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A rubber dam is recommended during restor-
ative, endodontic and pit-and-fssure sealant pro-
cedures. It is traditionally placed frst, followed
by the rubber dam clamps or foss ligatures, al-
though the placement frst of modifed clamps and
then the rubber dam is another option.
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Rubber
dam use appears nonetheless to be rather limited,
based on 2 surveys in the Dental Practice-Based
Research Network. In the restorative procedures
survey, 63% of 229 respondents reported never
using a rubber dam, and just 12% of restorations
(n=9,890) in 5,810 patients were placed under
rubber dam.
4
There was also wide variability in
rubber dam use during endodontic therapy in the
second study with 729 respondents, including 524
general dentists.
5

This may be due to perceptions of potential time
lost because of rubber dam placement, or patient
dislike of rubber dams. In reality, expert rubber dam
placement may save chairside time due to the ease
of isolation once it has been placed.
6
Patient reac-
tions are variable, with pediatric patients in a sealant
study fnding it less stressful than the use of cotton
rolls, while patients in another study reported that
rubber dam use caused them more discomfort than
cotton rolls and suction.
6,7
From the perspective of
clinical experience and outcomes, reports are con-
ficting. Some small studies have reported no differ-
ences under test conditions in clinical outcomes for
restorations placed under rubber dam or with cot-
ton rolls and suction.
7,8
Failure to use a rubber dam
may also infuence the choice of root canal irrigant,
Isolation in Clinical Practice
T
he isolation of clinical sites infuences the effcacy, effciency and safety of care, as well as patient
comfort. Options include cotton rolls and suction, dry angles, orthodontic elastomers, rubber
dams, and the Isolite System. Cotton rolls are easy and fast to place and, together with suction,
may often provide suffcient isolation for restorative and preventive care. However, this method may
be insuffcient for some patients, including those with high salivary fow, and does not protect patients
from accidental aspiration or ingestion of small objects or endodontic irrigants. The same advantages
and disadvantages apply to triangular cellulose-based dry angles, although these more readily absorb
saliva and adhere to the mucosa, which helps protect it from the high-volume evacuation (HVE).
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Using
orthodontic elastomers (separators) has also been recommended as a user-friendly, easy technique to
retract gingival tissue and isolate clinical sites prior to the placement of resin composite crowns in pri-
mary teeth.
2
Additional methods would still be necessary for thorough isolation and safety. Both rubber
dams, which are considered the clinical reference for isolation, and the Isolite System provide for greater
procedural effciency and safety in comparison to the methods described above.
General Overview
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Figure 1: Rubber dam use during endodontic
procedures
Figure 2: Rubber dam use during restorative
procedures
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due to concerns about the irrigant fowing into the
patients mouth, and may have a negative impact on
treatment outcomes.
5
Short-term gingival recession
has been observed with rubber dam use.
7
The Isolite System was introduced to provide
incremental benefts compared to other isolation
methods, while still isolating the clinical site and
providing for patient safety. The Isolite System
mouthpiece is designed with plastic fexible fang-
es buccally and lingually that isolate unilateral
upper and lower quadrants simultaneously. Visu-
alization is improved with an LED light with 5
levels of illumination and a cure-safe mode. Other
design elements also enhance procedures for den-
tal professionals and patients (Table 1).
9
As with
a rubber dam, aerosolized bacteria and spatter
are reduced and the Isolite System helps to pre-
vent the inhalation or ingestion of small foreign
objects.
9
Unlike rubber dams, the Isolite System
can also be used during all imaging procedures
and can be used during nonsurgical periodontal
therapy.
The Isolite System reduces chairside time and
has good patient acceptance. In a study of pediatric
patients (n=48, mean age 9 years), 340 seconds was
required for sealant placement using the Isolite Sys-
tem compared to 398 seconds using cotton rolls and
suction. Furthermore, patients found both methods
to be equally acceptable.
10

Conclusions
Considerations in the selection of an isolation
method include the clinical procedure, effcacy of
the isolation method, safety, patient comfort and
preference, and chairside time. While rubber dams
provide for excellent isolation and contribute to
patient safety, they are inconsistently used. In con-
trast, cotton rolls and suction are quicker and easi-
er to use, but do not provide for thorough isolation
or aid patient safety. The Isolite System provides
traditional and innovative benefts to meet the
needs and preferences of dental professionals and
patients alike.
Figure 3: Chair time for sealant placement (mean
seconds)
TABLE 1. Design of the Isolite system
Plastic fanges
Simultaneous isolation of full upper and lower quadrant
No need for clamps or ligatures
Isolite can be used during nonsurgical periodontal therapy
Protect the cheeks and tongue
Still permit use of a saliva ejector if wished
Bite block
Removes patient effort and reduces fatigue
No need to insert a separate bite block
LED light with 10,000-hour life
and cure-safe mode
Illuminates the clinical site with fve levels of illumination
Safe for materials that will be light-cured
Connects to operatory HVE
Targeted suction
No need to hold an HVE tip at the site
Reduces contaminated aerosols and spatter
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References
1. Mamoun J, Salamah M. Use of the dry angle isola-
tion adjunct in general dentistry: a clinical approach.
Dent Assist. 2010;79(1):13-4, 36-7.
2. Psaltis GL, Kupietzky A. A simplifed isolation
technique for preparation and placement of resin
composite strip crowns. Pediatr Dent. 2008;30
(5):436-8.
3. Owens BM. Alternative rubber dam isolation tech-
nique for the restoration of Class V. Oper Dent.
2006;31(2):277-80.
4. Gilbert GH, Litaker MS, Pihlstrom DJ, Amundson
CW, Gordan VV; DPBRN Collaborative Group.
Rubber dam use during routine operative dentistry
procedures: fndings from the dental PBRN. Oper
Dent. 2010;35(5):491-9.
5. Anabtawi MF, Gilbert GH, Bauer MR, Reams G,
Makhija SK, Benjamin PL, et al. Rubber dam use
during root canal treatment: fndings from The Den-
tal Practice-Based Research Network. J Am Dent As-
soc. 2013;144(2):179-86.
6. Innes N. Rubber dam use less stressful for children
and dentists. Evid Based Dent. 2012;13(2):48.
7. Daudt E, Lopes GC, Vieira LC. Does operatory feld
isolation infuence the performance of direct adhe-
sive restorations? J Adhes Dent. 2013;15(1):27-32.
8. Raskin A, Setcos JC, Vreven J, Wilson NH. Infuence
of the isolation method on the 10-year clinical be-
haviour of posterior resin composite restorations.
Clin Oral Investig. 2000;4(3):148-52.
9. Noro A, Kameyama A, Asami M, Sugiyama T, Mori-
naga K, Kondou Y, Tsunoda M. Clinical usefulness
of Isolite Plus for oral environment of Japanese
people. Bull Tokyo Dent Coll. 2009;50(3):149-55.
10. Collette J, Wilson S, Sullivan D. A study of the Isolite
system during sealant placement: effcacy and patient
acceptance. Pediatr Dent. 2010;32(2):146-50.

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