Microrobotics in endodontics: A perspective.

Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.

An Appraisal on Newer Endodontic File Systems: A Narrative Review.

AIM: This narrative review aims to explore and elicit the newer endodontic file systems used for root canal treatments. BACKGROUND: The primary goals of endodontic therapy continue to be the mechanical enlargement and shaping of the intricate endodontic root canal systems to aid in disinfection. Nowadays endodontists have access to a wide range of endodontic file systems for root canal preparations with various design characteristics and benefits. REVIEW RESULTS: ProTaper Ultimate (PTU) files' tip have a triangular convex cross-section, an offset mass of rotating design, a maximum flute diameter of 1.0 mm, and are constructed of gold wire, hence, commonly applied in conditions with restricted accessibility or an extremely curved canal. TruNatomyhas advantages over other cutting-edge file systems like maximum flute diameter of the corona, reduced distance between active cutting flutes, and shorter handles in comparison to SX instruments. In comparison to PTU files, ProTaper Gold (PTG) files are noticeably more elastic and fatigue-resistant. Compared to files in the F1-F3 range, size S1 and S2 files have a significantly longer fatigue life. MicroMega One RECI is more resistant to cyclic fatigue because of its heat treatment and reciprocating action and the C-wire heat treatment of the former gives it flexibility and controlled memory, enabling the prebending of the file. The RECIPROC blue demonstrated enhanced flexibility, increased fatigue resistance, and lower microhardness while maintaining the same surface qualities. CONCLUSION: As per the necessity and requirement on case to case basis, every endodontic file system has advantages and disadvantages as mentioned in this narrative review. According to the need, an endodontist can select the file system which is required specifically. Although several studies are comparing these various systems in the literature, this narrative review aims to give the clinician a summary of some recently launched endodontic rotary file systems available in the market and their clinical uses. CLINICAL SIGNIFICANCE: As per the priority and need of the case, whether removal and extrusion of debris, reduction of micro-organisms, keeping canal anatomy, and cutting efficiency, a specific required file system can be utilized.

Fractographic analysis of separated endodontic file designs.

Endodontic rotary files are cutting instruments used to perform root canal procedures within a tooth interior. Focusing on quantitative fractographic analysis increases necessary, clinical performance understanding of file separation failure. This research employed controlled, dynamic testing to failure of commercial rotary files, analyzing the fractographic, forensic characteristics in relation to Weibull reliability determination, considering: (1) design analysis; (2) stress concentrations; (3) times to failure; (4) number of cycles to failure (NCF). Ex vivo testing included three file designs, each having constant tip size (0.035 mm), taper (0.06 mm/mm), and length (25 mm). Files were individually tested using an electric, torque-controlled handpiece, rotating within a standardized, simulated canal until fracture separation occurred. Fractographic analysis, including critical measurements, was conducted using the scanning electron microscope (SEM) (PhenomProX, PhenomWorld, NL). Weibull statistical analysis established reliability factors per design group. Fractographic analysis identified separation fractures, processing inclusions, flexural-fatigue striations, and stress concentrations at flute pitches. Calculated NCF median values (1277-EE; 899-VB; 713-PI) demonstrated significant statistical differences among groups (p < 0.001). Separated apical fragments yielded statistically significant differences (p ≤ 0.05) for varying file design groups. Weibull moduli among groups were statistically equivalent. Fractographic analysis exposed a presence of multiple failure factors in addition to defect distribution, governing cyclic fatigue failure originating at stress concentration points irrespective of file design. Fractographic analysis indicated that a change in file design, specifically at the working edges, in addition to improved surface finish, has the potential of reducing failures by lowering points of stress concentration and reducing fracture initiating surface cracks.

Filling ability of three variants of the single-cone technique with bioceramic sealer: a micro-computed tomography study.

