First, it is important that we are clear about the concept of absolute isolation. Absolute isolation is a technique or procedure in which one or more teeth are selectively isolated from the other oral tissues, retracting soft tissues such as: gums, tongue, cheeks and lips. This is done in order to provide the appropriate conditions for the realization of treatments involving adhesion processes such as: restorations, resins, veneers, inlays, etc.
What is the purpose of absolute isolation?
Absolute isolation is performed with the objective of eliminating relative humidity inside the mouth and avoiding contact of the materials with saliva and gum fluids, as well as improving the visibility (field of view) of the area to be treated. In short, isolation allows the dentist access to a particular tooth or set of teeth by “isolating” it from the environment of the oral cavity which will improve the quality and longevity of the treatment to be performed.
As a dentist I consider that the best practice is to perform absolute isolation in endodontic treatments (root canal treatment), amalgam replacement and restoration processes involving adhesion: direct and indirect veneer cementation in smile designs, inlays and onlays, etc. In other words, absolute isolation should be used in all procedures that require adhesive systems given their sensitivity to humidity. When there is moisture at the tooth-restoration interface, there is no hermetic seal between the materials, causing filtration and bacterial growth that can lead to cavities or failure of the restoration.
What does absolute isolation consist of? How is it performed?
To carry out absolute isolation, each tooth is passed through perforations made to a square piece of elastic material (latex, vinyl, or nitrile), to keep them isolated and to provide a good seal. The teeth are retained in the elastic using stainless-steel clamps, which are in turn supported and stretched by a frame. Dental floss is also required to recede the gums, help get the elastic in between the teeth and stabilize it around the neck of the teeth. Once the assembly is complete, each tooth can be clearly observed, without obstructions, and we are now ready to start treatment.
What are the benefits of using this technique?
The following are the main benefits of using this technique:
- It contributes to the improvement of procedures in dental surgery, rehabilitation, and endodontics, since it provides a suitable environment for the adaptation of restorative materials, as well as for patient safety. Specifically in endodontic treatments, it helps prevent root canal infections due to bacteria present in saliva.
- Allows “dry” adhesion to avoid fluid and bacterial seepage.
- It serves as a physical barrier to prevent the patient from ingesting material such as composite, amalgam debris (mercury and heavy metals), other tissue debris (cavities bacteria), etc.
- Absolute isolation is of great importance for the removal of cavity tissue because bacteria from cavities and saliva could invade the dentin-pulp complex and lead to infection.
- Prevents the contact of chemical products (such as those used for adhesion, demineralizers, hypochlorite, etc.) with soft tissues and being ingested by the patient.
Although this is a very old technique (invented in 1864) and offers multiple benefits to patients, not all dental professionals know of it or how to implement it. Mainly because it is not part of the basic training of dentists, so it must be learned in complementary studies.
Another important factor to consider is that the isolation of each of teeth requires time, which could considerably extend the duration of a dental consultation (there are cases in which the patient must be anesthetized, some staples must be modified, etc.); so not all dentists are willing to do it.
In conclusion, absolute isolation is a fundamental tool in clinical practice and, although there is a high percentage of dentists who do not use it when performing restorations, it should be mandatory in endodontic procedures. The quality and longevity of treatments in dental surgery, rehabilitation and endodontics increase with the use of this procedure that provides a dry, clean, and safe environment for the patient. It also allows humidity control and avoids any possible risk of contamination during dental procedures.
Personalized course on absolute isolation
Since 2021 I have been training dentists in the absolute isolation technique through personalized courses. The course has an intensity of 16 hours and consists of three modules: theoretical module, practical on model and practical with live patient. If you are a dentist and you are interested in taking the course, do not hesitate to contact me!
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