GOOD MORNING

RUBBER DAM
ISOLATION
CONTENTS
• INTRODUCTION
• HISTORY AND RATIONAL REASONS FOR USING THE DAM: PROS AND CONS
• ISOLATION AIM & PLANNING
• OPERATIVE FIELD ISOLATION: ARMAMENTARIUM
• OPERATIVE TIMING IN ENDODONTICS: WHEN TO APPLY THE RUBBER DAM
• THE DAM: APPLICATION TECHNIQUES
• REMEDY FOR DENTAL DAM LEAKAGE PROBLEMS
• CONCLUSION
• REFERENCES
 INTRODUCTION
Nowadays the endodontic world is crazy for the technology, rotary
Instruments, endo motors, microscopes and so on, but some colleagues are
Loosing the attention on the basic principles of the root canal treatment
Underestimating the importance of the isolation in endodontics .

The rubber dam is still the first and the most important step of our treatment,
Not only to avoid infections but also to improve the access and the visibility of
The operative field.
A survey last year noted that less
than 10% of practices were using a
dental rubber dam. COVID-19 has the potential to spread
through droplets and aerosols from
The No. 1 reason at the time was lack infected individuals in dental clinics and
of proper training and time.  hospitals.
Documentation proves the
placement of a rubber dam  When dentists work with devices in the
significantly reduces airborne patient’s oral cavity, a large amount of
particles in a 3-foot diameter of the aerosol and droplets mixed with the
operational field by 70% during a patient’s saliva—or even blood—will be
procedure. generated.
History

University of Illinois - 1900

The invention of the rubber dam isolation technique dates back to 1864 in New York, when
young dentist Sanford Christie Barnum , finally found a solution to prevent the
contamination by oral fluids of the target tooth during fillings.

He took a rubber sheet, pierced it and tied it to the tooth to be filled with a silk floss, thus
obtaining an operative field with a humidity control which was definitely superior to the one
achieved by the means used so far.

Dr Barnum himself designed a set of steel clamps to stabilize the dam around the tooth.
The use of the Rubber Dam in Endodontics H O W - W H E N - W H Y by Filippo Cardinali & Fabio Gorni
 In 1873 the plier designed by Dr Royce to ease tooth clamping procedure was
already available for sale, while in 1875 Dr Delos Palmer introduced a set of 32
clamps, each one designed for a specific tooth.

Subsequently, in 1879 Dr Ainsworth launched the rubber dam punch plier, which
remained almost unchanged compared to the present version

In 1901, With The Introduction Of The Metal Frame By Dr Young, The Core
Instrumentation To Achieve Proper Operative Field Isolation Was Complete: Rubber
Sheet, Punch Plier, Clamp Set With Dedicated Plier And Metal Frame To Stretch The
Dam.

The use of the Rubber Dam in Endodontics H O W - W H E N - W H Y by Filippo Cardinali & Fabio Gorni
RATIONAL REASONS
FOR USING THE DAM:
PROS AND CONS
 Provides Dry And Clean Operating Field.


P Enhanced Access And Visibility To The Working Area.



Protects
 Patients From Possible Aspiration Or Swallowing Of

R
Endodontic Instruments, Medicaments, Irrigating Solutions And
Debris.
RetractsAnd Protects The Soft Tissues (Gingival Tissues, Tongue,

O


Lips And Cheeks) Against Possible Trauma From Rotary And Hand
Instruments And Endodontic Medicaments.

S Significantly
 Reduces The Microbial Content Of Air Turbine Aerosols
Produced During Endodontic Procedures, Thereby Reducing The
Risk Of Cross Infection.
Improves the properties of dental materials by preventing the
moisture contamination of restorative materials.
 Enhances operating efficiency and increased productivity.
Patient management is simplified by avoiding need to rinse the
mouth of debris.
 Protects dentists and dental assistants against infections which
can be transmitted by the patient‘s saliva .
 Minimizes patients conversation during root canal treatment
and encourages them to open their mouth.
 Eliminates need for repeated change of cotton rolls due to
flooding of saliva or root canal irrigants.
Infection control
The reduction in CFUs at one metre was
98.8%, 73.8% and 99.4% in the rubber dam
group, the antiseptic group and the antiseptic
with rubber dam group respectively. Bacterial
contamination almost disappeared for the
rubber dam group and for the antiseptic with
rubber dam group at 2 metres while the
reduction in the antiseptic group was 75.5%.

