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Year : 2022  |  Volume : 33  |  Issue : 2  |  Page : 209-211
Enhanced access and isolation by simple modifications of dental armamentarium

Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, M S Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India

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Date of Submission15-Nov-2019
Date of Decision25-Jun-2022
Date of Acceptance25-Jul-2022
Date of Web Publication13-Oct-2022


A good armamentarium facilitates the efficient working of the dentist which in turn improves the quality of treatment rendered to the patient. The present invention of the unit consisting of the flexible mirror attached to the suction and the dual suction tip aims at improving the clinical efficiency of dental treatments provided. This compact unit is designed to improve the visualization and isolation of the operating field. It is also easy to fabricate and alleviates the very relevant shortcomings of clinical work.

Keywords: Isolation, mouth mirror, rubber dam, suction

How to cite this article:
Shetty RV, Geevarghese S, Stuti, Mathew RS, Nagaraja S. Enhanced access and isolation by simple modifications of dental armamentarium. Indian J Dent Res 2022;33:209-11

How to cite this URL:
Shetty RV, Geevarghese S, Stuti, Mathew RS, Nagaraja S. Enhanced access and isolation by simple modifications of dental armamentarium. Indian J Dent Res [serial online] 2022 [cited 2022 Nov 29];33:209-11. Available from:

   Introduction Top

The oral cavity is a complex area to work in. Often vision and access are impaired by the lips, cheek, tongue, saliva, and the patient's inability to open the mouth. The standard hand-held dental mirror is a useful aid for retraction, illumination, and indirect vision essential for diagnosis and precise tooth preparation.[1],[2] It is particularly challenging for a dentist to visualize as well as access certain areas of the oral cavity holding the mirror in one hand and the airotor or hand instruments in the other. Often a third hand, usually an assistant becomes essential to direct the suction tip as well. However, dental schools and small dental setups do not always have the personnel to assist in such situations. It is, therefore, desirable to provide means by which the practitioner alone may control the apparatus for performing the dental procedure.

Another problem often encountered during rubber dam isolation is the pooling irrigants above and saliva in the mouth beneath the rubber dam. Excessive drooling has been known to cause angular cheilitis. When 5.25% sodium hypochlorite (NaOCl) comes in contact with vital tissues, it may cause hemolysis, skin ulceration, marked cell injury in endothelial cells and fibroblasts, and inhibition of neutrophil migration.[3] To counter these, rubber dam may have to be removed or the suction tip adjusted or two suction units might be needed which will take up the vital time of the dentist.

In some clinical situations where retraction of the cheek is difficult due to the thick buccal pad of fat or visualizing an inclined tooth, it may be desirous to modify everyday instruments to get the maximum benefit out of them. Therefore, an attempt was made to modify the currently available armamentarium to improve access as well as provide effective moisture control to enhance the quality of treatment.

Modification of mirror and suction apparatus

The conventional suction tip was modified to attach the mouth mirror head. A connector with two outlets was fabricated with acrylic to which was attached a suction tip to one outlet and the flexible shaft of the mirror to the other outlet and the whole unit was connected to the suction unit. The mirror having a flexible shaft can be bent to visualize the desired area and the whole unit can be held in either one of the operator's hand providing both visibility and isolation [Figure 1].
Figure 1: Flexible mirror with suction apparatus

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Modification of the suction apparatus: Dual suction apparatus

An adaptor with two outlets was fabricated with acrylic and two suction tips were connected to it and the whole entity was then connected to the suction unit. The advantage of this modification is that one tip can be placed below the rubber dam into the oral cavity and the other kept close to the isolated tooth/teeth for evacuation of the irrigants [Figure 2].
Figure 2: Dual suction apparatus