The present study evaluated the quality of single-cone root canal fillings with bioceramic (BC) sealer using three different techniques by means of micro-computed tomography (micro-CT). The canals of 30 extracted single-rooted permanent teeth were shaped with R40 Reciproc blue files and filled with the single-cone technique (SCT). BioRoot RCS BC sealer was placed inside the canals with one of the following master cones: R40 cone to working length (RWL, n = 10); R40 cone trimmed 1 mm short of working length (RWL-1, n = 10); non-standardized gutta-percha cone to working length (NSWL, n = 10). A quantitative and qualitative micro-CT analysis assessed the filling quality and internal/external voids formation. Collected data underwent statistical analysis by multivariate one-way analysis of variance (α = 0.05). In all groups, the voids were minimal and prevalently external. The NSWL and RWL-1 groups had increased sealer ratios in the whole canal and the apical canal portion, respectively. The lowest amounts of voids were found in the RWL group; the void volumes were slightly greater in the RWL-1 mm and NSWL groups, especially at the apical level. Two alternative SCTs showed satisfactory filling ability, uniform distribution of the BC sealer, and a minimally increased voids formation compared to the standard SCT with dedicated cone. The two tested alternative SCTs could take advantage of the beneficial characteristics of the BC sealer, which evenly filled the endodontic space, ideally sealing both the major and the accessory communications with the periodontium.

New thermomechanically treated NiTi alloys - a review.

In the past 10 years, several proprietary processing procedures for nickel titanium (NiTi) alloy were developed to improve the mechanical properties of NiTi endodontic instruments. Beside specific thermal and mechanical treatments, manufacturers introduced several machining procedures (e.g. twisting, electrical discharge machining), as well as techniques for final surface finishing. NiTi alloys used for endodontic instruments can be subdivided into instruments that mainly contain the austenite phase (austenitic: conventional NiTi, M-Wire, R-Phase) and those mainly containing the martensite phase (martensitic: CM Wire, Gold and Blue heat-treated NiTi). Thermomechanically treated NiTi alloys have been reported to be more flexible with improved cyclic fatigue resistance and greater angle of deflection at failure when compared to conventional NiTi. These enhanced properties may be attributed to a modified phase composition containing varying amounts of R-phase and martensite. Endodontic instruments made of austenitic alloys possess superelastic properties because of stress-induced martensite transformation and consequently tend to spring-back to their original form after deformation. In contrast, the martensitic instruments can easily be deformed due to the reorientation of the martensite variants and show a shape memory effect when heated. The use of martensitic alloy results in more flexible instruments, with an increased cyclic fatigue resistance compared with austenitic alloy.

Endodontic applications of 3D printing.

Computer-aided design (CAD) and computer-aided manufacturing (CAM) technologies can leverage cone beam computed tomography data for production of objects used in surgical and nonsurgical endodontics and in educational settings. The aim of this article was to review all current applications of 3D printing in endodontics and to speculate upon future directions for research and clinical use within the specialty. A literature search of PubMed, Ovid and Scopus was conducted using the following terms: stereolithography, 3D printing, computer aided rapid prototyping, surgical guide, guided endodontic surgery, guided endodontic access, additive manufacturing, rapid prototyping, autotransplantation rapid prototyping, CAD, CAM. Inclusion criteria were articles in the English language documenting endodontic applications of 3D printing. Fifty-one articles met inclusion criteria and were utilized. The endodontic literature on 3D printing is generally limited to case reports and pre-clinical studies. Documented solutions to endodontic challenges include: guided access with pulp canal obliteration, applications in autotransplantation, pre-surgical planning and educational modelling and accurate location of osteotomy perforation sites. Acquisition of technical expertise and equipment within endodontic practices present formidable obstacles to widespread deployment within the endodontic specialty. As knowledge advances, endodontic postgraduate programmes should consider implementing 3D printing into their curriculums. Future research directions should include clinical outcomes assessments of treatments employing 3D printed objects.

Defect propagation in NiTi rotary instruments: a noncontact optical profilometry analysis.

AIM: To evaluate the presence and propagation of defects and their effects on surfaces of nickel-titanium (NiTi) instruments using noncontact, three-dimensional optical profilometry, and to assess the accuracy of this method of investigation. METHODOLOGY: The flute surface areas of instruments from two commercial instrumentation systems, namely Reciproc R25 (n = 5) and WaveOne Primary (n = 5), were assessed and compared before and after performing two instrumentation cycles in simulated root canals in clear resin blocks. All the analyses were conducted on areas measuring 211 × 211 µm, located 3 mm from the tips of the instruments. A quantitative analysis was conducted before and after the first and second instrumentation cycles, using the Sa (average roughness over the measurement field), Sq (root mean square roughness) and Sz (average height over the measurement field) amplitude parameters. All the data were submitted to statistical analysis at a 5% level of significance. RESULTS: There was a significant increase (P = 0.007) in wear in both groups, especially between baseline and the second instrumentation cycle, with significantly higher wear values being observed on WaveOne instruments (Sz median values = 33.68 and 2.89 µm, respectively, for WO and RP groups). A significant increase in surface roughness (P = 0.016 and P = 0.008, respectively, for Sa and Sq) was observed in both groups from the first to the second instrumentation cycle, mostly in WaveOne specimens. Qualitative analysis revealed a greater number of defects on the flute topography of all the instruments after use. CONCLUSIONS: More defects were identified in WaveOne Primary instruments compared to Reciproc R25, irrespective of the evaluation stage. The investigation method provided an accurate, repeatable and reproducible assessment of NiTi instruments at different time-points.

