Superior Anterior Access: No More Cotton Rolls

By Lexi Marino March 10, 2021

When your dental working environment is predictable, the quality of your work shines through. In this piece, we’ll show how dental teams can achieve superior anterior access.

Watch this video to learn how the Isolite System helps you:

  • How to achieve continuous lip, cheek, and tongue retraction in anterior procedures.
  • Keep your patients feeling relaxed and comfortable.
  • Simplify your procedures. No more cotton rolls and dry angles.


Rolando Mia: Good day, everybody. Welcome to Dr. Tom’s Tips Case of the Week, 2021. Today, we’re going to see an incredible veneering case, but we’re especially excited because in addition to seeing that case what we’re also going to show you is Dr. Hirsch using the our Isolite® Anterior System.

Maintain Visibility and Access

Dr. Tom Hirsch, DDS: Hey everybody. Good morning, Rolando and to all those fabulous dentists out there. Great to see you.

So one of the challenges that I have in working with anterior dentistry is visibility and keeping the lips up and out of the way. So, what we used to do is we take cotton rolls and jam them all over the place. You know, and that’s fine, we can kind of gets a lip up and out of the way, but not really. Cotton rolls get wet and they have to be changed all the time.

So then a great product came along, the Optragate and I love the optragate. It’s been a fabulous product and all that. However, my issue that I had personally, and maybe you guys didn’t, I had just the toughest time putting this thing in and still have this problem today. I haven’t found the magic to put the Optragate in yet. Although, once it’s in this is a lovely product, great for scanning. Gets the lips up and out of the way.

So, because of that frustration and because the dental community kept asking us, “Why don’t you develop an anterior mouthpiece?” Well, we did. So, we came up with an Anterior Mouthpiece that we’re going to introduce today.

Isolite® Anterior Has Continuous HVE Built-in

This is it, the Isolite® Anterior Mouthpiece. Take it out of the pack. Just like that. It pops in the mouth and it just keeps the lips up and out of the way. For me, this was just a real easy way to have evacuation which I was not able to get with the Optragate, I had to have my assistant in there.

I want to show the device in a veneer case, not even the prep case, but the cementation. So, this is the first introduction on a very limited basis of our new Isolite Anterior Mouthpiece.

Okay, here we go. We got a 65 year old male. Look at all the composites that he had there. Even the cuspids had a lot of restorations, but due to finances, he couldn’t afford to do all 6 teeth at the same time. So, we just chose to do four teeth at this time: 7, 8, 9, and 10. We prepped them.

No More Cotton Rolls

What’s cool about this whole situation and the isolation aspect of it is that lip is up and out of the way. There are no cotton rolls.

Right behind my mirror there. In case you drop anything, those materials will go right up against that throat block. It’s not going down the throat, which is really cool.

Rolando Mia: So I noticed Dr Hirsch, the water is going straight down into the throat. You’re not having to worry about it because it’s evacuating.

Dr. Tom Hirsch, DDS: It’s evacuating everything. The HVE adaptor, can sit on the right side of the patient’s mouth or on the left side. I can go this way or that way, either way you want it to go.

Freeing Up the Hands of Your Dental Assistant

No, we’re just bonding everything. The thing that I want you to notice is the lip is up and out of the way, I’m not changing a cotton roll and I’m not dealing with a lip. I don’t have to pull on the lip at all. So, that’s a takeaway right there.

The second takeaway is my assistant. Rather than evacuating and retracting, she has her two hands just going full speed outside the mouth, getting everything ready, getting the bonding agents ready, passing me the light, getting the cement ready, and getting the crowns ready.

Where I’m by myself in the mouth and I can just go ahead and do all this curing and everything that I have to do. So, now we’re getting ready to place the crowns. We check the occlusion and all that.

So here we go, we bonded it and we’re seating the crowns right now. I like to seat them one at a time. Not cure them but seat them. The products that I use for this is called Insure and it’s totally light cured. So, it’s not a dual cure resin cement. It’s cured by light only. That way I’ve got all the time I need to clean up the cement and floss and don’t have to worry about rushing for a time set at all.

Creating a Predictable Oral Environment

Rolando Mia: And Dr. Hirsch, predictability. We’ve heard that predictability is important. How does this help and in making your cases a lot more predictable?

Dr. Tom Hirsch, DDS: If the lips are up and out of the way and I can just concentrate on my preps and I don’t have to worry about things going down the throat. It’s an easy, predictable situation. That’s going to be the same thing with minor variations every time. Even though the camera’s sped up, I’m just not rushing. I take all the time I want to get all that cement off, clean it up.

Rolando Mia: You don’t have to worry about anything falling down the throat.

Dr. Tom Hirsch, DDS: No.

Rolando Mia: It looks like as you’re going through the procedure, the mouth’s kept open really nicely. So you don’t need that bite block. Right?

Dr. Tom Hirsch, DDS: And these teeth, they look a little whiter on the video than they do in the mouth. Shows up just a little bit whiter, but he wanted them a little bit whiter anyway.

Anyway, your assistant is there with their extra hands. The Isolite Anterior Mouthpiece is like the fifth and sixth hand in the operatory. So, now we’re doing six-handed dentistry instead of four-handed dentistry.

Also, make sure you guys put on a glycerine gel for the oxygen-inhibited layer. That’s super important so you don’t get any staining your margins. We do it facial lingually and I just use, nothing fancy, it’s just K-Y Jelly.

Notice my assistant, not once in this entire procedure has she had to go in the mouth to evacuate any saliva, or any moisture. It’s just being taken away by the mouthpiece. It’s super easy.

Tongue and Lip Retraction

Rolando Mia: Yeah. And I noticed the tongue is down in here, it’s blocking everything.

Also, it looks like you can connect your evacuation on either side of the mouth, depending on access you have. Do you run into any issues with the the lips now? They’re completely out of the way, it looks like.

Dr. Tom Hirsch, DDS: It’s out of the way. So depending, this is an important factor, depending on whether I’m working on the upper or the lower.

Oh, back here in the very back of the mouth, there’s a little block, right back there on both sides so that the patient can rest their jaw on. So, depending on how much lip retraction I actually need, I can actually position this farther forward or farther backwards. So if I pop this in my own mouth like this.

Rolando Mia: You can pull it in and out. Notice all that water’s going down.

Dr. Tom Hirsch, DDS: Yeah. I mean, we’re flooding the heck out of that patient and it’s all getting sucked up. So, that’s just one of the nice features.

Then, this is how you take it out. I pull it right out, comes out really easy.

Rolando Mia: That is awesome. And as far as that case is concerned, if without the system, how long would it normally take you to kind of do a veneer in case like that?

Saving Time Without Cotton Rolls

Dr. Tom Hirsch, DDS: Rolando, I don’t think it would have taken me a whole lot longer to do that case. However, it just would have been more of a hassle with me changing cotton rolls and worrying about evacuation and worrying about something going down in the mouth.

So, maybe it gave me a 10 to 20% speed up in time. So, it’s not the fact that I can go faster, it’s the fact that there’s less headaches and less hassles. It’s more predictable and easier.

Rolando Mia: There you go. Awesome.

Dr. Tom Hirsch, DDS: And you can do six-handed dentistry instead of four-handed dentistry. I’d rather do that.

Rolando Mia: Awesome. Well, thank you so much for sharing that case.