RUBBER DAMPresented by : Cheng Yung Yew P11132

Goals of Isolation• Moisture Control• Retraction and Access• Harm Prevention• Local Anesthesia

Definition - Rubber Dam• A small latex or non-latex sheet • used to isolate a tooth or teeth from the oral

environment and to prevent migration of fluids or foreign objects into or out of the operative field

• providing a dry, visible and clean operative field.

Rubber Dam Isolation• 1864, New York City – S.C. Barnum, introduced

rubber dam• Ensures appropriate dryness of the teeth• Isolating one or more teeth from oral

environment• Prevent pulpal contamination from oral fluids

Advantages of Rubber Dam1. A dry, clean operating field2. Improved access and visibility3. Improved properties of dental materials4. Protection of patient and operator5. Operating efficiency

Disadvantages of Rubber Dam

1. Low usage among private practitioners2. Time consuming3. Patient objection4. Conditions precluding use of rubber dam

Teeth that have not erupted sufficiently Some third molars Extremely malpositioned teeth Patients with asthma (breathing difficult thru nose)

Materials and InstrumentI. Rubber Dam MaterialII. Rubber Dam Holder (frame)III. Rubber Dam Retainer (clamp)IV. Rubber Dam PunchV. Rubber Dam Retainer ForcepsVI. Rubber Dam NapkinVII. LubricantVIII.Modeling CompoundIX. Anchors

I. Rubber Dam MaterialDam material available in 5x5 inch or 6x6 inch

sheetsThicknesses or weights

o thin (0.15mm), medium (0.2mm), heavy (0.3mm), super heavy (0.35mm)

Has a shiny and a dull sideoDull side less light reflective placed facing the

occlusal side of the isolated teeth

II. Rubber Dam Holder ( Young’s frame)Maintains the borders of rubber dam in positionU-shaped metal frame Small metal projectionsAn optional Neck Strap may be placed behind the

patient’s neck attached to 2 hooks

III. Rubber Dam Retainer (clamp)Consists of 4 prongs and 2 jaws, connected by a

bowUsed to anchor the dam to most posterior tooth to

be isolatedUsed to retract gingival tissueAvailable in different sizes and shapesWings provide extra retraction of rubber dam

Disadvantage : interfere with placement of matrix bands, wedges

IV. Rubber Dam PunchA precision instrument having a rotating metal

table (disk) with 6 holes of varying sizes, and a tapered, sharp-pointed plunger

Plunger should be centered in the cutting hole avoid chipping of holes by plunger tip

V. Rubber Dam Retainer ForcepsUsed for placement and removal of retainer from

tooth

VI. Rubber Dam NapkinPlaced between rubber dam and patient’s skinAdvantages :

Prevents skin contact with rubber to reduce possible allergic reactions

Absorbs any saliva seeping at corners of mouthActs as cushionConvenient method wiping patient’s lip on removal of

the dam

VII.LubricantApplied in area of punched holes to facilitate the

passing of dam through proximal contactsCocoa butter, petroleum jelly applied to corners

of mouth to prevent irritation

VIII. Modeling CompoundSometimes used to secure retainer to tooth Prevent retainer movement during operative

procedure

IX. Anchors (Other than Retainers) Proximal contact may be sufficient to anchor the

dam on the tooth farthest from the posterior retainer

To secure the anchor further, a waxed dental tape (or floss), or a small piece of rubber dam material, can be passed through the proximal contact.

Hole Size and Position• Holes must be punched by following arch form• 5-6 holes in cutting table of rubber dam punch• Smaller holes incisors, canines & premolars• Larger holes molars, posterior anchor tooth

• Guidelines in Positioning the Holes : -1. Punch an identification hole in upper left corner

of rubber dam (optional)2. When operating on the incisors and mesial

surfaces of canines, isolate from first premolar to first premolar.

3. When operating on posterior teeth, isolate anteriorly to include the lateral incisor on the opposite side of arch from the operating site.

4. Isolation of minimum of 3 teeth is recommended except when endodontic therapy is indicated.

5. The distance between holes is equal to the distance from the center of one tooth to the center of adjacent tooth, measured at level of gingival tissue prevents wrinkles of the dam between teeth.

6. When a cervical retainer is used for isolation of a Class V lesion, a heavier rubber dam usually recommended for better tissue retraction.

Hole for the tooth should be punched slightly facial to arch form

The farther gingivally the lesion extends, the farther the hole must be positioned from arch form.

Hole should be slightly larger

7. When a thinner rubber dam is used, smaller holes must be punched, because thin dam has greater elasticity to seal around the teeth.

8. For inexperienced operator, a rubber stamp that imprints permanent and primary arch forms on rubber dam is available.

9. A plastic template can be also used to mark hole position.

Placement of Rubber Dam• Before placing the rubber dam dental chair

adjusted for optimal patient comfort• Usually, administering anesthetic precedes

application of rubber dam• Rubber dam and retainer can be placed

sequentially provides maximal visibility when placing retainer, reduces risk of impinging on gingival tissue

• Alternative placement : - Applying Dam and Retainer Simultaneously

1. reduce risk of retainer being swallowed 2. this approach ease the passing of the dam over a

previously placed retainer Applying Dam Before Retainer

1. There is no need of manipulate dam over retainer2. Reduction in visibility of underlying gingival tissue,

which may impinged on by retainer

Application of Rubber Dam Isolation• STEP 1 : Testing and Lubricating the Proximal

Contacts• STEP 2 : Punching the Holes• STEP 3 : Lubricating the Dam• STEP 4 : Selecting the Retainer• STEP 5 : Testing the Retainer’s Stability and

Retention• STEP 6 : Positioning the Dam over the Retainer• STEP 7 : Applying the Napkin• STEP 8 : Positioning the Napkin

• STEP 9 : Attaching the Frame• STEP 10 : Attaching the Neck Strap *(Optional)• STEP 11 : Passing the Dam Through Posterior

Contact• STEP 12 : Applying Compound *(Optional)• STEP 13 : Applying the Anterior Anchor (If

needed)• STEP 14 : Passing the Septa Through the

Contacts without Tape• STEP 15 : Passing the Septa Through the

Contacts with Tape

• STEP 16 : Technique for Using Tape *(Optional)• STEP 17 : Inverting the Dam Interproximally• STEP 18 : Inverting the Dam Faciolingually• STEP 19 : Using a Saliva Ejector *(Optional)• STEP 20 : Confirming a Properly Applied

Rubber Dam• STEP 21 : Checking the Access and Visibility• STEP 22 : Inserting the Wedges

Removal of Rubber Dam Isolation

• STEP 1 : Cutting the Septa• STEP 2 : Removing the Retainer• STEP 3 : Removing the Dam• STEP 4 : Wiping the Lips• STEP 5 : Rinsing the Mouth and Massaging

the Tissue• STEP 6 : Examining the Dam

Factors affecting Rubber Dam Placement

• Variation with Age• Errors in Application and Removal

1. Off-Center Arch Form2. Inappropriate Distance between the Holes3. Incorrect Arch Form of Holes4. Inappropriate Retainer5. Retainer-Pinched Tissue6. Shredded or Torn Dam7. Incorrect Location of Hole for Class V Lesion8. Sharp Tips on No.212 Retainer9. Incorrect Technique for Cutting Septa

Reference• Sturdevant’s Art and Science of Operative

Dentistry, Fifth Edition; Theodore Robertson, Herald Heymaan, Ed Swift; Chapter 10 Rubber Dam Isolation; 10:463-86

• http://www.youtube.com/watch?v=5e979h67YVc

You don't have to brush your teeth - just the

ones you want to keep.