Effect of multiple autoclave cycles on the surface roughness of HyFlex CM and HyFlex EDM files: an atomic force microscopy study.

AIM: To compare the effect of autoclave cycles on the surface topography and roughness of HyFlex CM and HyFlex EDM instruments using atomic force microscopy (AFM) analysis. METHODOLOGY: Eight new files of each brand were subdivided into four subgroups (n = 2/each subgroup). One group was allocated as the control group and not subjected to autoclave sterilization. The other three groups were subjected to different numbers (1, 5, and 10) of autoclave sterilization cycles. After the cycle instruments were subjected to AFM analysis. Roughness average (Ra) and the root mean square (RMS) values were chosen to investigate the surface features of endodontic files. The data was analyzed using one-way ANOVA and post hoc Tamhane tests at 5% significant level. RESULTS: The lowest Ra and RMS values were observed in the HyFlex EDM files that served as the control and in those subjected to a single cycle of autoclave sterilization (P < 0.05). The highest Ra and RMS values were observed in the HyFlex CM and HyFlex EDM files that were subjected to 10 cycles of autoclave sterilization (P < 0.05). The surface roughness values of the HyFlex CM group showed a significant increase after ten autoclave cycles, whereas those of the HyFlex EDM group exhibited a significant change after five autoclave cycles (P < 0.05). CONCLUSIONS: Although the initial surface roughness values of the HyFlex EDM files were lower than those of the HyFlex CM files, the surface roughness values of the EDM files showed a statistically significant increase after 5 cycles of autoclave sterilization. In contrast, the surface roughness values of the HyFlex CM files did not increase until 10 cycles of autoclave sterilization. CLINICAL RELEVANCE: Present study indicated that autoclave sterilization negatively affected the surface roughness of the tested NiTi files.

Dental Dam Application for Endodontics in Dogs-A Novel Clamp Kit.

Although rubber dams are widely used in endodontic treatment in humans with well-known advantages, their use in veterinary medicine is uncommon. The use of a dental rubber dam provides better control of cross-infection, prevents soft tissue contact of chemicals, and improves treatment efficiency. The purpose of this article is to describe a new line of clamps specifically designed for dogs and to review the procedure and materials used for isolating the operative field in endodontic patients. This new design of clamps, better adapted to canine tooth anatomy with different sizes and conformations, has been successfully used in dogs by the authors with good clinical results. The clamps allow for better adaptation to the tooth without injuring the gingiva or the furcation and provide increased retention of the dam for more effective isolation. Given the proven benefits in humans, the authors expect that the widespread use of a rubber dam with clamps specifically designed for canine dental anatomy will improve clinical outcomes in endodontics.

Movement kinematics and cyclic fatigue of NiTi rotary instruments: a systematic review.

The aim of this review was to provide a detailed analysis of the literature concerning the correlation between different movement kinematics and the cyclic fatigue resistance of NiTi rotary endodontic instruments. From June 2014 to August 2015, four independent reviewers comprehensively and systematically searched the Medline (PubMed), EMBASE, Web of Science, Scopus and Google Scholar databases for works published since January 2005, using the following search terms: endodontics; nickel-titanium rotary files; continuous rotation; reciprocating motion; cyclic fatigue. In addition to the electronic searches, manual searches were performed to include articles listed in the reference sections of high-impact published articles that were not indexed in the databases. Laboratory studies in English language were considered for this review. The electronic and manual searches resulted in identification of 75 articles. Based on the inclusion criteria, 32 articles were selected for analysis of full-text copies. Specific analysis was then made of 20 articles that described the effects of reciprocating and continuous movements on cyclic fatigue of the instruments. A wide range of testing conditions and methodologies have been used to compare the cyclic fatigue resistance of rotary endodontic instruments. Most studies report that reciprocating motion improves the fatigue resistance of endodontic instruments, compared to continuous rotation, independent of other variables such as the speed of rotation, the angle or radius of curvature of simulated canals, geometry and taper, or the surface characteristics of the NiTi instruments.

