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Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration by Dr. Arthur R. Volker

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Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration

by Dr. Arthur R. Volker

Introduction
The need for isolation is of primary importance for the execution of high-level operative dental procedures. This article demonstrates the restoration of a large multi-surface direct composite restoration which was facilitated using an Isolite Pro (Zyris) isolation system.


Methods of isolation
Cotton rolls are often the quickest and least costly option for isolation. They can provide isolation and can be effective, especially in primary molars.1,2 Issues arise if the rolls become saturated with fluid, as excess can then leak and contaminate the operative field. Rolls may also need to be replaced frequently during a procedure, which can also result in contamination of the field.

Rubber dams are considered the gold standard for isolation.3 They provide isolation from crevicular fluids. By using proper inversion techniques in conjunction with a heavy dam, papillary tissue can be retracted, allowing better access and visualization of subgingival areas.4 This is useful in procedures where the interproximal emergence profile of the tooth needs to be altered, such as in a diastema closure or a black triangle resolution. There can be a potential for an allergic reaction with the use of a latex dam.5,6 It is recommended that a non-latex option be used.

Isolite Pro, attached to a dedicated suction line, provides isolation, illumination, visualization and suction in a single-use mouthpiece. Additionally, it provides a mouth prop to the patient and acts as an airway protector. The Isolite demonstrates less leakage than cotton roll isolation and is more comfortable than rubber dam isolation.7


Case presentation
The patient, a 63-year-old woman in good general health, presented with a complaint of a “chipped tooth” on the upper right. A periapical film of the area was taken (Fig. 1). An examination revealed a mesio-occlusal-palatal fracture of tooth #2 with caries (Fig. 2). The patient was made aware of treatment options, including the possibility of root canal and full coverage. It was decided to attempt a direct restoration on tooth #2.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig. 1: Pre-operative periapical radiograph.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig. 2: Pre-operative clinical presentation.


The patient was anesthetized with 3% mepivacaine. A small Isolite mouthpiece was placed. Caries excavation was initiated with a carbide round bur (Fig. 3) and caries indicator (Snoop, Pulpdent). Though deep, no pulpal exposure was noted. During the excavation process, caries were present subgingivally, resulting in bleeding from the area (Fig. 4). At this point, a rubber dam clamp was to be placed. However, the short inciso-gingival height of the tooth as well as the extent of the cavity preparation precluded placement of the clamp. It was then decided to place a Greater Curve matrix band (Greater Curve) in a Tofflemeyer retainer with a wooden wedge. Once hemostasis was obtained, a liner (Activa, Pulpdent) was placed over the deepest dentinal areas (Fig. 5).
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.3: Caries excavation with a round bur.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.4: Bleeding from subgingival preparation.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.5: Placement of RMGI liner and Greater Curve matrix band with wedge positioned.


Using a total-etch protocol, the area was first conditioned with phosphoric acid, and a bonding agent was placed (Fig. 6). A dual cure restorative material (Anchor, Apex Dental) was placed in a single increment to fill the remainder of the cavity (Fig. 7). The Anchor was adapted with a hand instrument (Fig. 8) and cured. Excess material was removed with rotary instruments (Fig. 9). Occlusion and contacts were verified. Figure 10 demonstrates the final restoration, and Figure 11 shows the post-operative radiograph.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.6: Placement of bonding agent.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.7: Filling of cavity with Anchor.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.8: Adapting Anchor with a hand instrument
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.9: Trimming excess material
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.10: Completed restoration.
Clinical Case Spotlight: Using the Isolite Pro for a Difficult Posterior Restoration
Fig.11: Post-operative radiograph.


Conclusion
There are multiple methods for isolation available to the clinician. In areas where a rubber dam clamp may be untenable, such as in a multi-surface Class II on a terminal tooth—especially if the tooth is short and cannot hold a clamp—or if the clamp interferes with the restorative matrix, the Isolite Pro can help facilitate a predictable outcome.

References
1. Olegário IC, Moro BLP, Tedesco TK, Freitas RD, Pássaro AL, Garbim JR, Oliveira R, Mendes FM; CARDEC 03 collaborative group; Raggio DP. Use of rubber dam versus cotton roll isolation on composite resin restorations’ survival in primary molars: 2-year results from a non-inferiority clinical trial. BMC Oral Health. 2022 Oct 10;22(1):440.
2. Miao C, Yang X, Wong MC, Zou J, Zhou X, Li C, Wang Y. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst Rev. 2021 May 17;5(5):CD009858.
3. Lin PY, Huang SH, Chang HJ, Chi LY. The effect of rubber dam usage on the survival rate of teeth receiving initial root canal treatment: a nationwide population-based study. J Endod. 2014 Nov;40(11):1733-7.
4. Barros de Campos PR, Maia RR, Rodrigues de Menezes L, Barbosa IF, Carneiro da Cunha A, da Silveira Pereira GD. Rubber dam isolation: key to success in diastema closure technique with direct composite resin. Int J Esthet Dent. 2015 Winter;10(4):564-74.
5. Kean T, McNally M. Latex hypersensitivity: a closer look at considerations for dentistry. J Can Dent Assoc. 2009 May;75(4):279-82.
6. Hamann CP, Rodgers PA, Sullivan K. Management of dental patients with allergies to natural rubber latex. Gen Dent. 2002 Nov-Dec;50(6):526-36.
7. Bagher SM, Sabbagh HJ. A literature review of clinical efficiency, patient satisfaction, and future preference of Isolite and DryShield dental isolation systems among pediatric patients. J Clin Pediatr Dent. 2023 Jul;47(4):1-8.

Author Bio
Dr. Arthur R. Volker Dr. Arthur R. Volker graduated from the Columbia University School of Dental and Oral Surgery. He is a member of the continuing education committee for the New York State Academy of General Dentistry. Volker is a diplomate of the World Congress of Minimally Invasive Dentistry, and is a fellow of the Academy of General Dentistry and the American College of Dentists. He has also published articles and lectures on such topics as cosmetic dentistry, minimally invasive dentistry, dental materials and dental implants. Volker is also a member of the Dentaltown editorial board. He practices in Sunnyside, New York.
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