Efficacy of rubber dam isolation as an infection control procedure

in paediatric dentistry Eastern Mediterranean Health Journal 2020
C  Asthmatic patients
O Patients with latex allergy
Psychological reasons
N There is no established scientific evidence

S
describing the disadvantages arising from
correct dam utilization.
“DO BETTER WHAT YOU SEE & SEE BETTER WHAT YOU DO”
ARNALDO CASTELLUCCI

This phrase precisely summarizes the need for isolation of operative

field.

Better visualization increases the efficiency of the operator & vice

versa..
ARMAMENTARIUM
 Frame

Clamps Sheet

Primary

Forceps Punch

Template
 Lubricants

ACCESSORIES
Dental floss

Rubber dam
napkins
 1) RUBBER DAM SHEETS
The rubber dam sheet can be made of
latex or synthetic material.
Latex is a complex emulsion with two main
features: elasticity and resilience, that is
a material’s capacity to come back to its
original shape after being twisted or
squeezed
Elasticity prevents the sheet from
tearing apart when the practitioner
stretches it to fit it around the tooth
clinical crown.

Resilience contributes to a perfect seal

since the sheet adheres firmly to the
tooth neck (cervix).
 AVAILABLE RUBBER DAM THICKNESS
GAUGE THICKNESS
The 6” x 6” format is useful in restorative dentistry,
 THIN  0.006 (0.005-0.007) inch where it is necessary to isolate several teeth at the
same time.
 MEDIUM  0.008(0.007-0.009)inch
In Endodontics, where one tooth is isolated at a
 HEAVY  0.010(0.009-0.015)inch time, the 5” x 5” format is more than sufficient,
even for working in the posterior sectors of
 EXTRA HEAVY  0.012(0.0115- the mouth.
0.0135)inch
 SPECIAL HEAVY  0.014(0.0135-
0.0155)inch
 2. Flexi dam (Coltène/Whaledent)
1.Derma dam (Ultra dent
Products. Inc, USA)
 elastic nonlatex dental dam made
 It is also nonlatex and from an elastic plastomer
powder-free dental dam
 can be elongated more than 1000 %
 It has a low content of surface
before tearing.
proteins

 Advantage:  It is more tenacious than latex dam

 low dermatitis potential, and is simple to place.
 reduced allergic reactions
 greater tear resistance
 It needs to be stretched before use.
 2) Rubber dam punches & pliers

Pliers
– It is used to make round holes of different diameters
(0,7 – 2 mm), depending on the tooth to be isolated.
– Several brands are available. Nonetheless, it is
necessary to check whether the dam opening is
exactly round, without irregularities. Ainsworth The Ivory
– To determine this, it suffices to punch a hole in a dam type type
sheet and then enlarge this opening by stretching the
sheet in different directions. The dam should not tear.
The round-shaped hole rim improves
resistance to tearing when the sheet is
stretched and placed upon the tooth

As for diameters, the largest hole is

usually selected for the tooth to be
clamped, while gradually smaller
diameters are used to other purposes
(isolating molars, premolars, canines and
incisors).

A misuse of the piercing technique or

incorrect maintenance of the punch plier
can lead to an inaccurate hole with rim
irregularities

This can result in the sheet being less

resistant to tearing during its placement
and it loses the ability to perfectly adhere
to the tooth neck with the possibility of
saliva leakage.
 3) Rubber dam clamps
Clamps are needful to secure the rubber sheet to the tooth

Anterior

Clamps ACC to manufacturers

Three
types
Bicuspi
Molars
d
Recent advances in clamps
a) Clamp with long guard extension
These clamps retract and protect the cheek and
tongue along with isolation. They can be used with
gauze or cotton rolls just for the retraction of tongue
and cheek. The larger wing of the clamp is used for
the retraction of the tongue

b) Tiger clamp
These are the clamps with serrated jaws
These serrations will increase the stabilization of the clamp
on the partially erupted or broken down teeth.

c) S-G (Silker-Glickman) clamp

This is a clamp with anterior extension which allows for
retraction of the dam around a severely broken-down tooth,
and the clamp itself is placed on a tooth proximal to the one
being treated
d) Super Clamp (Dent Corp Research and
Development, NY, USA)
This new product facilitates the isolation of an
individual tooth without covering the patient‘s
whole mouth and nose . It protects the tongue and
cheeks while helping the patient and the dentist
feel more comfortable.

e) Gold colored clamps

These clamps have diamond grit on their jaw to improve the

retention of the clamp
4) Rubber dam clamp forceps
This instrument is necessary to open the clamp and
position it around the tooth.

