Eric D. Levine, DDS

Assistant Professor

Department of Endodontics, Prosthodontics, and Operative Dentistry

University of Maryland School of Dentistry

Phone: 410.706.7047

Email: elevine@umaryland.edu

Differences exist between the material and technical needs of many dental procedures. These differences sometimes make it difficult to simultaneously perform 2 separate procedures. The benefits of adhesive materials, as well as some patients’ goals for “metal free” restorations, have shifted the application of many materials from simply an esthetic alternative to a strong restorative option. The technical needs of composites as a restorative material, however, differ greatly from that of amalgam. The Isolite mouthpiece is one tool that helps create integrated solutions to multiple dental procedures.

It is often difficult to achieve a dry environment in the oral cavity. Whereas moisture control is necessary for most dental materials, it becomes especially important in the area of adhesive dentistry. A rubber dam is the most effective tool for providing isolation of a bonded restoration. Rubber dams, however, do not always provide the retraction necessary to complete a full-coverage restoration. The ability to quickly remove and replace a rubber dam also makes it difficult to complete tasks that require the opening and closing of the patient’s mouth.

Finally, the rubber dam clamp is often difficult to place without some discomfort for the patient. The clamp will also often create some damage to gingival tissue in the area where it was placed. The Isolite, with its unique mouthpiece, is able to provide a less traumatic means of isolation and moisture control. Dentists also benefit by working in an environment that is more visible and accessible.

Background

The Isolite was first introduced by Thomas and James Hirsh. It incorporates a flexible mouthpiece that can be attached to existing high-speed suction, providing the clinician with a solution for illumination, aspiration, and retraction. For the patient, these 3 important components to a dental procedure are carried out safely and comfortably.

The system consists of a fiber-optic light source and bundle combined with a vacuum line that delivers light and aspiration to the patented disposable mouthpiece. The mouthpiece, made of a flexible latex-free polymer called Isoflex, delivers tongue and cheek retraction while providing access to both upper and lower arches simultaneously. The mouthpiece has a symmetrical design and can be used on either the right or left side. It is available in 4 sizes: pediatric, small, medium, and large.

An ultra-bright LED provides illumination with adjustable settings including lighting that creates a shadowless field that will not affect bonding procedures. The LED module is rated for 5000 hours of operation and, as with all LED light sources, does not generate any heat so use is cool and comfortable. The convenient installation of the system requires no change or additional equipment to most dental units. In addition, its quick connection allows it to be moved easily from dental chair to dental chair.

Case Report

The use of composite during a fixed prosthodontic procedure was highlighted in this appointment. The patient needed a full-coverage crown to restore a severely decayed tooth No. 31. Proximal to this was a distal caries lesion on tooth No. 30. A porcelain fused-to-metal crown was treatment planned for tooth No. 31 along with a 2-surface direct composite for tooth No. 30 (Figure 1).

           
            Figure 1—Mandibular molars with recurrent decay.

           
            Figure 2—Isolite provides retraction of both the tongue and buccal mucosa.

Clinical Procedure

The preparation for the composite was completed before fully preparing for the crown. To ensure proper form for both teeth’s proximal surfaces, the composite placement was also completed before fully preparing the crown. Adequate moisture control for the restorative material was achieved with the placement of the Isolite (Figure 3).

The tooth was etched with Kerr Gel Etchant 37.5% phosphoric acid on dentin and enamel for 15 seconds. Next the tooth was rinsed with water for 15 seconds to completely remove the etchant. After rinsing, the prepared tooth was gently air-dried to prevent desiccating the dentin. OptiBond Solo Plus (Kerr Corporation) was applied with a light scrubbing motion for 15 seconds. The tooth was gently air-dried and cured with Demetron LC (Kerr Corporation) for 20 seconds. Esthet-X (Dentsply Caulk) was incrementally applied and light cured for 20 seconds.

            Finishing of the restoration was completed with 12 fluted carbides. At this time, the occlusal plane was finished to follow the tooth’s existing contours and those of the adjacent tooth.

            The Isolite was removed to verify the occlusion of the newly placed restoration. The restoration was polished with an Enhance cup (Dentsply Caulk) and the final polish was achieved with Prisma Gloss (Dentsply Caulk). The Isolite was then replaced in the patient’s mouth to continue with the preparation of the adjacent tooth.

Conclusion

The Isolite provides the patient with a comfortable way to tolerate lengthy and technical procedures. Many of this dentist’s patients comment on feeling confident in knowing that adequate retraction is achieved so the dentist and assistant can concentrate on the procedure being performed. Because the Isolite is entirely intraoral, the patient does not have the enclosed feeling of the rubber dam.

Through the use of the Isolite, the dentist will benefit from the convenience of working in a well isolated and illuminated environment. Isolation not only provides moisture control but also retraction of the surrounding tissues.