A new method for the assessment of the surface topography of NiTi rotary instruments.

AIM: To describe a new method for the assessment of nanoscale alterations in the surface topography of nickel-titanium endodontic instruments using a high-resolution optical method and to verify the accuracy of the technique. METHODOLOGY: Noncontact three-dimensional optical profilometry was used to evaluate defects on a size 25, .08 taper reciprocating instrument (WaveOne® ), which was subjected to a cyclic fatigue test in a simulated root canal in a clear resin block. For the investigation, an original procedure was established for the analysis of similar areas located 3 mm from the tip of the instrument before and after canal preparation to enable the repeatability and reproducibility of the measurements with precision. All observations and analysis were taken in areas measuring 210 × 210 µm provided by the software of the equipment. RESULTS: The three-dimensional high-resolution image analysis showed clear alterations in the surface topography of the examined cutting blade and flute of the instrument, before and after use, with the presence of surface irregularities such as deformations, debris, grooves, cracks, steps and microcavities. CONCLUSIONS: Optical profilometry provided accurate qualitative nanoscale evaluation of similar surfaces before and after the fatigue test. The stability and repeatability of the technique enables a more comprehensive understanding of the effects of wear on the surface of endodontic instruments.

Effect of sodium hypochlorite and saline on cyclic fatigue resistance of WaveOne Gold and Reciproc reciprocating instruments.

AIM: To compare the cyclic fatigue resistance of WaveOne Gold (Dentsply Tulsa Dental Specialties, Tulsa, OK, USA) and Reciproc (VDW, Munich, Germany) reciprocating instruments during immersion in sodium hypochlorite (NaOCl) and saline solutions at body temperature. METHODOLOGY: A total of 180 new WaveOne Gold primary size 25, .07 taper, and Reciproc size 25, .08 taper were randomly divided into three groups: group 1: no immersion (control, air); group 2: immersion in saline at 37 ± 1 °C; and group 3: immersion in 5% NaOCl at 37 ± 1 °C. The instruments were reciprocated in the test solution until fracture, and the number of cycles to failure was recorded. The data were analysed statistically using t-tests and one-way analysis of variance (anova) with the significance level set at P < 0.05. A Weibull analysis was performed on number of cycles to failure data. RESULTS: WaveOne Gold instruments had significantly greater number of cycles to failure than Reciproc instruments in all groups (P < 0.001). Fatigue resistance for both instruments tested in air was significantly higher than that in saline and NaOCl solutions (P < 0.001). For both instruments, there was no significant difference in the fatigue resistance between saline and NaOCl solutions (P > 0.05). The Weibull analysis showed that the predicted cycles of WaveOne Gold in air was 1027 cycles for 99% survival. However, Reciproc instruments tested in NaOCl solution had the lowest predicted cycles (613 cycles) among the groups. CONCLUSIONS: Immersion of WaveOne Gold and Reciproc reciprocating instruments in saline and NaOCl solutions decreased considerably their cyclic fatigue resistance. The fatigue resistance of WaveOne Gold instruments was higher than that of Reciproc instruments.

Apical transportation and canal straightening with different continuously tapered rotary file systems in severely curved root canals: F6 SkyTaper and OneShape versus Mtwo.

AIM: To compare apical transportation and canal straightening when using three continuous tapered rotary NiTi systems [F6 SkyTaper (Komet/Brasseler, Lemgo, Germany), Mtwo (VDW, Munich, Germany) and OneShape (Micro Méga, Besançon, France)] in severely curved root canals. METHODOLOGY: A total of 60 root canals in extracted human teeth with angles of curvatures ranging between 25° and 35° and radii ranging between 4 and 9 mm were divided into three groups (n = 20). Based on radiographs taken prior to instrumentation, the groups were balanced with respect to the angle and the radius of canal curvature (P = 1.0 and P = 0.994, respectively). All canals were prepared to an apical size 30 according to the manufacturer's instructions. Pre- and post-instrumentation radiographs were superimposed and apical transportation and canal straightening were analysed using a computer imaging program. Preparation time and instrument failure were also recorded. Data were analysed statistically using anova and Student-Newman-Keuls test. RESULTS: During preparation, no file fractured. All instruments maintained the original canal curvature well with no significant differences between the instruments (P = 0.542). Concerning apical transportation, no significant differences were obtained (P = 0.414). Regarding preparation time, no significant differences were obtained between F6 SkyTaper and OneShape (P > 0.05), but both were significantly faster than Mtwo (P < 0.05). CONCLUSION: Under the conditions of this study, all instruments respected the original canal curvature well and apical transportation was negligible. Instruments were safe to use. Preparation with F6 SkyTaper and OneShape was faster than with Mtwo.