The Ivory forceps are preferable, because they allow

the dentist to apply direct pressure toward the gum,
which is frequently necessary to position the clamp
securely below the bulge of the tooth crown.
 5) Rubber dam frame
The frame plays a lead role in operative
field isolation. Available in two forms

Because of this extra-oral anchorage the

stretched-over sheet is actually capable
of keeping soft tissues retracted for the
whole treatment duration, thus offering Transparent
Metal
plastic
better working access.
Recent advances in rubber
dam frame
 Pre-Framed Dental Dams

Articulated frame.

a) Insti dam (Zirc)

b) Handi dam (Aseptico)

c) Dry dam
Safe T frame d) Framed Flexi Dam (Coltène/Whaledent)

e) Opti Dam (Kerr)

f) Optra Dam (Ivoclar Vivadent, USA)

Instidam (Zirc company)
Has inbuilt flexible radiolucent nylon
frame
eliminating the need for separate one.
Off centre pre-punched hole which
customizes fit to any hole

Advantages:
 Simple & effective isolation system
 Radiographs can be taken by bending the frame
 Single use; eliminates need for sterilization
 HANDIDAM (ASEPTICO,
WOODENVILLE)

 Has a built in foldable

radiolucent frame and a
plastic tube inserted in
prepared holes in rubber
dam material to keep the
dam open

 Available in one size

FRAMED FLEXI DAM
(COLTÈNE/WHALEDENT)
Non- latex

The flexible frame is designed with a convenient working size of 100 mm x

105 mm to ensure easy placement without limiting access.

The dam has good tear resistance and is latex allergy free and
odorless.

The smooth surface of the plastic frame helps to maximize patient comfort
when positioned against their skin
Optra Dam (Ivoclar Vivadent, USA)

 combining the benefits of a lip and cheek retractor (Optra

Gate), with the total isolation of a rubber dam

 No need of clamp

 there is no need for a separate rubber dam frame making it

even more time and cost efficient

 maintain full mobility of their jaw along with added

comfort throughout the procedure.
Rubber dam stamp.
Rubber stamps provide a very convenient and efficient way of marking the dam
for punching.

There are commercially available stamps, or stamps can be made by any rubber
stamp manufacturer
from a pattern such as the one shown in Fig or any custom design.

Dams should be pre stamped by an assistant so that the marks for the maxillary
central incisors are positioned approximately 0.9 inch from the top of the dam.

Exceptions to normal tooth position are easily accommodated.

RUBBER DAM TEMPLATE
 Made of plastic
 Can be placed over the dam & mark can be made
 Approximately same size & shape of unstretched
rubber dam.
A Rubber dam napkins

c These prevent direct contact between the rubber sheet and the patient’s cheek. By absorbing
the saliva that accumulates beneath the dam by capillary action, they facilitate treatment.
c Their use is not mandatory; however, they are particularly indicated in cases of allergy to the
e rubber of the dam.

s
s
o
r
i
e
s
Lubricant
Before positioning the dam, it is an advisable to lubricate
the inner surfaces well with Vaseline or, more simply,
soap, so that the sheet will slide better over the contours
of the teeth, more easily overcome the contact areas,
and close tightly around the cervix of the tooth.

