ISOLATION OF THE

OPERATING FIELD

DR ASMA CHANNA
 Goals of Isolation
 Moisture control
 Retraction and access
 Harm prevention
 Safe and aseptic operating field
 Prevent accidental swallowing of restorative
materials and instruments
 Prevent bacterial contamination from saliva
 Local anesthesia
 Methods for Isolation
1. Rubber Dam Isolation
2. Cotton roll isolation and Cellulose wafers
3. Throat Shields
4. High volume evacuator and saliva ejector
5. Retraction cords
6. Mirror and Evacuator tip retraction
7. Mouth Props
8. drugs
 Rubber Dam
isolation
 ADVANTAGES
 Complete isolation of the teeth from saliva, blood,
or gingival fluid exudate is possible. (esp.
required for bonded restorations)

 Aids isolation from bacteria in saliva.

 Also indicated when infection for the rest of the

mouth must be excluded, for example in direct
and indirect pulp capping and endodontic
treatment.
 Cont Cont ….….
 protects the patient from swallowing or inhaling instruments

 protects the dentist from infection from the patient

 has the effect of psychologically, as well as physically,

separating the dentist from the patient (patients are more
relaxed)
 Materials and Instruments
Parts of the rubber Dam kit
1. Rubber dam sheet
2. Rubber dam stamp
3. Rubber dam punch
4. Rubber dam clamps
5. Dental floss
6. Rubber dam lubricant
7. Rubber dam clamp forceps
8. Rubber dam cutting scissors

9. Rubber dam napkins

 Dam material
•Available in 5x5 inches or 6x6inches
•Thin --------------- 0.15mm
•Medium------------0.2mm
•Heavy--------------0.25mm
•Special heavy----0.35mm
•Shiny surface and dull surface.
•Dull surface in occlusal
 2. Holder or frame

Maintains the borders in position

Two types:- 1.plastic
2. stainless steel
3. Retainers
 Two types:
1. wingless
2. winged
 Anchor the dam to the teeth
 Retract the gingival tissues
4. Plastic tray for holding clamp
5. Retainer Forceps

 for placing and removal of retainer

 6. Punch
 For producing holes in the rubber dam for the
teeth
 It is an instrument having a rotating metal table
with six holes of varying sizes and a tapered
sharp pointed puncher
 Larger holes-Molars
 Medium sized holes-premolars , canines and
upper incisors
 Smallest hole –lower incisors.
Rubber dam punch
 7.Napkin

 Between rubber dam and patients skin

 Reduce allergic reaction
 Absorbs saliva
 8. lubricant
 Liquid soap
 Petroleum and cocoa butter should not be used
 9.Modelling compound
 Prevent the movement of retainer
 Hole size and position

•holes punched by following the arch

•Hole should be approximately over the centre of incisal or
occlusal surface of teeth
•Guide Holes- along the upper border of rubber dam
-for identification of upper surface of dam
•For conservative treatment – 3 holes
•For endodontic treatment – 1 hole
 Placement of rubber dam
3 methods
1. Dam first technique
2. Clamp first technique
3. Clamp and dam together technique
 Removal of rubber dam
 Cutting the septa
 Removing the retainer
 Removing the dam
 Wiping the lips
 Rinsing the mouth
 Massaging the tissue and
 Examining the dam
 Cotton roll isolation and cellulose wafers
 They are absorbents
 Provide moisture control with saliva ejector
 Isolation of maxillary teeth
- cotton roll in facial vestibule
- simple method
 Isolation of mandibular teeth
- medium sized cotton in vestibule and
large one between teeth and tongue
- difficult method
 Cellulose wafers - retraction and additional
absorbency
 Throat shields
 Prevent aspiration and swallowing
 Mainly maxillary teeth
High volume evacuator and saliva ejector

For suctioning water and debris

Advantages
-both solid and liquid
-improve access and visibility
-prevent dehydration of oral tissues
-less pain for patient
 Retraction cords
 Control sulcular fluid
 Vasoconstrictor (epinephrine) along this
 Prevent aberration of gingival tissues
 Prevent excess restorative materials from
entering the gingival sulcus
 Mirror and evacuator tip retraction
 Cheek , lip and tongue retraction
 Secondary function
 Mouth props

For lengthy appointments

For relieving patients mouth muscles
2 types
1. block type- low cost
2. ratchet type- large size and high cost
 Drugs
 Rarely indicated
 Atropine