The Benefits of Isolation

An often overlooked area of root canal treatment is proper isolation and the myriad of benefits that come from it.  While it is true that a good rubber dam will prevent contamination of your working field and prevent irrigants from disturbing your patient, additional benefits include assistance in locating canals, preventing iatrogenic misadventures, and allowing the preservation of coronal tooth structure.

It all comes down to the clamp.  Instead of looking at it as something that holds the dam on, think of it more like a retraction cord that allows one to see the margins.  Try the clamp on before you place the rubber dam. Place it on root surface so that it does not rock and clearly exposes tooth structure apical to the CEJ on the buccal and lingual aspects. Just because a particular clamp fits on most upper molars does not mean it always will. Take an extra minute or two to find the right clamp. It will save you at least 10 minutes in the long run.

With root surface exposed, this will allow you to change your target. Now, instead of using crown anatomy to find canals, you can line your bur up relative to the to the roots (where the canals are generally centered). In easy to locate canals this will provide a more conservative access preserving much needed coronal tooth structure and preventing fractures).  In cases with artificial crowns, you will detect rotations, angulations, or unusual crown/root anatomy. In calcified cases, canals will be located without “looking” for them (removing excess dentin in the hopes of finding) and it will provide a reference to a coronal-apical dimension allowing you to stop if you don’t find canals where you expected instead of discovering the alveolar process.

The time it takes to achieve good isolation will pay itself forward exponentially in time as well as in quality of treatment and reduction of stress.  Good clamp selection will preserve tooth structure, prevent contamination of the field, provide better visibility, prevent iatrogenic misadventures by locating canals more easily.

 

Dr. Jason Conn

Dr, Jason Conn, DMD, CAGS, FRCD(C)

ABOUT Dr. JASON CONN, DMD, CAGS, FRCD(C)LANGLEY ENDODONTICS

Dr. Conn was born and raised in Langley. He completed a Bachelors in Chemistry at Simon Fraser University before receiving his DMD and Certificate of Advanced Graduate Study in Endodontics at Boston University where he wrote a thesis in clinical decision making and another in odontogenic stem cell differentiation.

Dr. Conn has maintained an active practice alongside Dr. Bittner since 2012 while teaching as a part-time clinical assistant professor at the University of British Columbia.

In his free time, Dr. Conn is a Cub Scout leader, long distance runner, back-country hiker, snowboarder and yogi-in-training.

On February 22, 2016, posted in: News for Doctors by