1.
Isolation:
The Rubber Dam
Presented by:
Aaron Sarwal
MDS 3rd Prof

2.
Introduction
• Do no harm.
- Prevent alarming the patient
- Prevent instrument/debris
aspiration
- Prevent soft tissue damage
• Increase patient comfort.
• Thus isolation is KEY.

3.
Classification
- Isolation from moisture
A. Direct methods
1. Rubber Dam
2. Cotton Rolls and cellulose wafers
3. Saliva Ejectors and Evacuator systems
4. Gingival Retraction Chord
5. Mouth Props
B. Indirect methods
1. Patient Comfort and relaxation
2. Local Anesthesia
3. Drugs
- Anti-sialogouges
- Anti- anxiety drugs
- Muscle relaxants

4.
GOALS OF ISOLATION
• Moisture control
• Retraction and access
• Harm prevention
• Safe and aseptic operating field
• Prevent accidental swallowing of restorative materials
and instruments
• Bacterial contamination from saliva
• Local anesthesia

5.
THE RUBBER DAM
“It’s hard to believe
that a sheet of
rubber can make
you feel more
comfortable about
dental treatment
and allow us to do
better dentistry but,
rubber dam can.”
- S C Barnum
1864 – New York City

6.
SHORT HISTORY OF RUBBER DAM
• Dr. Sanford Christie Barnum on 15th march 1864,
Connecticut valley dental society, New York
• 1870, Dr. J.F.P. Hodson,7 types of clamps & no
forceps used
• 1870, Dr. Tees festooned clamps
• 1878,Dr.Elliot design clamp forceps
• 1879, Ainsworth rubber dam punch
• 1880, Dr.Hickman’s lipped clamps
• 1890, clamps with holes
• Early 20th century –Rubber dam frame
introduced(metal Fernauld’s frame)

7.
Why rubber dam?
• Achieves all the goals of isolation.
Dry, clean operating field.
Improved Accessibility &
Visibility.
Improved properties of
dental materials.
Protection to patient and
operator.
Increased operator
efficiency.
Minor damage to marginal
gingiva &cervical cementum
during clamp removal.
Metal crown margins show
microscopic defects following
clamp removal.
Ceramic crowns could
fracture if clamps are allowed
to grip the margins.
Difficulty in taking
radiograph
Advantages
Disadvantages

8.
Armamentarium

9.
CONDITIONS WHERE RUBBER DAM
NOT USED (?):
• Partially erupted teeth – serrated clamps/split
dam technique
• Some third molars
• Extremely malpositioned teeth
• Asthma patients – cannot risk airway obstruction
• Psychological reasons - claustrophobia
• Latex allergy – alternates, non latex, non coated,
polythene, sillicone

10.
RUBBER DAM SHEET
• Size: 5”x 5” and 6”x 6”
• Color: Black, Blue, Green, Translucent
• Surfaces: Shiny (Tissue) + Dull (occlusal)
• Thickness:

11.
Rubber Dam Sheets
Latex Non- Latex

12.
RUBBER DAM FRAME
• Maintains borders of rubber dam in position
• Supports edges of rubber dam sheet.
• Retracts soft tissues
• Improves access
• Two types:
1. Plastic 2. Stainless steel

13.
Stainless Steel Rubber Dam Frames
Fernauld’s frame: Young’s Frame

14.
Plastic Rubber Dam Frames
Star Visi Frame: Nygaard-Ostby frame:

15.
Hinged Rubber Dam Frame
SAUVEUR OVAL FRAME

16.
Safe-T Frame
• It is composed of two hinged
frame members whose snap
sheet locking mechanism
securely clamp the rubber dam
sheet in place.
• Offers a secure fit without-
stretching the rubber dam
sheet.