Evolution of Nickel-titanium Alloys in Endodontics.

To improve clinical use of nickel-titanium (NiTi) endodontic rotary instruments by better understanding the alloys that compose them. A large number of engine-driven NiTi shaping instruments already exists on the market and newer generations are being introduced regularly. While emphasis is being put on design and technique, manufacturers are more discreet about alloy characteristics that dictate instrument behavior. Along with design and technique, alloy characteristics of endodontic instruments is one of the main variables affecting clinical performance. Modification in NiTi alloys is numerous and may yield improvements, but also drawbacks. Martensitic instruments seem to display better cyclic fatigue properties at the expense of surface hardness, prompting the need for surface treatments. On the contrary, such surface treatments may improve cutting efficiency but are detrimental to the gain in cyclic fatigue resistance. Although the design of the instrument is vital, it should in no way cloud the importance of the properties of the alloy and how they influence the clinical behavior of NiTi instruments. CLINICAL SIGNIFICANCE: Dentists are mostly clinicians rather than engineers. With the advances in instrumentation design and alloys, they have an obligation to deal more intimately with engineering consideration to not only take advantage of their possibilities but also acknowledge their limitations.

Comparison of the Antimicrobial Efficacy of the EndoVac System and Conventional Needle Irrigation in Primary Molar Root Canals.

PURPOSE: The purpose of this study was to compare the antimicrobial efficacy of the EndoVac system and conventional needle irrigation to eliminate E faecalis in primary molar root canals. STUDY DESIGN: 60 extracted human primary second molar roots were instrumented up to an apical size .04/35 and randomly divided into two groups; Group 1: conventional needle (n=30) and Group 2: EndoVac (n=30), and four subgroups (two experimental subgroups; (a) 2.5% sodium hypochlorite (NaOCl) + ethylenediaminetetraacetic acid (EDTA) (n=20), (b) ozonated water (OW) + EDTA (n=20), and control groups (c) 5.25% NaOCl (n=10) and (d) saline (n=10). All roots were sterilized and then inoculated with E.faecalis. Before and after final irrigation procedures, root canals were sampled and the grown colony forming units (CFUs) were counted. Data were analyzed by Kruskall-Wallis and Mann-Whitney U tests using a 0.05 significance level. RESULTS: The EndoVac reduced more bacteria than the conventional needle did but it was not statistically significant (p>0.05). NaOCl alone or followed by EDTA totally eliminated bacteria. OW + EDTA showed higher reduction of bacteria but could not totally eliminate bacterias. CONCLUSIONS: In the context of bacterial elimination, the EndoVac was not significantly better than the conventional needle. Although, there were fewer CFU/mg when using EndoVac, there was not any statistically significant superiority to conventional needle irrigation. An OW+EDTA regimen showed antibacterial effect in the primary molar root canals but it was significantly less effective than NaOCl+EDTA.

[Endodontic treatment efficacy enhancement by means of instrumental physiotherapy]. / Povyshenie éffektivnosti éndodonticheskogo lecheniia s pomoshch'iu apparaturnykh metodov.

The article describes in detail and examines the prospects of such methods as electroodontodiagnosis, diathermocoagulation and apex-phoresis. It proves the necessity of development and standardization of devices for the mentioned treatment modalities that will improve the effectiveness an quality of caries complications treatment.

A review of instrumentation kinematics of engine-driven nickel-titanium instruments.

Over the years, NiTi alloys have become indispensable materials in endodontic treatment. With technological advancements in metallurgy, manufacturers have attempted to produce instruments with enhanced features. In parallel with these developments, endodontic motors have undergone improvements in terms of torque control and kinematics that are adjustable in different directions. This review presents an overview of the advancements in instrumentation kinematics and the effect of instrumentation kinematics on root canal shaping procedures and instrument performance. The literature search for this narrative review was conducted in Google Scholar, Scopus, PubMed and Web of Science using the keywords 'kinematics and endodontics' and 'reciprocation and endodontics'. In addition, historical literature was searched using the keyword 'nickel-titanium and endodontics'. Overall, 143 articles were included up to 2015.

