EndoEvolution: Endodontic Isolation

- Isolation of  the operative field in endodontics: advantages
- Armamentarium
- Clamp selection
- Techniques for rubber dam application
- Leakage control: the use of liquid dam
- Isolation of the operative field in complex cases endodontics
- Isolation of the prosthetic stump: rational, tips & tricks
- The isolation of teeth with a damaged clinical crown: rational, tips & tricks
- Pre-treatment to ease the rubber dam application: periodontal (crown lengthening/gingivectomy), orthodontic (extrusion), restorative (build-up), mixed
- Pretreatment: pro & cons
- The role of pre-treatment according to the treatment plan

Isolation of complex cases covers a series of clinical situations where dam placement can prove to be difficult for the practitioner. It should not be forgotten that isolating the field with the dam is crucial to reliable endodontic and conservative treatment.

Therefore, even in more complex cases the practitioner is required to perform isolation to ensure safe and predictable treatment.

Hard-to-isolate teeth are no excuse for avoiding the rubber dam: the more difficult the tooth, the more the dentist will appreciate the advantages of using the dam.

In these cases, isolation ought to be carefully planned and only knowledge paired with operative experience, accurate clinical assessment and proper operative timing will allow the practitioner to achieve a totally stable and isolated field for the whole treatment.

Nevertheless, it is of key importance to appreciate that once the field is isolated, the clinical case will be transformed from complex to simple with noticeable benefits for the operative procedures to follow.

In endodontics there are usually 2 kinds of common clinical situations which may prove to be difficult when it comes to field isolation: teeth with a damaged clinical crown and prosthetic stumps.

A deep analysis of the complex case is mandatory in order to choose the best operative strategy for the isolation, according with the treatment plan: in some clinical situations a pre-treatment is really useful, in other cases a pre-treatment can increase the difficulty of the endodontic treatment.