In dentistry, separation of a tooth or group of teeth from oral tissues and saliva by use of a dental dam, cotton rolls, or other means to improve access, visibility, and control moisture contamination while restorative or operative dental procedures are performed.

1. “AN OUNCE OF PREVENTION IS
WORTH A POUND OF CURE.”
― BENJAMIN FRANKLIN

2. ISOLATION
BY:-
GAURAV JAWARIYA
(B.D.S FINAL YEAR)

3. CONTENTS :
• INTRODUCTION
• GOALS OF ISOLATION
• ISOLATION FROM MOISTURE
(a) DIRECT METHODS :-
RUBBER DAM
COTTON ROLLS AND ABSORBER WAFERS
EVACUATOR SYSTEM AND SALIVA EJECTOR
GINGIVAL RETRACTION CORD
MOUTH PROP
(B) INDIRECT METHODS :-
COMFORTABLE POSITION OF PT. AND RELAXED SURROUNDINGS.
LOCAL ANESTHESIA
DRUGS
ISOLATION OF SOFT TISSUES :-
RETRACTION OF CHEEKS , LIPS AND TONGUE
RETRACTION OF GINGIVA
CONCLUSION

4. INTRODUCTION
 Good accessibility and visibility ,
 Adequate room for instrumentation
 Necessary for easy manipulation and insertion of restorative
materials
 This control is attained through isolation

5. GOALS OF ISOLATION : -
Moisture control
Retraction and access
Harm prevention
Safe and aseptic operating field
Prevent accidental swallowing of restorative materials and
instruments

6. ISOLATION FROM MOISTURE
DIRECT METHOD
• RUBBER DAM
• COTTON ROLLS AND
HOLDER
• GAUGE PIECES
• ABSORBENT WAFER
• SUCTION DEVICES
• GINGIVAL RETRACTION
DEVICES
INDIRECT METHOD
• COMFORTABLE POSITION
AND RELAXED
SURROUNDING TO THE PT.
• LOCAL ANESTHESIA
• DRUGS :-
ANTI-SIALOGOGUES
ANTI-ANXIETY DRUGS
MUSCLE RELAXANTS

7. RUBBER DAM
(A GOLD STANDARD FOR ISOLATION)
 One of the most effective means of isolating teeth
Developed by SC Barnum in 1864.

8. ADVANTAGES OF RUBBER DAM
• Increases visibility & accessibility
• Provides a dry field
• Effectively retracts tongue, cheeks away from the field
of operation
• Saves time
• Reduces the chances of injury to soft tissues
• Produces calming effect in children
• Protects against bad taste of the materials used
• Prevents any aspiration or ingestion of dental
instruments

9. DISADVANTAGES OF RUBBER DAM
• Takes time to be applied
• Communication with the patient can be difficult
• Incorrect use may damage porcelain crowns/gingival tissues
• Insecure clamps can be swallowed or aspirated

10. CONTRAINDICATIONS
Child with upper respiratory tract infection, congestion of
nasal passage or nasal obstruction
 Presence of some fixed orthodontic appliances
 Recently erupted tooth
With allergy to latex
Grossly carious teeth

11. ARMAMANTERIUM
• Rubber dam sheet
• Rubber dam template
• Rubber dam punch
• Rubber dam clamps
• Rubber dam forceps
• Rubber dam frame
• Rubber dam napkin
• Waxed dental floss
• Scissors
• Lubricants

12. RUBBER DAM SHEET
• Made of latex or non-latex.
• Available in 2 sizes- (i) 5”*5” (ii) 6”*6”
• Available in varying thickness :-
Thin – 0.15 mm
Medium – 0.20 mm
Heavy – 0.25 mm
Extra-heavy – 0.30 mm
Special heavy – 0.35mm
• Light and dark sheets are available, may be flavored for the
children
• Has a shiny and dull surface, dull side will be facing the
operating field

13. RUBBER DAM TEMPLATE
Have positions of the teeth marked on them and are used to
transfer them to the rubber dam sheet for holes to be
punched.