17.
Safe-T Frame
• Dam sheet is under
less tension, and
hence exerts less
tugging on clamp.

18.
RUBBER DAM PUNCH
• A precision instrument having a
metal table and a tapered, sharp
pointed plunger which is used
to produce clean-cut holes in
the rubber dam sheet through
which the teeth can be isolated.
• Types:
• Single hole punch
• Multi-hole punch
a. Ivory pattern
b. Ash or Ainsworth pattern

19.
TYPES OF RUBBER DAM PUNCH
SINGLE HOLE
PUNCH
AINSWORTH
PATTERN
IVORY
PATTERN

20.
RUBBER DAM PUNCH HOLES

21.
PUNCH PLUNGER CENTERING
INCORRECT CENTERING CORRECT CENTERING

22.
CLEAN – CUT HOLE
• Proper punching includes proper
alignment of the punch table with the
pin, alignment of the pin with the hole
mark on the dam, and punching; then,
pulling the dam up over the point of the
punch.
• An improperly cut hole will result in a
nick or tag that may cause the dam to
rip while it is being placed (consistent
nicks or tags may be indicative of a dull
punch).

23.
CONSIDERATIONS FOR MULTIPLE HOLE
PUNCHES IN RUBBER DAM SHEET
• The distance between holes is
equal to the distance from
centre of one tooth to the centre
of adjacent tooth ,at level of
gingival tissue i.e.,
approximately 6 mm.
• If the dam material is excessive
it will wrinkle between the teeth.
Conversely too little distance
between holes causes the dam to
stretch, resulting in space
around the teeth and leakage.

24.
RUBBER DAM FORCEPS
• Forceps are needed to stretch the jaws of the clamp open in a
controlled manner during placement and removal.
• Three widely used designs are:
• Ash or stokes pattern
• Ivory pattern
• Washington pattern

25.
RUBBER DAM FORCEPS
Ash-or- Stokes Pattern Ivory Pattern
It has notches near the tips
of their beaks in which to
locate the holes of a rubber
dam clamp.
It allows a range of rotation
for the clamp so that it may
be positioned on teeth that
are mesially or distally
angled.
It has stabilizers that
prevent the clamp
from rotating on the
beaks.
It limits the use of
these forceps to teeth
that are within a range
of normal angulation.

26.
RUBBER DAM FORCEPS
Brewer ForcepsUniversity Of Washington Pattern

27.
RUBBER DAM HARNESS
• Retracts only sides of RD.
• Attached to vertical edges of
the RD by metal clips from
which elastics pass around the
back of head & apply traction
to the edges of RD.
• Advantages : Max Retraction
• Types: Woodbury Wizard

28.
RUBBER DAM STAMP & TEMPLATE
• It provides a very convenient and efficient way of
marking the dam for punching.

29.
RUBBER DAM RETAINERS - CLAMPS
• Retainers are a general classification for devices
that hold the dental dam in place. Examples of
retainers are clamps and WEDJETS® Cord.
• There are two types of clamps:
▫ Winged
▫ Wingless.
• Winged clamps have projections at the jaws,
while wingless do not.

30.
RUBBER DAM CLAMPS
BASED ON
MATERIAL
METALLIC
STAINLESS
STEEL
CARBON
STEEL
PLASTIC
BASED ON
NUMBER OF
BOWS
SINGLE
BOW
DOUBLE BOW

31.
RUBBER DAM RETAINERS - CLAMPS
PRONGS HOLES

32.
CLAMP SELECTION
• Select a clamp that will maintain four-point contact with the
tooth’s proximal surfaces.
• If a clamp is too large, it will impinge on the soft tissues.
• If it is too small, it will not properly grasp the tooth’s
surface, and will be unstable.

33.
WHICH CLAMP WHERE?
• Anterior Tooth: Use a double-bowed clamp (i.e. #9,
#212 SA).

34.
ANTERIOR CLAMP MODIFICATION

35.
FIT CERVICAL CLAMP #214

36.
• Premolar: Use a small, flat-jawed clamp, (i.e.
#00, #2) or curved-jawed clamp (#1) for
maxillary premolar.
WHICH CLAMP WHERE?