Influence of electronic apex locators and a gutta-percha heating device on implanted cardiac devices: an in vivo study.

AIM: To evaluate the potential for electromagnetic interference (EMI) of electronic apex locators (EALs) and a gutta-percha heating device (HD) in patients with implantable cardiac pacemakers (ICPs) or cardioverter-defibrillators (ICDs). METHODOLOGY: Two types of EALs (Romiapex A-15 and Novapex) and a HD (Touch'n Heat) were tested in patients followed in an outpatient clinic for cardiac arrhythmias. The heart rhythm was monitored on a computer screen during all experimental phases. After baseline data collection, the patient held each appliance (turned on) for 30 s, simulating their clinical use. If background noise was detected on the cardiac monitor, the sensitivity of the ICP/ICD was lowered by the cardiologist to evaluate the intensity of the detected EMI. RESULTS: Twelve patients were evaluated (5 female and 7 male), and in nine instances, background noise in their cardiac devices related to the use of the endodontic devices was detected (6 patients). After lowering the sensitivity of the cardiac implants, three patients had more severe EMI in six instances, including pauses in ICP function. The presence of a symptomatic or asymptomatic pause was related to the patient's underlying heart rhythm. The HD device produced background noise more often compared to EALs. These were associated with more severe types of EMI. CONCLUSION: The EALs and gutta-percha HD were capable of causing background noise detection or pauses in cardiac implants in vivo. The use of electronic dental devices nearby patients with cardiac implants should be carefully considered in clinical practice.

Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative Dentistry.

Light amplification by stimulated emission of radiation (laser) has been used widely in a range of biomedical and dental applications in recent years. In the field of restorative dentistry, various kinds of lasers have been developed for diagnostic (e.g. caries detection) and operative applications (e.g. tooth ablation, cavity preparation, restorations, bleaching). The main benefits for laser applications are patient comfort, pain relief and better results for specific applications. Major concerns for using dental lasers frequently are high cost, need for specialized training and sensitivity of the technique, thereby compromising its usefulness particularly in developing countries. The main aim of this paper is to evaluate and summarize the applications of lasers in restorative dentistry, including a comparison of the applications of lasers for major restorative dental procedures and conventional clinical approaches. A remarkable increase in the use of lasers for dental application is expected in the near future.

Why dentists don't use rubber dam during endodontics and how to promote its usage?

BACKGROUND: This survey study aimed at investigating the frequency of rubber dam use during root canal treatment, identifying influencing factors for not using it by Saudi general dental practitioners (GDPs) and endodontists. It also aimed at identifying measures that increase rubber dam usage. METHODS: After obtaining an ethical approval, two pilot studies were conducted on staff members at Taibah University College of Dentistry and a group of GDPs. A final online survey was constructed comprising 17 close-ended questions divided into six categories: demographics, endodontic practice, rubber dam use, alternative isolation methods, reasons for not using rubber dam, and measures and policies that increase its usage. The survey was emailed to 375 GDPs randomly selected from the dental register and all endodontists (n = 53) working in the western province, Saudi Arabia. Data were analyzed using the Chi-square and Linear-by-Linear association tests at p ≤ 0.05. RESULTS: The proportion of endodontists who used rubber dam (84.8 %) was significantly greater than that of GDPs (21.6 %) (p < 0.001). Significantly the highest proportion (40.5 %) did not use rubber dam because of unavailability at working place. Most rubber dam none-users (69.25 %) used a combination of other isolation means. The highest proportion of those who used rubber dam were working in the governmental sector (54.3 %). Among rubber dam users, the greatest proportion graduated from Saudi Arabia (57.8 %) compared to those graduated from Egypt (34.3 %) and Syria (22.4 %). There was a significant correlation between the patterns of rubber dam use during undergraduate training and its usage after graduation (p = 0.001). The highest proportion of participants (48.1 %) reported better undergraduate education as the most important factor that would increase rubber dam use in dental practice. CONCLUSIONS: Using of rubber dam was not common in Saudi general dental practice. Dentists must follow the recommended standards of care. Place of work and patterns of using rubber dam during undergraduate study were the most influencing factors. Better undergraduate education was the most important proposed measure to increase its usage. The combination of cotton rolls and saliva high-volume ejector or gauze was the most common alternative to rubber dam isolation.