RUBBER DAM HISTORY:

Dr. Sanford Christie Barnum on 15th march 1864, Connecticut valley dental society, New York
1870, Dr. J.F.P. Hodson,7 types of clamps & no forceps used
1870, Dr. Tees festooned clamps 1878,Dr.Elliot design clamp forceps 1879, Ainsworth rubber
dam punch 1880, Dr.Hickman’s lipped clamps 1890, clamps with holes Early 20th century –
Rubber dam frame introduced(metal Fernauld’s frame)

ABCD’s of rubber dam

Adequate access and visibility in the operating field
Better patient protection and management Control of moisture in the operating field
Decreased operating time

Dry and clean operating field Access & visibility Improved property of dental materials Protects
patient and operator Operator efficiency Reduces risk of cross contamination especially to root
canal system. Psychological benefit Advantages :
1. 13. DISADVANTAGES: • 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
2. 14. INDICATIONS Endo, bleaching, caustic chemicals……
3. 15. Allergies Upper respiratory tract inf Presence of some fixed ortho app A recently
erupted tooth that does not retain a clamp Psychological reasons
4. 16. Materials and instruments RUBBER DAM SHEET  Size  Color  Surfaces 
Thickness Thickness mm inch Thin 0.15 0.006 Medium 0.20 0.008 Heavy 0.25 0.010
Extra heavy 0.30 0.012 Special heavy 0.35 0.014
5. 17. Non latex rubber dam  Synthetic/silicone, Powder free, highly elastic
6. 18. RUBBER DAM FRAMES • Maintains borders of rubber dam in position • Supports
edges of RD, retract soft tissues, improves access • Fernauld’s frame
7. 19. Star visi frame:  U shaped  Exerts less tension on dam & easy to use.  Useful
while taking radiographs
8. 20. Nygaard-Ostby frame: • Shield shaped to fit the face (nylon) • Placed on tissue side
Disadv : • Rubber close to nose ,frame presses nose
9. 21. • Le cadre articule ( articulated frame) • Dr.G.Sauveur( France) • Curved to fit the
face & hinged in the middle to fold back allowing easier access for radiographic film
placement
10. 22. Young’s frame: • U shaped • Open at 1 end Adv of plastic frames: • Universally used
Disadv : • More bulkier • Cannot take heat sterilization • Short life span
11. 23. Safe T frame:  It is composed of two hinged frame members whose snap sheet
locking mechanism securely clamp the rubber dam sheet in place.  Offers a secure fit
without- stretching the rubber dam sheet.  Dam sheet is under less tension, and hence
exerts less tugging on clamp.
12. 24. RUBBER DAM PUNCH • A precision instrument having a rotating 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.
13. 25. Types: Single hole 2 sizes Multiple hole Ivory pattern Ash/ainsworth pattern
14. 26. RUBBER DAM FORCEPS Forceps are needed to stretch the jaws of the clamp open
in a controlled manner during placement and removal. Parts…. Sterilization….. Steam/
dry heat Working life…. Sliding ring Forceps handles Hinge Forceps arms Pointed tips
15. 27. The tips of the rubber dam forceps modified for ease of use. The second groove for
removal of the rubber dam clamp
16. 28. HARNESSES  Retracts only sides of RD.  Attached to vertical edges of the RD by
metal chips from which elastics pass around the back of head & apply traction to the
edges of RD. Advantages : max retraction Advantages of frames over harnesses 
Types: Woodburry Wizzard
17. 29. RUBBER DAM CLAMPS / RETAINERS • Used to anchor the dam to the most
posterior teeth to be isolated • Also retract gingival tissues Parts:>
18. 30. • 4 point contact • Circumferenti al contact Anchoring clamps
19. 31. Types:
20. 32. Single bow Double bow Metallic Plastic Carbon steel plated Stainless steel
21. 33. Sizes: Maxillary teeth Clamps Maxillary molar 6, 9, 210, 212 Central incisor 6, 9, 210,
00 Canine 6, 9, 210 Premolars 0, 2, 2A, W2A Molars 3, W3, W8A, 14,14A Mandibular
teeth Clamps Incisors 6, 9, 210, 212 Canine 6, 9, 210 Premolars 0, 00, 2, W2A Molars 3,
W3, W8A, 14, 14A
22. 34. Common RD clamps for pediatric use: Partially erupted permanent molar: 14A,
14AD, 14, 8A, 8AD, W8AD Fully erupted perm molar: 14, 14A, 14AD, 8, SSW 201. 2nd
primary molar: 4, 14, 3 Ivory 1st primary molar: 2, 00, SSW 210 Primary incisors &
canines: 00, 2, SSW 209, 210
23. 35. SPECIALIZED CLAMPS Extended bows: prepn of distal surface of clamped tooth
Modified bow clamps : 3rd molars Cervical retainers Tiger clamps S-G (Silker –
Glickman) clamps Fit Cervical Clamp 214
24. 36. ANCHORS/ OTHER RETAINERS Dental floss(waxed)/ dental tape: • Test interdental
contacts and for making ligatures when needed. • Also for flossing the rubber dam
through tight contacts Cut rubber dam sheet: secure dam Orthodontic elastics:
25. 37. Wedjet Stabilizing cords and wedges An elastic cord -secure the dam around the
teeth farthest from the clamp. Also to push the dam through the interproximal contact As
a retainer instead of clamp. Modeling compound • To secure the retainer to the tooth
-prevent retainer movement during the operator procedure.
