Rubber Dam Isolation

Dr. Afrina Huda Rifa

FCPS Part II Trainee
Contents

 Introduction
 Methods of moisture control
 Isolation with rubber dam
 Advantages
 Disadvantages
 Contraindications
 Components of Rubber dam
 Recent modification on design of rubber dam
 Methods of Rubber Dam application
INTRODUCTION

 To achieve the first principle of endodontic treatment, a safe and aseptic operating
technique needs to be maintained. For this, application of rubber dam is
mandatory. It is the only sure safeguard against bacterial contamination from
saliva and accidental swallowing of root canal instruments.
Methods of moisture control

Direct methods
 Rubber dam
 Aspiration
 Air-Water Syringe
 Absorbent materials
 Gingival retraction cord
 Electrosurgery.
Local anesthetics
Pharmacological methods
 Antisialagogues
 Antianxiety drugs
 Muscle relaxants.
Isolation with rubber dam

 Rubber dam can be defined as a flat thin sheet of latex/nonlatex that is held by a
clamp and frame which is perforated to allow the tooth/teeth to protrude through
the perforations while all other teeth are covered and protected by sheet.
Advantages

 Dry aseptic field

 Protects patient’s soft tissues from sodium hypochlorite irrigation and other
caustic medicaments

 Prevents aspiration of endodontic instruments

 Improves access and visibility

 Prevents contamination of root canal with oral microbial flora

Disadvantages

 Takes time to be applied

 Communication with patient can be difficult

 Incorrect use may damage porcelain crowns/crown margins/ traumatize gingival

tissues

 Insecure clamps can be swallowed or aspirated.

Contraindications

 Asthmatic patients

 Allergy to latex

 Mouth breathers

 Extremely malpositioned tooth

 Third molar (in some cases).

Components of Rubber dam

 Rubber dam material

 Rubber dam clamps
 Rubber dam clamp carrying forceps
 Rubber dam punch
 Rubber dam frames
 Rubber dam template
 Rubber Dam accessories
 Wedget cord
 Dental silk floss
 Rubber dam napkin
 Lubricant
1.Rubber Dam Material

 Rubber dam material is available a heavy, medium, and light, and in different
colors and standard sizes. Readymade sheets are available in sizes 5 × 5" and 6 ×
6", and rolls according to need which may be conveniently cut into necessary
size. The rubber dam material is usually a latex material. However, for patients
with known allergy, nonlatex rubber dam material should be made available in the
clinic. Medium weight thickness is usually recommended for endodontic purpose.
2. Rubber Dam clamps
Types
Based on number of wings– Winged

-Wingless

Based on Material- Metallic

-Plastic

Based on Number of Bow –Single

-Double
Clamp placement

 The lingual jaws of the clamps are applied first to the tooth surface.

 Then positioned below the highest point on the lingual contours of the tooth that
is below the crest of the curvature

 The operator then rotates his hand buccally to apply the buccal jaw of the clamp
below the height of buccal contour

 The clamp is then released from the forceps

3.Rubber Dam Punch

 This is used to punch the rubber dam for application on specific tooth or
teeth.The rubber dam punch has a moving table with holes of different diameters.
The smallest one is for the lower anterior teeth and the largest is for the posterior
teeth.
4. Rubber Dam Holder or Frame

 Rubber dam frames serve following purposes

 Supporting the edges of rubber dam

 Retracting the soft tissues

 Improving accessibility to the isolated teeth.

 There are Two types of frame – Plastic & Metallic

 The plastic frames, contoured facially, have the additional advantage of being
radiolucent and do not have to be removed when taking working radiographs of
the tooth during treatment.
5. Rubber Dam Template

 The rubber dam template is provided to the clinician to make an exact punch on the
tooth in question for both upper and lower teeth.The holes in the rubber dam
should be punched approximately over the center of the incisal or occlusal surface
of the teeth to be engaged using a rubber dam template below the rubber dam
sheet.
6. Wedget Cord

A wedget cord is used to stabilize the interproximal area of the rubber dam. It is a
flexible elastic material that can be passed over the dam interproximally below the
contact area.
7. Dental Silk Floss

Silk floss is required for rubber dam application, especially for endodontic
procedures or during inoffice nonvital or vital bleaching. Two additional holes are
provided by the manufacturer for securing the rubber dam clamp by passing silk
floss and holding the free end of the floss outside the patient’s mouth. This is a safety
measure while removing the rubber dam clamp if it snaps.
8. Rubber Dam Napkin

The rubber dam napkin is placed between the dam and the patient’s skin in order to
avoid any potential latex-related allergic reactions.
9.Lubricant

 A Water soluble lubricant applied in the area of the punched holes facilitates the
passing of the dam septa through the proximal contacts

 It is applied on both sides of the dam in the area of the punched holes

 A rubber dam lubricant is commercially available but other lubricants such as

shaving cream or soap slurry, are also satisfactory
Recent modification on design of rubber dam

 OptraDam- recently introduced systems which is considered to be an

anatomically shaped rubber dam which can be used with or without clamps.
 ŠInsti-Dam is a disposable rubber dam system available in both latex and
nonlatex materials. Salient Features of Insti-Dam
 It is natural latex dam with prepunched hole and builtin white frame
 Its compact design is just the right size to fit outside the patient’s lips
 It is madeup of stretchable and tear-resistant, medium gauge latex material
 Radiographs may be taken without removing the dam
 Built-in flexible nylon frame eliminates bulky frames and sterilization
 Off-center, prepunched hole customizes fit to any quadrant—add more holes if
desired.
Methods of Rubber Dam application

Method I—Clamp placed before rubber dam

 Select an appropriate clamp according to the tooth size.
 Tie a floss to clamp bow and place clamp onto the tooth.
 Larger holes are required in this technique as rubber dam has to be stretched over
the clamp. Usually two or three overlapping holes are made.
 Stretching of the rubber dam over the clamps can be done in the following
sequence
 Stretch the rubber dam sheet over the clamp
 Then stretch the sheet over the buccal jaw and allow to settle into place beneath that
jaw
 Finally, the sheet is carried to palatal/lingual side and released.
Method II—Placement of rubber dam and clamp together
• Select an appropriate clamp according to tooth anatomy
• Tie a floss around the clamp and check the stability
• Punch the hole in rubber dam sheet
• Clamp is held with clamp forceps and its wings are inserted into punched
hole
• Both clamp and rubber dam are carried to the oral cavity and clamp is
tensed to stretch the hole
• Both clamp and rubber dam is advanced over the crown. First, jaw of
clamp is tilted to the lingual side to lie on the gingival margin of lingual
side
• After this, jaw of the clamp is positioned on buccal side
• After seating the clamp, again check stability of clamp
• Remove the forceps from the clamp
• Now, release the rubber sheet from wings to lie around the cervical margin
of the tooth.
Method III—Split dam technique: This method is split
dam technique in which rubber dam is placed to isolate
the tooth without the use of rubber dam clamp.

This technique is indicated

• To isolate anterior teeth
• When there is insufficient crown structure
• When isolation of teeth with porcelain crown is required.
In such cases placement of rubber dam clamp over the crown
margins can damage the cervical porcelain.