Isolation: Where Are We in 2017?

Although I haven’t quite put my finger on exactly what it is that brings about such disdain for the contraption, there is a universal aversion to using a rubber dam post-graduation. In fact, for most students, the diploma might as well read, “license to practice dentistry without a dam.”

I ran from using one as fast as the rest of you likely did. And I practiced dentistry for a few years without solid isolation, too.

While I consider myself a fairly reasonable individual, I can’t fathom how I rationalized a rubber dam being worse than the hypertension that would ensue as the clock ticked, the saliva pooled and I wasn’t done condensing the composite yet. Adhesive dentistry in a wet, dark environment is just awful!

Today I have a large armamentarium of isolation options. Regardless of which I use, I make sure that I’m using one. You just can’t do quality dentistry today without isolation! Your dentistry won’t last, your patients will be symptomatic, and you won’t have the time to achieve the level of care you otherwise would. So how am I isolating?

Best posterior dental isolation system

The workhorse of isolation in my practice is hands-down the Isolite. When I’m working in the posterior, I use this about 90 percent of the time. Most patients will tolerate it and even like it if you give them reasonable expectations.

We let patients know that it’s awkward on the way in, and equally as awkward on the way out. The patient is made aware that they can generate a swallowing reflex by biting into the block if needed, and that it won’t hurt their teeth or our work. There is an occasional patient who won’t tolerate it, and in that case, we use a rubber dam.

Our biggest struggle with the Isolite is the spatial limitation. It makes it so easy to work in terms of creating a dry field, but prepping the palatal or lingual cusps for a crown or placing a composite ring can be a real struggle - especially on second molars (are second molars ever easy to work on?).

Anterior dental isolation system options

When we are working in the anterior, we either use an Optragate, a rubber dam or a Comfortview cheek retractor. When I’m working on anterior teeth for either preparations for future indirect restorations, or placing direct composite, I really like the Comfortview cheek retractor. It retracts in a similar way to the Optragate, but the benefit is that it spares the frenum from excessive pressure during longer procedures. It’s more expensive to use than an Optragate because the replacement pieces (shown in pink in the photo) cost about $5.00 per placement. When we have larger cases, we’ll put the replacement pieces into the case pan for re-use at multiple visits.

Here’s a photo of an Optragate:

And here is the Comfortview cheek retractor:

If you’re using a rubber dam, the split dam technique is a nice way to work on multiple teeth in a quadrant or on teeth that require sub- or para-gingival preparations. Rather than punching a hole for each individual tooth, you can punch a hole for the two teeth at ends of your quadrant or sextant and cut a line between those holes:

Other dental isolation options

If you’re interested in an Isolite but don’t want to jump into the investment, the Isovac is a great option for those of you that have headlights. It’s much less expensive and offers the same isolation without the illumination. This is a great option for hygienists placing sealants or using the piezo as well.

If you’re using cotton rolls and dry angles, I’d recommend trying a dam or other isolation system on a patient that won’t mind you fumbling to try an instrument you haven’t used in a while. You’ll be amazed at how much less stressful adhesive dentistry is, and you might even enjoy the extra time you have to work on anatomy and customization of the restorations. 

(Click this link for more dentistry articles by Dr. Courtney Lavigne.)

Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author - http://www.courtneylavigne.com