26. 38. NAPKINS • Precut sheet of absorbent material which can be placed between the
rubber sheet and the oral soft tissues.
27. 39. LUBRICANTS  A water-soluble lubricant applied to both sides of the dam.  In the
area of the punched holes facilitates the passage of the dam through the proximal
contact  Hygienic or KY jelly or topical LA  Cocoa butter/ petroleum jelly
28. 40. TEMPLATES AND STAMPS Commercial aid to locate hole position
29. 41. Application of dam in children  Sheet…5˝×5"  Frame…5˝ Young’s pattern  Clamps
retentive type  Tell-show-do tech.  Euphemisms like “rubber rain coat”
30. 42. PREPARATION OF THE DAM  Selection  Position of the holes -Single tooth
isolation -Multiple teeth isolation Heavy Thin Dark Light/ translucent Medium
31. 43. GUIDELINES FOR MAKING THE HOLES
32. 44. PUNCHING OF THE DAM • Distance between holes PUNCHING THE HOLES
LUBRICATING THE DAM
33. 45. SELECTION OF THE CLAMP  Anchor teeth…..  Anterior teeth  Most distal tooth 
Acid etching  Maximal coronal diameter  Four point contact  Length of the clamp jaw =
MD width of the root
34. 46. CUSTOMIZATION OF THE CLAMPS S.S clamps- cold working, carbon plated- heat
working
35. 47. a)Fit sloped root surface b)Versatile application c)Curvature of labial surfaces of
lower incisor.
36. 48. FLOSS TYING
37. 49. CORRECT CLAMP PLACEMENT TESTING THE CLAMP’S STABILITY &
RETENTION
38. 50. PREPARATION OF THE MOUTH Deposits Contacts Rinse mouth Shade selection
Anesthesia Mark the tooth TESTING & LUBRICATING PROXIMAL CONTACTS
39. 51. APPLICATION TECHNIQUES DOUBLE MOTION TECHNIQUES:  Clamp
placement prior to the rubber dam TESTING THE CLAMP’S STABILITY & RETENTION
40. 52. RUBBER DAM APPLICATION • Rubber dam undoubtedly is one of the best methods
for providing isolation from saliva and soft tissues. • Remember the following points
during rubber dam application: • When using rubber dam, isolate at least three teeth at a
time. • · Single tooth isolation is usually not recommended except in certain cases when
 root canal treatment is to be performed. • · For working on central incisors, lateral incisors
or on mesial aspect of canines, isolation is done from first premolar to first premolar of
the opposite side. Isolation in the anterior area may not require the use of retainers. The
use of supplemental aids of retention may suffice. • · For working on the distal aspect of
canines and premolars, isolate two teeth posteriorly and punch holes until the opposite
lateral incisor anteriorly. • · For working on the molars, isolate until the posterior most
teeth on the same side and until the lateral incisor on the opposite side. • · Spacing
between two holes in the dam should be adequate (approximately of an inch). • · If
inadequate spacing is present between the holes there are chances that the rubber dam
sheet will move to the mesial or the distal of the papilla thereby exposing and injuring the
gingival as well not providing proper isolation. This also increases the chances of tear of
the dam. If the holes are over spaced rubber dam will bunch in between the teeth thus
interfering with the operative procedure.
