PRINCIPLES OF ENDODONTIC
ROLL NO: 59
RUBBER DAM ISOLATION
COMPONENTS OF RUBBER DAM KIT
TECHNIQUE OF RUBBER DAM APPLICATION
STERILIZATION OF INSTRUMENTS
GLASS BEAD STERILIZERS
The basic principles underlying the treatment of teeth with
endodontic problems are those underlying surgery in general
An antiseptic technique, debridement of the wound, drainage and
gentle treatment of the tissues with both instruments and drugs
“Cardinal principles of surgery”
Specifically, pain must be controlled if present
During treatment, all pulp tissue must be removed, the root canal
enlarged and irrigated , the canal surface rendered sterile as
determined by bacteriologic examination, and root canal well
obturated to prevent the possibility of reinfection.
RUBBER DAM ISOLATION
To achieve the first principle of endodontic treatment a safe and
septic operating technique needs to be maintained.
Application of rubber dam is imperative to achieve a safe and aseptic
operating technique for endodontic treatment
It is the only sure safeguard against bacterial contamination from
saliva and accidental swallowing of root canal instruments.
All endodontic operations should be performed under the rubber dam.
A rubber dam or dental dam is a rectangular sheet of latex used by
dentists, especially for root canal treatment, but also for things like
tooth-coloured fillings. If you are allergic to latex, there are non-latex
Introduced by Dr. S C Burman in the year 1864 and he stated that “the
most time consuming thing about a rubber dam is the time required to
convince a dentist to use it.
Dry aseptic field
Protects patients soft tissue from sodium hypochlorite
irrigation and other caustic medicaments
Prevention of aspirating endodontic instruments
Access and visibility are improved
Prevention of contamination of root canal with oral
COMPONENTS OF RUBBER
Rubber dam material
Rubber dam clamps
Rubber dam clamp carrying forceps
Rubber dam punch
Rubber dam frames
Rubber dam templates
Dental silk floss
Rubber dam napkin
Apart from the above, recently introduced systems include the
Optradam which is considered to be an anatomically shaped rubber
dam which can be used with or without clamps.
Instidam is a disposable rubber dam system available in both latex
and non latex materials
Rubber Dam Material
The rubber dam material is available as heavy,
medium and light, and in different colours and
Readymade sheets are available in sizes 5 5”&
6 6”and rolls according to need.
Has a shiny and a dull side. Dull side is less light
reflective, placed facing the occlusal side of the
Rubber dam is usually made of latex material.
However for patients with known allergy ,non
latex rubber dam material should be made
available in the clinic.
Medium weight thickness is usually recommended
for endodontic purpose.
Rubber Dam Clamps
Different types of clamps are
available according to the tooth
to be isolated.
Clamps with wings lead to more
rapidity of work and efficiency.
Plastic clamps are available from
MOYCO Union Broach in two sizes,
large and small, basically to see
that the radiographs are not
overlapped by the shadow of
Most anterior teeth may be
clamped satisfactorily with the
Ivory No.9 or No.9 ON clamp.
Whenever the tooth is small, as
the upper/lower lateral incisor
Ivory No.12 or its equivalent may
In posterior teeth, Ivory No.27
clamp (wingless)/HF No. 26 may
PARTS OF A CLAMP
CENTRAL WING, ANTERIOR WING
RUBBER DAM CLAMP
Available from different
companies like Ash, Ivory and
Used to carry the rubber dam
clamp on the tooth.
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
The smallest one is for the lower anterior and the
largest is for the posterior teeth
RUBBER DAM TEMPLATE
It is provided to the clinician to
make an exact punch on the tooth
in question for both upper and
The holes in the rubber dam should
be punched approximately over the
centre of the incisal or occlusal
surface of the teeth to be engaged
using a rubber dam template under
the rubber dam sheet.
DENTAL SILK FLOSS
Silk floss is required for the
rubber dam application
especially for endodontic
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 patients mouth.
This is a safety measure while
removing the rubber dam clamp
if it snaps.
It is used to stabilize the
interproximal area of the
It is flexible material that
can be passed over the
dam interproximally below
the contact area.
RUBBER DAM HOLDER or
The type of rubber dam holder one uses is a matter of
individual preference but whichever one chooses,it
should not interfere with the endodontic operation.
Some operators prefer one that lies flat against the
patients face because it permits easy access to the
operating field around the tooth.
Other prefer the frame type of holders made of stainless
steel ( Young) or plastic (Nygaard- Ostby,Brave) because
they can be applied quickly and have additional
advantage of being radiolucent and do not have to be
removed when taking working radiographs of the tooth
Maintains the borders of rubber dam in position
U-shaped metal frame
Small metal projections
RUBBER DAM NAPKIN
Placed between rubber dam and patient’s skin
Prevents skin contact with rubber to reduce
possible allergic reactions.
