RUBBER DAM

Dr.Nilesh Rathi

Introduction

Dr Sanford Christie Barnum in 1864.

Rubber dam method application by Dr Hodson in 1870.

Advantages Isolation of the tooth from saliva, blood,

gingival exudates.

Aids isolation from bacteria of saliva.

Protects patients from swallowing or inhaling the instruments.

Prevents infection of patient to the dentist

Creates a psychological barrier between patient and dentist.

Additional uses

After periodontal surgery along with periodontal pack

Root planning Thermal test Electric pulp testing

Disadvantages

Patient cannot speak

Claustrophobia

Time consuming

Sensitivity to teeth for some time after removal.

Contraindication

Contact allergy

Metal crowns

Ceramic crowns

Mouth breathing

Respiratory problems

Classification

Winged and Non winged

Metal and Polycarbonate (Endo-technic)

Bland and Retentive

Armamentarium Rubber dam sheet Rubber dam frame Rubber dam clamp Rubber dam clamp holder Ainsworth rubber dam punch Floss or wedges or wood stick Rubber dam template Rubber dam lubricant Napkin

Armamentarium

Clamp forcep Punch forcep

Rubber dam frame

Rubber dam clamp

Armamentarium

Armamentarium

Rubber dam Sheet

Rubber dam template

Lubricant

Armamentarium

Steps of Rubber Dam Application

Cleaning of teeth Selection of clamp Punching of hole in rubber dam Flossing the clamp Application of the rubber dam Application of lubricant & flossing

through contact with lubricant Application of napkin and holder

Pre Operative Assessment

1. Patient`s mouth – calculus or any sharp edges of instrument

2. Contact points3. Rinse and dry mouth4. Local anesthesia before application

Selection of clamp

Four point contact below the maximum coronal diameter.

Try bland type first followed by retentive Measure M-D crown length at gingival

margin and select clamp just smaller to it.

For sub gingival restoration use- Ferrier 212 clamp Thick rubber dam

Clamp selection

S No Clamp Teeth

1 #8 A, #14 A

For irregularly shaped, structurally compromised or partially erupted molars

2 #9, #212 Anteriors

3 #00, #1,

#2

Maxillary Premolars, Primary incisors and CanineLarge Bicuspids, Primary first molar

4 #3, #4, #8, #7, #W56

Molars

5 #12A #13A

Lower right, Upper right molarsLower left & upper left molars

Rubber Dam Sheet

Sr No

Type Thickness (mm)

Thickness (inches)

1 Thin 0.15 0.006

2 Medium 0.20 0.008

3 Heavy 0.25 0.010

4 Extra heavy 0.30 0.012

5 Super heavy 0.35 0.014

Colour of sheet

Sr No Colour Special Uses

1 Blue/ Green Photography

2 Black For contrast with enamel for fillings

3 Grey Alternative for black colour

4 Transparent Endodontics

Punch holesS No

Hole Teeth

1 A Mandibular 1 molar, Large maxillary molar

2 B Maxillary molar small, Second primary molar

3 C Canine , Premolars, First primary molar

4 D Upper incisors

5 E Lower incisors

Floss Method

Rubber dam fixationSingle tooth isolation Multiple teeth isolation

1. Fissure sealants2. Class I and Class V cavity

restoration3. Endodontics

1. Bleaching 2. Class II restoration3. Multiple restorations

Preferably winged clamp for retaining

Preferably wingless clamp for retaining

Posterior most tooth or operating tooth

Premolar to premolar , premolar to contra lateral lateral incisor

Method of Application

Sr No

Methods Utility

1 Clamp before rubber dam Posterior teeth in children and adults

2 Clamp along with rubber dam

Third molars

3 Clamp after rubber dam placement

Anteriors and Premolars

Guidelines

Sr No

Teeth Operating

Teeth applied with rubber dam

1 Incisors Canine to canine (Clamp not compulsory)

2 Canines 1st premolar to 1st premolar

3 Posteriors Two teeth distal to lateral incisors of contralateral side

4 Any other At least one tooth distal and one tooth mesial

Sterilization

Autoclave Hot Air Oven

Clamps, frame, forceps

Punches

References:

Sturdevent. Textbook of Operative Dentistry.

Raymond Braham. Rubber Dam in Clinical Practice.

Thank you