Dental floss

Apart from preventing the ingestion or aspiration of

the clamp, dental floss is particularly useful for assessing the
condition of the mesial and distal contact areas, and thus for
facilitating the passage of the rubber sheet beneath them.
Cushees Wedjets
(Hygenic)
• These are stretchable elastic
 These are soft thermoplastic cashew shaped stabilizing cords made from
nodules which are grooved on their inner surface and natural latex rubber and used as a
act as rubber dam clamp cushions. rubber dam retainer
 It is slipped over the tooth attachment blade of clamp • These are a faster and
prior to clamp application. easier method of retaining the
rubber dam than using
conventional clamps.
• Placed like dental floss over the rubber
dam in the interproximal areas of the
teeth
• They are especially used in the isolation
of anterior teeth.
 Recent alternatives to Rubber Dam

Kool dam.

light cured material applied on the gingiva or tooth surfaces

prior to power bleaching, sand blasting or other procedures
requiring intraoral protection or isolation

• It remains flexible after curing and has good tear resistance.

• It stacks on itself smoothly and evenly and is easy to remove.
• It is moisture friendly and works well in the oral environment and is a rubber dam
substitute.
• A similar resin product called as OpalDam is manufactured by Ultradent Incorporation.
 Fast dam
Anatomically-shaped fast dam is designed to provide a superior means of
maintaining a dry quadrant field

It can be used in place of cotton rolls to retract the cheek and

tongue while maintaining a dry field.

Continuous aspiration is achieved by means of 17

suction holes along the perimeter, eliminating the need to change
saturated cotton rolls while retracting the cheek and tongue.

Fast dam fits into the valve of all standard saliva ejectors.

Fast dam is also suitable when conventional rubber dam is too

cumbersome.
Isolite
The Isolite is a new dental device that simultaneously delivers continuous throat
protection, illumination, retraction and isolationt has a unique soft, flexible
mouthpiece which isolates maxillary and mandibular quadrants simultaneously, retracts
and protects the soft tissues from accidental damage from high speed turbines, delivers
shadow less illumination and continuously aspirates fluids and prevents the aspiration of
foreign objects.

It can be particularly useful in young people with incompletely erupted teeth.

Using Isolite, a core buildup during endodontic treatment can be done immediately by
placing a matrix or core-former, and thus completing the process in one step.

This reduces the amount of time and number of steps needed as compared to
conventional rubber dam.
A similar device, Isodry, is also available which performs the same function, but
require external lighting.
It has the following disadvantages:
(a) It is significantly more expensive than the rubber dam.
(b) (b) It does not provide the color contrast with the teeth that some practitioners
find helpful when using rubber dam.
(c) (c) It may cause damage to the gingiva, since Isolite does not seal the gingiva
from irrigants or intra canal medicaments.
 ISOLATION AIM & PLANNING

THE PURPOSE OF THE ISOLATION is the creation of an operative field with the following
characteristics:
• Stable
• Leakage-free
• Made to last for the whole treatment time
A Comprehensive Isolation Planning Is Synonymous With:
Easy And Correct Dam Placement

 A Dam Usage Which Is Not Detrimental To The Treatment

Dam Placement Time Reduction

Increased Patient’s Compliance

A rational and thoughtful operational sequence calls for a careful analysis of the
following key factors:

1) Determination Of The Extension Of The Isolation

2) Clamp Selection
3) Inspection Of The Target area-problems Interception
4 ) Sheet and frame Selection
5) Sheet Piercing
6) Dam Placement
7) Rubber Sheet Fitting And Leakage Control
DETERMINATION OF THE EXTENSION OF THE ISOLATION
As A General Rule, When It Comes To A Strictly Endodontic, Isolation Will Affect A Single
Element; On The Other Hand, If The Planned Restorative Treatment Affects Interproximal
Surfaces, Then Isolation Will Involve More Teeth.
 CLAMP ROLE IN ISOLATION PROCEDURE
FINDING THE RIGHT CLAMP is the
most important moment of the
isolation procedure
• To Stabilize The Operative
Field For The Whole
Treatment Duration
• To Make Dam Placement
Easier
• Is Strictly Related To Chosen
Treatment
• And Target Tooth
The target tooth should be thoroughly checked in size, shape and position, as well
as in relation to the periodontium and the nearby teeth.
Two dimensions are crucial:
the vestibular-lingual and mesio-distal diameters.
These values will be compared with the
diameters of the tooth to be clamped
and the chosen clamps will meet
the following criteria:

-The Distance Between The Two Mesial

And Distal Contact Points (A) Of Each Jaw
Must Be Lower Than The Tooth Mesio-
Distal Diameter (A).