41. 53. • Step 1: Testing and Lubricating the Proximal Contacts. The operator receives dental
floss from the assistant to test the interproximal contacts and remove debris from the
teeth to be isolated. Passing (or attempts to pass) floss through the contacts identifies
any sharp edges of restorations or enamel that must be smoothed or removed to prevent
tearing the dam. Using waxed dental tape may lubricate tight contacts to facilitate dam
placement. Tight contacts that are difficult to floss but do not cut or fray the floss may be
wedged apart slightly to permit placement of the rubber dam. A blunt hand instrument
may be used for separation. For some clinical situations, the proximal portion of the tooth
to be restored may need to be partially prepared to eliminate a sharp or difficult contact
before the dam is placed).
42. 54. • Step 2: Punching the Holes. • It is recommended that the assistant punch the holes
after assessing the arch form and tooth alignment. However, some operators prefer to
have the assistant prepunch the dam using holes marked by a template or a rubber dam
stamp.
43. 55. • Step 3: Lubricating the Dam. • The assistant lubricates both sides of the rubber dam
in the area of the punched holes using a cotton roll or gloved fingertip to apply the
lubricant. This facilitates passing the rubber dam through the contacts. The lips and
especially the corners of the mouth may be lubricated with petroleum jelly or cocoa butter
to prevent irritation
44. 56. Step 4: Selecting the Retainer. The operator receives (horn the assistant) the rubber
dam retainer forceps with the selected retainer and floss tie in position(4A). The free end
of the tie should exit from the cheek side of the retainer. Try the retainer on the tooth to
verify retainer stability. If the retainer fits poorly, it is removed either for adjustment or
selection of a different size. (Retainer adjustment, if needed to provide stability, is
presented in the previous section, Rubber Dam Retainer). Whenever the forceps is
holding the retainer, care should be taken not to open the retainer more than necessary
to secure it in the forceps. Stretching the retainer open for extended periods causes it to
lose its elastic recovery. Retainers that have been deformed (“sprung”), such as the one
shown in B, should be discarded).
45. 57. Step 5: Testing the Retainer’s Stability and Retention. If during trial placement the
retainer seems acceptable, remove the forceps. Test the retainer’s stability and retention
by lifting gently in an occlusal direction with a fingertip under the bow of the retainer. An
improperly fitting retainer will rock or be easily dislodged.
46. 58. • Step 6: Positioning the Dam Over the Retainer. • Be applying the dam, the floss tie
may be threaded through the anchor hole, or it may be left on the underside of the dam.
With the forefingers, stretch the anchor hole of the dam over the retainer (bow first) and
then under the jaws. The lip of the hole must pass completely under the jaws. The
forefingers then may thin out, to a single thickness, the septal dam for the mesial contact
of the retainer tooth and attempt to pass it through the contact, lip of the hole first. The
septal dam must always pass through its respective contact in single thickness. If it does
not pass through readily, it should be passed through with dental tape later in the
procedure.
47. 59. • Step7: Applying the Napkin. • The operator now gathers the rubber dam in the left
hand while the assistant inserts the fingers and thumb of the right (or left) hand through
the napkin’s opening and grasps the bunched dam held by the operator.
48. 60. • Step 8: Positioning the Napkin. The assistant then pulls the bunched dam through
he napkin and position it on the patient’s face. The operator helps by positioning the
napkin on the patient’s right side. The napkin reduces skin contact with the dam.
49. 61. • Step 9: Attaching the Frame: The operator unfolds the dam. (If an identification hole
was punched, it is used to identify the upper left corner). The assistant aids un unfolding
the dam and, while holding the frame in place, attaches the dam to the metal projections
on the left side of the frame. • Simultaneously, the operator stretches and attaches the
dam on the right side. The frame is positioned outside the dam. The curvature of the
frame should be concentric with the patient’s face. The dam lies between the frame and
napkin. Either the operator or assistant attaches the dam along the inferior border of the
frame. Attaching the dam to the frame at this time controls the dam to provide access
and visibility. Secure free ends of the floss tie to the frame.