37.
• Mandibular Molar: Use a flat-jawed clamp,
(i.e. #3, #7).
WHICH CLAMP WHERE?

38.
WHICH CLAMP WHERE?
• Maxillary Molar: Use a clamp with curved
jaws (i.e. #8, #56, #4).

39.
MOLAR CLAMP MODIFICATION

40.
• Partially-Erupted Tooth: Use a clamp with
sub-gingivally designed jaws, suitable to the size
of anchor tooth (i.e. #2A, #8A, #14, #14A).
WHICH CLAMP WHERE?

41.
S-G(SILKER-GLICKMAN) CLAMP
• Indication:
▫ Severely broken down tooth
▫ Placed on a tooth distal to the one being treated.

42.
SPECIAL MOLAR CLAMPS

43.
EXTENDED BOW CLAMP
FOR PREPARATIONS INVOLVING DISTAL SURFACE OF CLAMPED TOOTH

44.
CUSHEE- RUBBER DAM CLAMP CUSHION

45.
CLAMP PLACEMENT
• The lingual jaws of the clamp are
applied first to the tooth surface.
• They are positioned below the highest
point on the lingual contour of the
tooth i.e. below the crest of curvature.
• The operator then rotates his hand
buccally to apply the buccal jaw of the
clamp below the height of buccal
contour.
• The clamp is then released from the
forceps.

46.
Floss the dam, floss the clamp!

47.
CLAMP SWALLOWING/ ASPIRATION

48.
BROKEN CLAMP

49.
RUBBER DAM ACCESSORIES
• These improve the ease of rubber dam
placement, increase patient comfort and safety.
• These include:
▫ Dental Floss
▫ Rubber Dam Wedjets
▫ Modelling Compound
▫ Rubber Dam Lubricant
▫ Rubber Dam Napkin

50.
DENTAL FLOSS
• Required for testing the
interdental contacts and
for making ligatures when
they are needed.
• Also aid in flossing the
rubber dam through tight
contacts.

51.
RUBBER DAM WEDJETS
• This is an elastic cord
generally used to secure
the dam around the teeth
farthest from the clamp.
• It can also be used to
push the dam through the
interproximal contact
and also in some places
as a retainer instead of
clamp.

52.
MODELLING COMPOUND
• Low fusing modelling compound is
used sometimes used to secure the
retainer to the tooth to prevent
retainer movement during the
operative procedure.

53.
RUBBER DAM LUBRICANTS
• A water-soluble lubricant applied in
the area of the punched holes
facilitates the passing of the dam
septa through the proximal contacts.
• It is applied on both sides of the dam
in the area of the punched holes.
• A rubber dam lubricant is
commercially available, but other
lubricants, such as shaving cream or
soap slurry, are also satisfactory

54.
RUBBER DAM NAPKIN
• It is a disposable paper which
is placed between the patients
skin and the rubber dam sheet.
• Uses:
a) Prevents contact of rubber
dam sheet to the skin thus
preventing any possible
allergic reaction.
b) It absorbs saliva seeping
through the corners of the
mouth.
c) It acts as a cushion.

55.
STEPS OF RUBBER DAM APPLICATION
(Sturdevant)
TESTING AND LUBRICATING
PROXIMAL CONTACTS
PUNCHING THE HOLES

56.
STEPS OF RUBBER DAM APPLICATION
LUBRICATING DAM SHEET CLAMP SELECTION

57.
STEPS OF RUBBER DAM APPLICATION
TESTING THE CLAMP’S STABILITY & RETENTION

58.
STEPS OF RUBBER DAM APPLICATION
POSITIONING THE DAM OVER THE CLAMP

59.
STEPS OF RUBBER DAM APPLICATION
APPLYING THE NAPKIN

60.
STEPS OF RUBBER DAM APPLICATION
ATTACHING THE FRAME

61.
STEPS OF RUBBER DAM APPLICATION
PASSING THE DAM
THROUGH POSTERIOR
CONTACT
APPLYING THE COMPOUND

62.
STEPS OF RUBBER DAM APPLICATION
APPLYING THE ANTERIOR
ANCHOR [ IF NEEDED ]
PASSING THE SEPTA
THROUGH THE CONTACTS
WITHOUT TAPE