Absorbs any saliva seeping at corners of mouth.
Acts as cushion
Convenient method wiping patient’s lip on removal
of the dam
TECHNIQUE OF RUBBER DAM
Application of rubber dam with high power suction when
used in conjunction with totally sterile instruments may
take care of infection control to a greater extent.
Placement of Rubber Dam :
Before placing the rubber dam the dental chair adjusted
for optimal patient comfort.
Usually, administering aesthetic precedes application of
Rubber dam and retainer can be placed sequentially
provides maximal visibility when placing retainer, reduces
risk of impinging on gingival tissue.
When a clamp is used on an
anterior tooth, the rubber dam
should first be slipped over the
tooth , one should stretch the
dam, over the tooth between
the thumb and the index finger
of the left hand, while the
clamp is adjusted with the
In posterior teeth, the clamp is
preferably inserted half way
into the previously punched
hole on the rubber dam , and
the arms of the clamp are then
spread apart with the forceps
It is significant to ensure optimal patient care, eradication of existing
infectious diseases and preventing any new infections.
The instruments directly come in contact with tissues, blood and tissue
fluids, saliva which may sweep through the rubber dam, if not properly
To maintain the cycle of asepsis, processing and sterilization of reusable
instruments is mandatory. Endodontic instruments which are reusable have
to be autoclaved.
This should take the form of a clearly defined process of decontamination.
It is a combination of processes including cleaning,
disinfection and sterilization, used to make reusable
surgical instruments safe for further use.
The effective decontamination of reusable medical
devices is essential in reducing the risk of transmission
of infectious agents.
Can be achieved either by manual/mechanical
Mechanical method is more effective than manual
It provides high standards of cleanliness, reduces
infection to the staff involved.
Washer disinfectors are more efficient at pre
sterilization cleaning than ultrasonic cleaners.
Hand cleaning must not be a substitute for
Disinfection is a process which uses chemical
substances or heat to reduce the number of
It may not inactivate some viruses and bacterial
Disinfection should not be used as a substitute for
Inspection should be performed before sterilization in
order to ensure that appropriate safety levels are
Instruments should be examined to ensure that they are
clean with no sign of debris remaining and there is no
evidence of damage.
Substandard instruments should be removed from the
It is required for items which are to be stored for later
Packed items should be processed in the vacuum
Sterilization is a process to render an
object free from viable
microorganisms, including bacterial
spores and viruses.
Sterilization of objects can be
achieved in many ways including hot
air, gas, irradiation and
Steam sterilization which is the most
commonly practiced method for
sterilizing reusable medical devices in
health care premises because it has
high lethality, its rapid and is non
In all cases storage should be clean and dust free.
Whether an instrument needs to be sterile at the point of
use depends on the procedure to be carried out and the
associated risk to the patient.
Processing of storage is also affected by levels of risk :
LOW RISK PROCEDURES – where items come in contact only
with the skin, thermometers and blood pressure cuffs. They
should be cleaned as per manufacturers instructions.
MEDIUM RISK PROCEDURES: are those where instruments
come in contact with intact mucous membrane/body
fluids such as gingiva and teeth. These instruments must
be cleaned and sterilized after use. Eg mouth mirrors,
HIGH RISK PROCEDURES: are those where instruments
come into contact with breaches in the skin or when
they enter a sterile body cavity such as endodontic
microsurgical procedures. The instruments must be
sterile at the point of use immediately after
It is preferable to protect the points of instruments with
cotton in order to prevent bag perforation.
Sterilize instruments with hinges in an open position.
Allow drying cycle to finish completely.
Never overfill a sterilizer.
Instruments should be bagged before storage after
Instruments that have been bagged are considered sterilized
for 4 months if the bag is intact.
Store it in a dry and low traffic area
It is a method for chairside disinfection of noncritical instruments and chair
side accessories and cannot replace the role of steam sterilization.
Cold sterilization is not recommended because:
Process is not effective against all varities of microbial life.
The length of time which is 20 mins is too long to destroy the
The cold sterilizing solution consists of phenol , sodium tetraborate ,
glutaraldehyde and sodium phenate ,
Disinfects cleaned instruments in 10 minutes at room temperature , kills
aerobic spore formers including Bacillus subtilis in 3 hours and achieves
sterilization in 6.75 hours
GLASS BEAD STERILIZERS
These sterilizers used to consists of either hot salt or
glass beads as a medium for dry heat sterilization . The
temperature range employed was between 425-475
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