50. 62. • Step 10 (Optional): Attaching the neck Strap. • The assistant attaches the neck
strap to the left side of the frame and passes it behind the patient’s neck. The operator
then attaches it to the right side of the frame. Neck strap tension is adjusted to stabilize
the frame and hold the frame (and periphery of the dam) gently against the face and
away from the operating field. If desired, using soft tissue paper between the neck and
strap may prevent contact of the patient’s neck against the strap.)
51. 63. • Step 11: Passing the Dam through Posterior contact. If there is a tooth distal to the
retainer, the distal edge of the posterior anchor hole should be passed through the
contact (single thickness, with no folds) to ensure a seal around the anchor tooth. If
necessary, use waxed dental tape to assist in this procedure (see Step 15 for the use of
tape). If the retainer comes off unintentionally as this is done or during subsequent
procedures, passage of the dam through the distal contact anchors the dam sufficiently
to allow easier reapplication of the retainer or placement of an adjusted or different
retainer.
52. 64. • Step 12 (Optional): Applying Compound. If the stability of the retainer is
questionable, low-fusing modeling compound may be applied. The assistant heats the
end of a stick of compound in an open flame and tempers it by holding it in water for a
few seconds. While the assistant holds the unheated end, the operator pinches off a
sufficient amount to form a cone about 1, inch (12.7 mm) long.) • The assistant should
ensure dryness by directing a few short bursts from the air syringe on the occlusal
surface of the tooth before compound placement. The operator positions the compound
cone on the ball of the gloved forefinger, briefly resoftens the tip of the cone in the flame,
and carries the compound to its place, covering the bow of the retainer and part of the
occlusal surface of the tooth. The compound should not cover the holes in the jaws of the
retainer. The compound will adhere to the tooth if the tooth is dry.
53. 65. • Step 13: Applying the Anterior Anchor (If Needed) • The operator passes the dam
over the anterior anchor tooth, anchoring the anterior portion of the rubber dam. Usually,
the dam passes easily through the mesial and distal contacts of the anchor tooth if it is
passed in single thickness starting with the lip of the hole. Stretching the lip of the hole
and sliding it back and forth aids in positioning the septum. When the contact farthest
from the retainer is minimal (“light”), an anchor may be required in the form of a double
thickness of dental tape or a narrow strip of dam material that is stretched, inserted, and
released. If the contact is open, a rolled piece of dam material may be used.
54. 66. • Step 14: Passing the Septa through the Contacts without Tape. The operator
passes the septa through as many contacts as possible without the use of dental tape by
stretching the septal dam faciogingivally and linguogingivally with the forefingers. Each
septum must not be allowed to bunch or fold. Rather, its passage through the contact
should be started with a single edge and continued with a single thickness. Passing the
dam through as many contacts as possible without using dental tape is urged because
the use of tape always increases the risk of tearing holes in the septa. Slight separation
(wedging) of the teeth is sometimes an aid when the contacts are extremely tight.
 Pressure from a blunt hand instrument (e.g., beaver-tail burnisher) applied in the facial
embrasure gingival to the contact usually is sufficient to obtain enough separation to
permit the septum to pass through the contact.
55. 67. • Step 15: Passing the Septa through the Contacts with Tape. Use waxed dental tape
to pass the dam through the remaining contacts. Tape is preferred over floss because its
wider dimension more effectively carries the rubber septa through the contacts. Also,
tape is not as likely to cut the septa.. The waxed variety makes passage easier and
decreases the chances for cutting holes in the septa or tearing the edges of the holes.
The leading edge of the septum should be over the contact, ready to be drawn into and
through the contact with the tape. As before, the septal rubber should be kept in single
thickness with no folds. The tape should be placed at the contact on a slight angle. With
a good finger rest on the tooth, the tape should be controlled so that it slides (not snaps)
through the proximal contact, thus preventing damage to the interdental tissues.
56. 68. • Step 16 (Optional): Technique for Using Tape. Often, several passes with dental
tape are required to carry a reluctant septum through a tight contact. When this happens,
previously passed tape should be left in the gingival embrasure until the entire septum
has been successfully placed with subsequent passage of tape. This prevents a partially
passed septum from being removed or torn. The double strand of tape is removed from
the facial.
57. 69. • Step 17: Inverting the Dam Interproximally. Invert the dam into the gingival sulcus to
complete the seal around the tooth and prevent leakage. Often, the dam inverts itself as
the septa are passed through the contacts as a result of the dam being stretched
gingivally. The operator should verify that the dam is inverted interproximally. Inversion in
this region is best accomplished with dental tape.