-The Distance Between The Two Jaws (B)

Must Be Lower Than The Tooth Vestibular-
Lingual Diameter (B).
The “rule of 4” is the main criteria for a fruitful clamp selection in Endodontics and
Restorative dentistry.
Amongst clamp selection criteria, the practitioner should be familiar with the “rule of 4”.
Every clamp has 4 prongs or contact points (2 each jaw) to grip on the tooth.
According to the “rule of 4”,
” a clamp gripping on the tooth with all its four contact points at the same time is
considered potentially stable and the pressure applied on the tooth is equally distributed
on the 4 points, thus reducing the possibility of causing iatrogenic damages to the
dental structure’’ The “rule of 4” is the main criteria for a
fruitful clamp selection and only once we
selected a clamp with the 4 prongs
grabbing the tooth at the same time we
could move to the next step that is the
test to definitely asses if the clamp could
be stable for the whole treatment
duration or not.
Endodontics clinical practice might call for using anterior clamps on premolars or
molars, and premolar clamps on molars.
The most important thing is to always comply with the “rule of 4this often happens
when it comes to endodontic treatment of prostethic abutment and/or teeth with a
severely damaged crown for caries or fracture.
In single isolation
procedures, for example, With an intact crown it is
the Authors would like to suitable to
recommend winged choose flat-jawed clamps
clamps so the sheet since
is more apically they are less traumatic
stretched around the to the
tooth and the tooth itself periodontium.
is more visible
and better highlighted

On the contrary if the tooth’s crown is

damaged by caries or fractures or if it is
a prosthetic stump, operative field
stability is easier to achieve by using
clamps with more aggressive jaws,
capable of gripping the tooth at the
gingival sulcus due to their angulation

Fig. 20. The tooth shows a distally damaged clinical

crown so it is isolated with a tilted-jawed clamp (8A).
In multi-rooted teeth, aggressive-jawed clamps are very effective since their tilt
allows them to reach for the stump deeply and apically to the tooth preparation end line.

However, before using these clamps, the Authors always recommend to attempt to
acheive stability through the use of less aggressive and flatter jaws such as the ones in
clamp 4.
CLAMP STABILITY TEST

The first one checks stability by applying

an up-and-over oscillating pressure upon
the jaws with your fingers (Fig. 25).
Secondly the practitioner puts his/her
finger distally to the bracket and pulls in
mesial direction, outward from the oral
cavity (Fig. 26).
INSPECTION OF THE TARGET AREA:
PROBLEMS INTERCEPTION
When the clamp has been chosen, it is necessary to test the accessibility to
interproximal spaces - where the rubber sheet is going to be inserted – with the
dental floss.

If Contact Points Are So Narrow To Prevent

Dental Floss From Passing Through Or Should
The Floss Gets Torn By Jagged
Interproximal Surfaces (Especially In Case Of Old
Tooth Fillings), Similarly The Dam Is Going To
Get Stuck Or Damaged.

In endodontics (and usually in single tooth

isolations), any major obstacles preventing the
dam from sliding into interproximal space is
not a problem.
• On the contrary, if the interference is due to orthodontic splints or arches, gaps arising
from a poorly fitting rubber sheet around the tooth are likely to cause saliva leakage:
these gaps can be properly sealed using liquid dams
SHEET AND FRAME SELECTION

conservative dentistry requires metal frame and a dark-colored dam to contrast

restoration materials,
while endodontics calls for a light-colored dam to make operative field brighter
and a radio-transparent plastic frame to ease intraoperative radiograph.

The choice of the frame affects the way

to take the intra-operative radiograph
during the endodontic treatment.
THE IMPORTANCE OF A CORRECT PIERCING
THE DAM: APPLICATION TECHNIQUES

CLAMP
WING
FIRST
TECHNIQU
TECHNIQU
E
E

RUBBER
BRACKET
FIRST
TECHNIQU
TECHNIQU
E
E
 Clamp first technique
The target tooth is first clamped, then the dam is inserted by stretching the rubber
around the bracket and subsequently around the branches until tooth neck is entirely
covered .
 ADVANTAGES
 The “clamp-first” technique is a two-handed procedure so it
doesn’t need any assistance.
 Its biggest benefit is the excellent operative field visibility during
placement.
 It can be implemented only with single-bracket (premolars-
molars) and preferably wingless clamps

DISADVANTAGES
 The Risk Of Swallowing And/Or Inhaling It Is Surely Higher.