14. RUBBER DAM PUNCH
• Used to make the holes in the sheet through which the teeth
can be isolated.

15. RUBBER DAM CLAMPS
• Made of shiny & dull stainless steel
• consists of a bow & 2 jaws
• Aid in anchoring the dam to the tooth & in soft tissue
retraction
• 2 types : (i) Winged (ii)Wingless

16. FREQUENTLY USED CLAMPS IN
PEDO.
• 12 A Clamp - Maxillary left second primary molar and the
mandibular right second primary molar.
• 13A Clamp – Maxillary right second primary molar and the
mandibular left primary second molar.
• 2A Clamp – First primary molars.
• 14 Clamps – Fully erupted permanent molars.
• 14 A Clamps - Partially erupted permanent molars.
• Clamps for front teeth :-
IVORY#6 , IVORY#9 , IVORY#90N , IVORY#212S ,IVORY#15

18. DENTAL FLOSS
• After selecting the appropriate clamp a 12 inch piece of
dental floss is placed on the bow of the clamp to aid in
retrieval of the clamp if it is dislodged from the tooth and
falls into the posterior pharyngeal area.

19. RUBBER DAM CLAMP FORCEPS
• Used for placement and removal of retainer from the tooth.

20. 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

21. PLASTIC FRAME
Nygard - Ostby frame :-
 U-shaped frame made of plastic
 Because of its shape, exerts less tension on the dam
 Easier to use
 Requires no absorbent napkin, when taking radiographs
 Stands away from face

22. METAL FRAME
YOUNG FRAME :-
 U-shaped metal frame with small metal projections for
securing borders of the rubber dam.

23. MODIFICATIONS
Le Cadre Articule rubber dam frame (articulated
frame):-
 Developed in France by Dr. G Saveur.
 Curved to fit the face and hinged in the middle to fold back.
 Advantage -- Allows easier access for radiographic film
placement.

24. Handidam (Aseptico, Woodenville):-
• Has a built in foldable radiolucent frame and a plastic tube
inserted in prepared holes in rubber dam material to keep
the dam open
• Available in one size

25. Quick dam :-
 Comes with an attached flexible plastic frame or rim that
supports dam intraorally
 Effective in saliva control anterior part of the mouth than
posterior part
 Has a pliable plastic frame around perimeter of the rubber
dam

26. Instidam (Zirc company):-
• Simple & effective isolation system
• It is a pre punched rubber dam mounted on a frame
• Compact design fits outside patient lips

27. COTTON ROLLS & CELLULOSE
WAFERS
• Available in different diameters, cut to variant lengths &
have plain or woven surfaces
• Stabilized & held sublingually with specific holders or with
an anchoring rubber dam clamp
• Can be applied without holders, over or lateral to salivary
gland orifices
• Cellulose wafers provide additional absorbency

28. Advantage : -
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

29. GAUZE PIECE OR THROAT SHIELD
• Indicated when there is danger of aspirating or swallowing
small objects, when rubber dam is not being used
• Used in pieces of 2”x2” or larger
• Particularly important when treating teeth in maxillary arch

30. • Gauze sponge unfolded & spread over the tongue&
posterior part of the mouth
Advantage –
 Better tolerated by delicate tissues
 Less adherence to dry tissues compared to cotton

31. SALIVA EJECTOR & HIGH VOLUME
EVACUATING EQUIPMENT
• Saliva ejector prevent pooling of saliva in the floor of the
mouth
• High volume evacuating equipment removes solid debris
along with water Saliva ejector High volume evacuator

32. GINGIVAL RETRACTION CORDS
• Used for isolation & retraction in direct procedures of
treatment of accessible sub gingival area.
• Diameter of cord should be selected such that it is gently
inserted into gingival sulcus, producing lateral displacement
of the free gingiva without blanching.
• Cord may be moistened with a non caustic styptic before
insertion.

33. • SIZES AVAILABLE :-

34. ADVANTAGES :-
 May help restrict excessive restorative materials from
entering the gingival sulcus
 Provide better access for contouring & finishing the
restorative material
 Prevent abrasion of gingival tissue during tooth preparation
 Used primarily to push the gum tissue away from the
prepared margins of the tooth, in order to create an accurate
impression of the teeth

35. MOUTH PROPS
• Can be potential aid for lengthy appointment on posterior
teeth
• Should maintain suitable mouth opening
• Types – (i)Block
(ii)Ratchet

36. • IDEAL REQUIREMENTS :-
 Should be adaptable to all mouths
 Should be easily positioned & removed with no patient
discomfort
 Should be stable once applied
 Should be either sterilizable or disposable

37. MOUTH MIRROR
• Secondary function –
• Helps to retract cheeks, lip & tongue in the absence of
rubber dam

38. INDIRECT METHODS
LOCAL ANESTHESIA
DRUGS :-
ANTI – SIALOGOGUES (ATROPINE)
ANTI – ANXIETY (DIAZEPAM)

39. REFERENCE
• Sturdevant’s Art and Science of Operative Dentistry.
• Grossman’s Endodontic practice.
• Sanjay Marwah, Textbook of Pedodontics .

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