58. 70. • Step 18: Inverting the Dam Faciogingivally. • With the edges of the dam inverted
interproximally, complete the inversion facially and lingually using an explorer or a
beaver-tail burnisher while the assistant directs a stream of air onto the tooth. This is
done by moving the explorer around the neck of the tooth facially and lingually with the
tip perpendicular to the tooth surface or directed slightly gingivally. A dry surface prevents
the dam from sliding out of the crevice. Alternatively, the dam can be inverted facially and
lingually by drying the tooth while stretching the dam gingivally and then releasing it
slowly.
59. 71. • Step 19 (Optional): Using a Saliva Ejector. The use at a saliva ejector is optional
because most patients are able, and usually prefer, to swallow excess saliva.
Furthermore, salivation is greatly reduced when profound anesthesia is obtained. If
salivation is a problem, the operator or assistant uses cotton pliers to pick up the dam
lingual to the mandibular incisors and cuts a small hole through which the saliva ejector is
inserted.
60. 72. • Step 20: Confirming a Properly Applied Rubber dam. The properly applied rubber
dam will be securely positioned and comfortable to the patient. The patient should be
assured that the rubber dam does not prevent swallowing or closing the mouth (about
halfway) when there is a pause in the procedure.
61. 73. • Step 21: Checking for Access and Visibility Check to see that the completed rubber
dam provides maximal access and visibility for the operative procedure.
62. 74. • Step 22: Inserting the Wedges. For proximal surface preparations (Classes II, Ill,
and IV), many operators consider the insertion of interproximal wedges as the final step
in rubber dam application. Wedges are generally round toothpick ends about half inch
(12.7 mm) in length that are snugly inserted into the gingival embrasures from the facial
or ling embrasure, whichever is greater, using No. 110 pliers. • To facilitate wedge
insertion, first stretch the dam slightly by fingertip pressure in the direction opposite
wedge insertion, and then insert the wedge while slowly releasing the dam.
63. 75. Placement of rubber dam 3 methods 1. Dam first technique 2. Clamp first technique
3. Clamp and dam together technique
64. 76. INSERTING THE WEDGES
65. 77. Clamp placed after the rubber dam
66. 78. SINGLE MOTION TECHNIQUE Clamp & rubber dam placed together ( endodontics)
67. 79. REMOVAL OF THE RUBBER DAM CUTTING THE SEPTA REMOVING THE
RETAINER
68. 80. REMOVING THE DAM WIPING THE LIPS
69. 81. MASSAGING THE TISSUES EXAMINING THE DAM
70. 82. ERRORS IN APPLICATION & REMOVAL Off-center arch form Inappropriate dist.
between the holes Incorrect arch form of the holes Inappropriate retainer Shredded/ torn
dam Sharp tips on No. 212 retainer Incorrect technique of cutting septa
71. 83. LOSS OF TOOTH/ PORCELAIN CROWNS/ VENEERS SPLIT DAM TECHNIQUE
72. 84. MEDICAL PROBLEMS Mouth breathing ×
73. 85. Allergies PVC or polyethylene High risk patients
74. 86. DERMA DAM • Pliable metal frame secures dam -improving patient comfort •
Flexibility -radiographs without dam or frame removal • Dam sheet: Powder free, high
tear resistance • DermaDam synthetic -no sensitizing proteins • Low dermatitis potential
ADVANCES
75. 87. INSTI DAM  translucent natural latex  very stretchable,  tear-resistant  provides
easy visibility
76. 88. FLEXI DAM Convenient built-in-frame( pliable plastic frame around the perimeter of
RD) – saves time Highly elastic Flexi Dam material – tear resistant and easy placement
Latex free – allergy free Odourless – patient comfort
77. 89. OPTI DAM •3-D, anatomically designed frame and dam provide widened
access,visibility & comfort •Preshaped frame & dam
78. 90. HANDI DAM  Built in frame and rod for insertion to keep the dam open.  A plastic
tube is inserted in prepared holes in RD  One size  Excellent elasticity and tear
resistance
79. 91. DRY DAM  Svenska  Does not require frame or harness  Small sheet of rubber
set into centre of an absorbent paper sheet with light elastics on either side to pass over
ears  Quickly isolating anterior teeth
80. 92. OPTRA DAM
81. 93. OPAL DAM / Liquid dam Great for tissue isolation during in-office bleaching Light-
cured resin barrier
82. 94. Isolation ISOLATION FROM MOISTURE A) Direct methods I. Rubber dam 2. Cotton
rolls and cotton roll holders 3. Absorber wafers 4. Suction devices and Evacuator system
B) Indirect methods I. Comfortable position of the patient and relaxed surroundings 2.
