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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
Creates

infection of patient to the dentist

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
Metal

allergy

crowns

Ceramic
Mouth

crowns

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

Armamentarium

Rubber dam frame

Clamp forcep

Punch forcep

Rubber dam clamp

Armamentarium

Armamentarium

Rubber dam template

Rubber dam Sheet


Lubricant

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.
2.
3.
4.

Patient`s mouth calculus or any sharp


edges of instrument
Contact points
Rinse and dry mouth
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

#8 A,
#14 A

For irregularly shaped, structurally


compromised or partially erupted molars

#9, #212

Anteriors

#00, #1,

Maxillary Premolars, Primary incisors and


Canine
Large Bicuspids, Primary first molar

#2
4

#3, #4, #8,


#7, #W56

Molars

#12A
#13A

Lower right, Upper right molars


Lower left & upper left molars

Rubber Dam Sheet


Sr
No

Type

Thickness
(mm)

Thickness
(inches)

Thin

0.15

0.006

Medium

0.20

0.008

Heavy

0.25

0.010

Extra heavy

0.30

0.012

Super heavy

0.35

0.014

Colour of sheet
Sr No

Colour

Special Uses

Blue/ Green

Photography

Black

For contrast with enamel for fillings

Grey

Alternative for black colour

Transparent

Endodontics

Punch holes
S
No

Hole

Teeth

Mandibular 1 molar,
Large maxillary molar

Maxillary molar small,


Second primary molar

Canine , Premolars,
First primary molar

Upper incisors

Lower incisors

Floss Method

Rubber dam fixation


Single tooth isolation

Multiple teeth isolation

1. Fissure sealants
2. Class I and Class V cavity
restoration
3. Endodontics

1.
2.
3.

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

Bleaching
Class II restoration
Multiple restorations

Method of Application
Sr
No

Methods

Utility

Clamp before rubber dam

Posterior teeth in
children and adults

Clamp along with rubber


dam

Third molars

Clamp after rubber dam


placement

Anteriors and
Premolars

Guidelines
Sr Teeth
Teeth applied with rubber
No Operatin dam
g
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