 To Avoid Any Kind Of Displacement The Practitioner Should

Choose A Stable Clamp Since It Is Meant To Undergo A Severe
Strain During Sheet Placement. For these reasons the clamp
should be fastened with a ligature.
 CLINICAL CONSIDERATIONS
This technique is very comfortable because once the clamp stability test is
done and the right clamp has been chosen, the practitioner can leave it on
the tooth and proceed with rubber sheet placement.
However, the clamp should never be left unattended inside the mouth if it is not
secured with a dental floss ligature.
WING TECHNIQUE
This very common procedure calls for the simultaneous placement of
clamp and rubber sheet: it takes its name from the clamp, which is
engaged and held within the sheet hole by means of the central wings
ADVANTAGES
 The wing technique is a two-handed procedure so it doesn’t need any
assistance.
 It is safe because, should the clamp unfasten from the plier during
placement, still it would be engaged on the rubber sheet hole without
risks of being swallowed and/or inhaled by the patient.
 Dam placement is very quick and the patient does not feel the oral
cavity invaded by practitioner’s hands.

DISADVANTAGES
 Using winged clamps is a necessary condition of this technique.
 The main issue lies in limited tooth visibility during clamping.
 The practitioner can only see the tooth through the hole the clamp is
engaged to.
 If the tooth is not well recognizable, an inexperienced practitioner
could clamp the adjacent tooth by mistake.
CLINICAL CONSIDERATIONS
• Wing procedure is very quick and minimally invasive.
• For this reason it should be considered the most suitable technique for patients
with a strong emetic reflex or who seem baffled by dam usage.
• Limited visibility inherent to this technique can cause the clamping of the
wrong tooth especially if the target tooth does not have any distinguishing
features.
• A tip To solve this issue is“marking” the tooth by creating with the turbine a
slight cavity to be subsequently completed after dam placement.
 RUBBER FIRST TECHNIQUE
This is a four-handed procedure thus the presence of a second operator is needed. One
operator, generally the assistant, stretches the hole with his/her fingers and places the
dam directly into the oral cavity by fitting the tooth through the open gap. Now the
dentist can clench the tooth with the previously “armed” clamp from the dedicated plier
ADVANTAGES
DISADVANTAGES
 The “rubber-first” technique is quick and safe: if the clamp
gets somehow disengaged from the plier it falls on the
rubber sheet without being swallowed and/or inhaled by  The first issue is limited visibility of the
the patient. target tooth during placement.

 Besides being suitable for every type of clamp, this is the  The second disadvantage is patient
top procedure when using double-bracket wingless clamps discomfort due to the invasive action of the
such as the 212 or 90N. assistant’s hands, who should
maintain the sheet low around the tooth neck
 On top of that this is the ultimate technique also with whilst waiting for the dentist to place the
latex-free dams. clamp.
 BRACKET TECHNIQUE
 In this procedure the clamp and the rubber sheet are simultaneously positioned on the tooth.

 It takes its name from the clamp being engaged and held within the sheet hole by the bracket.

 The bracket is passed through the hole until it comes out from the sheet side facing the
practitioner.

 With the dominant hand, the practitioner “arms” the clamp by means of the plier, while the other hand
laterally folds and gathers the rubber sheet.

