIRATING OR
SWALLOWING DEBRIS AND SMALL INSTRUMENTS DRY, CLEAR
OPERATING FIELD
• PROTECTION OF THE SOFT TISSUES
• INFECTION CONTROL FOR PATIENT, DENTIST, AND CHAIRSIDE
ASSISTANT POSSIBILITIES FOR DISINFECTING THE FIELD OF
OPERATION
• @ADVANCES IN OPERATIVE DENTISTRY VOLUME 1: CONTEMPORARY CLINICAL PRACTICE

10. INDICATIONS
• ENDODONTIC PROCEDURES
• EXCAVATIONOF DEEPCARIES
• ADHESIVE RESTORATIONS
• BLEACHING
• SUBGINGIVAL RESTORATIONS
• HIGH RISK PATIENTS

11. RD FACILITATES THE EFFICIENT, EFFECTIVE COMPLETION OF OPERATIVE
PROCEDURES. THE APPLICATION OF RUBBER DAM SHOULD NOT TAKE MORE THAN
3 TO 4 MINUTES. IF CIRCUMSTANCES PRECLUDE THE PLACEMENT OF RUBBER DAM
IN SUCH A SHORT PERIOD OF TIME, ONE SHOULD CONSIDER OTHER FORMS OF
ISOLATION, INCLUDING COTTON ROLLS, CELLULOSE PADS, OR RETRACTION
CORDS COMBINED WITH HIGH-VOLUME SUCTION OR SALIVA EJECTORS. THE
BENEFITS TO THE OPERATOR AND PATIENT OF USING RUBBER DAM INCLUDE THE
OPPORTUNITY TO UNDERTAKE TREATMENT IN A CONTROLLED, RELAXED MANNER.

12. DISADVANTA
GE OF USING
RD
• TIME CONSUMING AND PATIENT OBJECTION
• PATIENT CAN NO LONGER SPEAK EASILY
• COMMUNICATION WITH THE PATIENT CAN BE
DIFFICULT
• INCORRECT USE MAY DAMAGE PORCELAIN
CROWNS, GINGIVAL TISSUES
• INSECURE CLAMPS CAN BE SWALLOWED OR
ASPIRATED
• USAGE IS LOW AMONGST PRIVATE
PRACTITIONERS
• DIFFICULT BE USED IN CASE OF MALPOSITIONED
TEETH

13. CONTRAINDICATI
ONS
• ASTHMATIC PATIENTS
• PRESENCE OF SOME FIXED ORTHODONTIC
APPLIANCES
• INSUFFICIENTLY ERUPTED TEETH UNABLE TO
SUPPORT RETAINER
• THIRD MOLARS(IN SOME CASES)
• EXTREMELY MALPOSITIONED TEETH
• ALLERGY TO LATEX MOUTH BREATHERS
• PSYCHOLOGICAL REASONS

14. BEST WAYS
TO
IMPROVE
PATIENT
ACCEPTAN
CE TO
RUBBER
DAM
• GIVING CONCISE EXPLANATION REGARDING THE
BENEFITS OF RUBBER DAM PRIOR TO COMMENCING
ROOT CANAL THERAPY.
• INCREASE THE SKILL OF APPLYING RUBBER DAM
WITH MORE HANDS-ON TRAINING
• REDUCE THE RUBBER DAM APPLICATION TIME BY
PRACTICING IT MORE.
• PHILIPS OF DENTAL SCIENCES
• MCCBABE DENTAL MATERIALS

15. • -STUDY 2017 IN KSA. PUBLISHED IN NCBI
-ATTITUDE AND KNOWLEDGE OF ISOLATION IN OPERATIVE
FIELD AMONG UNDERGRADUATE DENTAL STUDENTS.
@UNDER THE LIMITATION OF THIS STUDY, WE CAN
CONCLUDE THAT RUBBER DAM APPLICATION HAS A WIDE
ACCEPTANCE AMONG UNDERGROUND STUDENTS. HOWEVER,
WE CANNOT DEPEND COMPLETELY ON THE RESULT OF THE
SURVEY, BUT IT IS ACCEPTABLE TOOL TO GIVE AN
INDICATION OF WHAT WILL BE THE CLINICAL PRACTICE IN
THE NEAR FUTURE