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   Discussion Top

The most difficult areas to visualize during operative procedures are the disto-facial surfaces of the maxillary and mandibular posterior teeth as well as disto-lingual surfaces of the mandibular posterior teeth.[4] Posterior most areas of the oral cavity are difficult to visualize due to the rigid shaft of the mouth mirror. Therefore, the present modifications were performed to overcome the limitations of the conventional instruments. Articulated mirror attachment for dental suction tips (Patent number: US5230622A) was previously developed based on the concept of a ball and socket joint for movement and flexibility of the mirror.[5] However, a ball and socket joint confines the movement only in the axial direction leaving the most distal parts of the oral cavity inaccessible. Similarly, the combined dental mirror and suction instrument (Patent number: USD320075S) that was also developed previously had a suction inbuilt within the handle which could have debris clogging the inlet.[6] A reverse-angle dental mirror has a shaft angulated at 45° which is not flexible.[7] As the authors stated, some amount of practice may be required to visualize the occlusal surfaces of teeth with the modified mirror because of the altered angulations.

The second modification, having a dual suction tip can aid in simultaneous moisture control both above and below the rubber dam. A case of accidental skin injury caused by leakage of sodium hypochlorite solution from the rubber dam during root canal preparation has been reported. Even after the placement of a rubber dam and initiation of root canal treatment, the patient often complained of a burning sensation following sodium hypochlorite irrigation.[8] Another case of buccal mucosa necrosis due to leakage of 3% NaOCl through the rubber dam during the root canal treatment procedure of 46 and irrigation with 3% sodium hypochlorite has also been reported.[9] Such situations can be avoided using the dual suction device.

The Sippressor™ is a commercially available suction device, which is controlled by the patient and the device can be turned on and off as and when required by the patient. However, the device is not compatible with the rubber dam system as it does not take care of the fluids accumulating over the rubber dam and is also a quadrant-specific device.

In this era where the use of microscope has taken over the dental practice, these modifications will improve isolation, provide stable vision, and contribute to less fatigue to the operator. There is scope for refining the contraption regarding the material and design. Further, challenges in clinical use need to be addressed to enhance clinical efficiency as well as patient and practitioner acceptance.

   Conclusion Top

The modified mouth mirror and the dual suction device are easy to fabricate, enhance accessibility, visibility, and provide additional isolation, thereby improving efficiency during treatment. This product has received a provisional patent.


The authors would like to thank the scientific advisors: Dr. Eva Shukla—collected data and Dr. Sylvia Mathew—participated in the writing or technical editing of the manuscript.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Vlazny AL. The intraoral mirror: A useful dental device. Quintessence Int 1984;15:659-61.  Back to cited text no. 1
Surathu N, Nasim I. Assessment of the use of a dental mouth mirror. IOSR J Dent Med Sci 2015;14:115-21.  Back to cited text no. 2
Pashley EL, Birdsong NL, Bowman K, Pashley DH. Cytotoxic effects of NaOCl on vital tissue. J Endod 1985;11:525-26.  Back to cited text no. 3
Van Dis ML, Zitterbart PA. Clinical evaluation of an illuminated dental mirror. Oral Surg Oral Med Oral Pathol 1996;81:180-5.  Back to cited text no. 4
John S. Articulated mirror attachment for dental suction tips-Patent number: US5230622A. United States Patent 1993;19. Available from:  Back to cited text no. 5
Schein H. Combined dental mirror and suction instrument- Patent number: USD320075S. United States Patent. 1991. Available from:  Back to cited text no. 6
Dimashkieh MR. A reverse-angle dental mirror. J Prosthet Dent 2002;87:345-6.  Back to cited text no. 7
Serper A, Özbek M, Çalt S. Accidental sodium hypochlorite-induced skin injury during endodontic treatment. J Endod 2004;30:180-1.  Back to cited text no. 8
Deliverska E. Oral mucosa damage because of hypochlorite accident – A case report. J IMAB-Ann Proce (Sci Papers) 2016;22:22-3.  Back to cited text no. 9

Correspondence Address:
Dr. Shruthi Nagaraja
Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, MS Ramaiah University of Applied Science, Bangalore, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_866_19

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