 The clamp-dam-plier unit shape reminds of a person strapped to a parachute (that’s why the bracket
technique is also known as the “parachute” technique). When the tooth is clamped, the dam is
stretched over the frame then it is manually slid beneath both clamp branches .
ADVANTAGES DISADVANTAGES
 Wingless clamps are recommended.
 This is a two-handed procedure so it doesn’t
need any assistance.  Winged clamps - same design but bigger– would
force the practitioner to apply a
 It is a safe technique because, should the clamp
strong tension on the sheet to make it
get disengaged from the plier during placement, slide under the wings, therefore
still it remains engaged on the rubber sheet hole placement would be not so easy and the
without the risk of being swallowed and/or risk of tearing the sheet would be higher.
inhaled by the patient.
 This procedure cannot be implemented
 Oral cavity visibility is excellent so it is very easy
with double-bracket anterior teeth
for the practitioner to identify the tooth to be clamps.
clamped.
 The excessive twisting of the sheet while
Sliding under the branches causes the
sheet structure to collapse.
 SPLIT DAM TECHNIQUE
Rubber dam is placed to isolate the tooth without the use of
clamp
2 overlapping holes punched in the dam
Dam stretched over tooth to be treated and adjacent tooth on
each side
Indication –
- isolate anterior teeth
- insufficient crown structure
- isolation of teeth with porcelain crown required

Rubber dam in clinical practice- Bhavin Bhuva et al; ENDO (Lond Engl)
2008;2(2):131–141
RUBBER SHEET FITTING
& LEAKAGE CONTROL
PROBLEM SOLVING IN FIELD OF
ISOLATION
LEAKAGE
EXCESS SALIVATION
LATEX ALLERGY
CROWDING
BRIDGE ABUTMENTS, SPLINTS & ORTHODONTIC
WIRES
RUBBER SHEET FITTING
Regardless of the technique, once the
dam has been applied the practitioner
must slide the sheet through the mesial
and distal interproximal spaces of the
clamped tooth to get a proper fitting
that will result in a good leakage control.

This is ensured if accessibility of

interdental spaces has been floss-tested
beforehand.
LEAKAGE CONTROL
sealing products be
missing, a fluid composite (flow) can be
used without acid-etching nor dentin-
enamel adhesive
SEVERELY DAMAGED TOOTH WITH
PERIODONTAL SURGERY
1.SEVERELY DAMAGED TOOTH WITH
PERIODONTAL SURGERY
2.SEVERELY DAMAGED TOOTH WITH
PERIODONTAL SURGERY
OPERATIVE TIMING IN
ENDODONTICS: WHEN TO APPLY
THE RUBBER DAM
 The key role of the dam in the infection control is understood, it is
clear that the dam should always be placed before accessing the endodontic
space in order to avoid its contamination by oral cavity microorganisms.

1 2
3
4
Canal
projection
technique

JPFA, Vol. 26, December, 2012

Ahmed et al. Rubber dam application in endodontic practice : an update on critical
educational and ethical dilemmas: Australian dental
journal: 2014; 59: 457–63
 CONCLUSION
The rubber dam has been introduced to endodontics over past 120 years. It is
obligatory in endodontics, so much so that endodontics should not be performed without
a rubber dam. However, its use in endodontics has been unfortunately rejected by many
in the profession. Many unfounded reasons for its use like, time for its placement, cost of
equipment and materials, difficulty in use and patient acceptance are given by the dental
practioner‘s. However, recently by the introduction of many newer variations, its use in
endodontics has been made easy.
S . C. barnum stated: “ the most time- consumingthing about
rubber dam is the time taken to convince the dentist to use it”

This stigma needs to be overcome by the dentists and maximum

isolation needs to be achieved during a treatment procedure

one thing that has remained consistent is that be it of any form,

maximum isolation is to be achieved during a procedure,
whether its endodontic or conservative.
References
• The use of the Rubber Dam in Endodontics H O W - W H E N - W H Y by Filippo
Cardinali & Fabio Gorni
• Tooth Isolation: The Rubber Dam – Arnold castalluchi
• Summit 4th edition.
• RUBBER DAM IN ENDODONTICS - AN OVERVIEW OF RECENT ADVANCES
• Rubber dam isolation for restorative treatment in dental
• patients (Review)
REFERENCES
• The efficacy of the rubber dam as a barrier to the spread of microorganisms during
dental treatment
• Precision and security in restorative dentistry: the synergy of isolation and
magnification
• Using Cyanoacrylate to Facilitate Rubber Dam Isolation of Teeth J. O. Roahen,
DDS, MS, and Christopher A. Lento, DDS
• Improvement of the Rubber Dam Frame Gabriel Sauveur, MCU-PH
• RUBBER DAM IN ENDODONTICS - AN OVERVIEW OF RECENT ADVANCES
THANK YOU