Local anesthesia 3. Drugs ISOLATION OF SOFT TISSUES 1. Retraction of the cheeks,
lips & tongue 2. Retraction of gingiva ISOLATION FROM MOISTURE A) Direct methods
I. Rubber dam 2. Cotton rolls and cotton roll holders 3. Absorber wafers 4. Suction
devices and Evacuator system B) Indirect methods I. Comfortable position of the patient
and relaxed surroundings 2. Local anesthesia 3. Drugs ISOLATION OF SOFT TISSUES
1. Retraction of the cheeks, lips & tongue 2. Retraction of gingiva
83. 95. COTTON ROLLS AND HOLDERS FLUID ABSORBING MATERIALS - Moisture
absorbents - Aid in minimally retracting soft tissues - Alternative when rubber dam
application is not practical or possible.
84. 96. Cotton rolls Manually rolled Pre-fabricated Smooth Woven •When used in association
with profound anaesthesia, cotton rolls provide acceptable dryness for procedures like
-Examination - Sealant placement - Impression taking - Topical fluoride application
-Cementation
85. 97. Holders • Cotton rolls can be placed into position and stabilized with commercial
holding devices known as Cotton roll holders. • Advantage -Provide slightly more
retraction -Improve accessibility and visibility of working area • Disadvantage -They have
to be removed from the mouth for changing cotton rolls -Relatively time consuming
86. 98. Application techniques × For isolation in maxillary anterior area Small sized rolls are
placed on either side of labial frenum
87. 99. Application techniques × For isolation in mandibular anterior area Small sized rolls
are placed on either side of mandibular labial frenum along with in lingual sulcus.
88. 100. ABSORBENT PADS/ CELLULOSE WAFERS (Young dental)
89. 101. Silver Dri-Aid The laminated side prevents soak- through and reflects light for
improved visibility. Parotid shield/ Dry aid
90. 102. GAUZE PIECES/ THROAT SHIELDS 2˝× 2˝ (5 ×5 cm) •Same function as cotton
rolls •Better tolerated by delicate tissues •Less chances of adhesion to dry tissues
91. 103. EVACUATION SYSTEM • Two types: - High vaccum evacuation system - Low
vaccum evacuation system
92. 104. DEBRIS AND FLUID EVACUATION EQUIPMENTS HIGH – VOLUME
EVACUATION • -Apprx. 150ml water in 1 sec • More efficient Metallic autoclavable tips
Disposable plastic TRK-O-VAC™ (Plasdent)
93. 105. Advantages of High Volume Evacuators • Removes shavings of tooth and
restorative material as well as other debris from the working site. • Toxic material is
readily removed. • Decreases treatment time as intermittent rinsing and washing is
avoided.
94. 106. SALIVA EJECTORS Metallic autoclavable tips Disposable plastic
95. 107. Placement Saliva ejectors should be placed with their tips on the floor of the mouth,
directed backwards and not directly in contact with the tissues.
96. 108. SWEFLEX SALIVA EJECTORS Flexible, curved Efficient, comfortable, reduces
aerosols with superior suction capability.