16. RUBBER DAM EQUPMENTS
• RUBBER DAM SHEET (DIFFERENT COLOR, SIZE AND THICKNESS) SHINY SURFACE AND
DULL.
• RUBBER DAM TEMPLATE (STAMP)
• RUBBER DAM PUNCH
• RUBBER DAM CLAMPS (WINGS, WINGLESS)
• RUBBER DAM FORCEPS
• RUBBER DAM FRAME
• WAXED DENTAL FLOSS
• SCISSORS
• LUBRICANTS (APPLIED IN THE AREA OF PUNCHED HOLES ON THE RUBBER DAM TO
ALLOW EASY SLIDING OF THE SHEET OVER THE TEETH )

17. PUNCHES

19. RD FRAMES

20. RD
PLACEMENT
TECHNIQUE
• MANY DIFFERENT
APPLICATION
TECHNIQUES ARE
DESCRIBED AND TAUGHT,
WITH SELECTION
DEPENDING ON PERSONAL
PREFERENCE.

21. • THE MOST TIME-CONSUMING THING ABOUT RUBBER DAM IS THE TIME TAKEN
TO CONVINCE THE DENTIST TO USE IT” THIS STIGMA NEEDS TO BE OVERCOME
BY THE DENTISTS AND MAXIMUM ISOLATION NEEDS TO BE ACHIEVED DURING A
TREATMENT PROCEDURE . ONE THING THAT HAS REMAINED CONSISTENT IS
THAT BE IT OF ANY FORM, MAXIMUM ISOLATION IS TO BE ACHIEVED DURING A
PROCEDURE, WHETHER ITS ENDODONTIC OR CONSERVATIVE.
• THEODORE M. ROBERSON, HARALD HEYMANN, EDWARD J. SWIFT, CLIFFORD M. STURDEVANT. STURDEVANT’S ART AND SCIENCE OF OPERATIVE
DENTISTRY. 5TH EDITION. PUBLISHED BY MOSBY; 2006

22. ULTERNATIVE ISOLATION METHODS
COTTON ROLLS AND CELLULOSE WAFERS
• AVAILABLE IN DIFFERENT SIZE ALLOW SLIGHT RETRACTION OF CHEEKS AIDING
IN VISIBILITY & ACCESS PRECAUTION: MOISTEN THE COTTON ROLLS &
CELLULOSE WAFERS WHILE REMOVING TO PREVENT INADVERTENT REMOVAL OF
EPITHELIUM FROM CHEEKS, FLOOR OF MOUTH OR LIPS.

23. ULTERNATI
VE
ISOLATION
METHODS
SALIVA EJECTOR
ASPIRATE'S SALIVA COLLECTED IN THE FLOOR OF THE
MOUTH • ALSO REMOVES WATER FROM AIR ROTOR
DURING CAVITY PREPARATION •

24. DRYSHIELD ISOLATION SYSTEM
IT PROVIDES ISOLATION,
EVACUATION OF ORAL FLUIDS,
RETRACTION OF THE CHEEKS,
SHIELDING OF THE TONGUE,
PROTECTION OF THE AIRWAY,
AND A BITE BLOCK. IT IS A
DEVILOPED VERSION OF MOUTH
PROPS AND SALIVA EJECTOR !
ULTERNATIVE
ISOLATION
METHODS

25. REFRENCES • LIEBENBERG WH. EXTENDING THE USE OF RUB- BER DAM ISOLATION:
ALTERNATIVE PROCEDURES. PART I,II,III. QUINTESSENCE INT 1992;23:657-
665.
• 4. MARSHALL K, PAGE J. THE USE OF RUBBER DAM IN THE UK. A SURVEY. BR
DENT J 1990;169:286-290.
• 5. WILDER A, MAY KN, STRICKLAND WD. ISOLATION OF THE OPERATING FI
ELD. IN: STURDEVANT CM, ROBERTSON TM, HEYMANN HO, STURDEVANT JR.
• THE ART AND SCIENCE OF OPERATIVE DENTISTRY. ST. LOUIS: MOSBY, 1995.
• ADVANCE IN OPERATIVE DENTISTRY TEXTBOOK
• ADVANCES IN OPERATIVE DENTISTRY VOLUME 1: CONTEMPORARY CLINICAL
PRACTICE
• STURDEVANT'S ART AND SCIENCE OF OPERATIVE DENTISTRY 5TH EDITION
• PHILIPS OF DENTAL SCIENCES
• MCCBABE DENTAL MATERIALS