97. 109. INDIRECT METHODS COMFORTABLE POSITION OF PATIENT AND RELAXED
SURROUNDINGS
98. 110. LOCAL ANESTHESIA Reducing discomfort less anxious less sensitive to stimuli
less salivation
99. 111. DRUGS Antisailogouges Antianxiety drugs and barbiturates sedatives Muscle
relaxants
100. 112. SOFT TISSUE ISOLATION- TISSUE RETRACTION & PROTECTION
TONGUE RETRACTORS: • Guards and depressors • Svedopter
101. 113. SVEDOPTER E. C Moore
102. 114. HYGOFORMIC SALIVA EJECTORS Comfortable n less traumatic
103. 115. CHEEK AND LIP RETRACTORS • Pulls cheeks & lips backwards &
outwards • Photographic purposes • Working on anterior teeth
104. 116. LIP RETRACTORS  Simple lip retractor, 11cm 4 ½ "  Wire lip retractor 
Oringer lip retractor  Plastic lip retractors, adult 12cm 4 ¾"
105. 117. CHEEK AND TONGUE RETRACTORS  DISPOSABLE SPAND- EZZ
EXPANDERS Sizes: small (green) medium (blue) large (red)
106. 118. DRY FIELD SYSTEM Sealants, ortho bonding, posterior restorations High
heat plastic/ silicone construction Autoclavable at 2800F Red-pedo White- adult
107. 119. FAST DAM  17 suction holes along the perimeter  When applying
sealants (Practicon)
108. 120. MIRRO-VAC SALIVA EJECTOR MIRRORS  Upper suction inlet relieves
tissue grab and ensures anti-fog acrylic mirror stays clear—even under direct exhalation
 Ideal for sealants, air abrasion, bonding and other dry field procedures
109. 121. Mouth props For the patient • Relief of responsibility of maintaining adequate
mouth opening • Relief of muscle fatigue and muscle pain For the dentist • The prop
ensures constant and adequate mouth opening and permits extended and multiple
operations if desired
110. 122. Mouth props Rubber Latex Non latex Molt Ratchet type McKesson
111. 123. ISOLITE • Retraction, protection, aspiration & illumination • Size- adult small
-adult medium -adult large -pediatric
112. 124. Mouth piece:
113. 125. Attach mouthpiece to Isolite tube Align Bite Block at 1st or 2nd bicuspid area
keeping Cheek Shield outside the mouth.
114. 126. Place Isthmus behind maxillary tuberosity. Position Cheek Shield in buccal
vestibule
115. 127. GINGIVAL RETRACTION AIDS  Gingival retraction collars  Retraction
cords Collars : Physical retraction Better tissue control Less chance of recession Margins
fully visible(subgingival)
116. 128. Retraction of Gingiva • There are four means of accomplishing gingival
retraction and are frequently used in combination. 1) Physico mechanical means 2)
Chemico mechanical means 3) Electrochemical means 4) Surgical means
117. 129. Physico mechanical means • This involves mechanically forcing the gingiva
away from the tooth surface both in the lateral and apical direction. • It should be used
only when gingiva is healthy with a very good vascular supply and there is a definite zone
of attached gingiva apical to the free gingiva. • Bone support should be sufficient without
signs of resorption.
118. 130. • Any one of following techniques can be used: -Rubber dam -Gingival
retraction cord -Rolled cotton twills with or without fast setting ZOE cement -Wooden
wedges -Gutta percha or eugenol packs -Copper band -Oversized temporary crown
119. 131. Chemico-Mechanical means • The most popular technique for gingival
retraction - Vasoconstrictor - Astringent and styptics Alum 100% Aluminium potassium
sulphate 10% Aluminium chloride 15-25% Tannic acid 15-25% Biologic fluid coagulant
Tissue coagulant Zinc chloride 8% Silver nitrate 2% This chemicals can be carried to the
operating site by following means: • Cords • Cotton rolls • Cotton pellets
120. 132. • Gingival retraction agents (GRAs) are used in clinical practice in the form
of - Gingival retraction fluids (GRFs) or - Gingival retraction gels (GRGs) (Nowakowska
and Panek, 2007) • With respect to the pharmacological effects of the active substance,
they belong either to - Class 1 (vasoconstrictors, adrenergics) or - Class 2 (haemostatics,
astringents) (Nowakowska, 2008) Gingival Retraction Cords
121. 133.  Gingival retraction collars Adv. : Physical retraction Better tissue control
Less chance of recession Margins fully visible(subgingival)
122. 134. Newer Materials • Magic foam cord • Expasyl • Retrac • Merocel • Laser
123. 135. Magic Foam Cord • First expanding material designed for easy & fast
retraction of sulcus without potentially traumatic packing or pressure.
124. 136. POSSIBLE COMPLICATIONS & CORRECTIVE MEASURES IN
ISOLATION  Injury to the soft tissues  Strained muscles & Painful TMJ (subluxation) 
Facial emphysema  Rubber dam left over  Gagging
125. 137. Swallowing/ aspiration of the foreign bodies