63.
STEPS OF RUBBER DAM APPLICATION
PASSING THE SEPTA THROUGH THE CONTACTS WITH TAPE

64.
STEPS OF RUBBER DAM APPLICATION
INVERTING THE DAM
INTERPROXIMALLY
INVERTING THE DAM
FACIOLINGUALLY

65.
STEPS OF RUBBER DAM APPLICATION
TESTING AND LUBRICATING
PROXIMAL CONTACTS
CONFIRMING A PROPERLY
APPLIED RUBBER DAM

66.
ISOLATION ACCORDING TO OPERATION
Sr. No. OPERATION FIELD REQUIRED ISOLATION
1. Incisors and mesial surfaces
of canines
First premolar to first premolar.
2. Canine First molar to the opposite lateral incisor.
3. Posterior teeth Anteriorly to include the lateral incisor on the
opposite side of the arch.
4. Premolars One to two teeth distally, and extend
anteriorly to include the opposite lateral
incisor.
5. Molars As far distally, and extend anteriorly to
include the opposite lateral incisor.
6. Endodontic therapy Only the tooth to be treated is isolated

67.
METHODS OF RUBBER DAM APPLICATION
1. Dam First Technique
2. Clamp First Technique
3. Clamp And Dam Together Technique
4. Single Motion Technique
5. Substitution of a Retainer With a Matrix
6. Split Dam Technique

68.
DAM FIRST TECHNIQUE

69.
CLAMP FIRST TECHNIQUE

70.
CLAMP AND DAM
TOGETHER TECHNIQUE

71.
SINGLE MOTION
TECHNIQUE

72.
SPLIT DAM TECHNIQUE

73.
ERRORS IN RUBBER DAM APPLICATION
• An off-centre dam- occlude the patient’s nasal airway.

74.
ERRORS IN RUBBER DAM APPLICATION
• Punched arch form is too
small, the holes are
stretched open around
the teeth, permitting
leakage.

75.
ERRORS IN RUBBER
DAM APPLICATION
• If the punched arch form is
too large the dam wrinkles
around the teeth and may
interfere with access.

76.
ADVANCEMENTS
• DERMA DAM
• INSTI DAM
• FLEXI-DAM
• OPTI-DAM
• HANDI-DAM
• DRY-DAM
• OPTRA-DAM
• OPAL-DAM/LIQUID DAM

77.
DERMA DAM
• Pliable metal frame secures
dam -improving patient
comfort
• Flexibility -radiographs
without dam or frame removal
• Dam sheet: Powder free, high
tear resistance
• DermaDam synthetic -no
sensitizing proteins
• Low dermatitis potential

78.
INSTI DAM
• Translucent natural latex
• Very stretchable
• Tear-resistant
• Provides easy visibility

79.
HYGENIC FLEXI-DAM
• Convenient built-in-
frame( pliable plastic frame
around the perimeter of RD)
• Saves time
• Highly elastic Flexi Dam
material Tear resistant and
easy placement
• Latex free Allergy free
• Odourless Patient comfort

80.
OPTI DAM
• 3-D, anatomically
designed frame and
dam provide widened
access, visibility &
comfort
• Preshaped frame &
dam

81.
HANDI DAM
• Built in frame and rod
for insertion to keep
the dam open.
• A plastic tube is
inserted in prepared
holes in RD
• One size
• Excellent elasticity
and tear resistance

82.
DRY DAM
• Svenska
• Does not require frame or
harness
• Small sheet of rubber set
into center of an absorbent
paper sheet with light
elastics on either side to
pass over ears
• Quickly isolating anterior
teeth

83.
OPTRA DAM

84.
OPAL DAM/ LIQUI DAM
• Great for tissue isolation
during in-office bleaching.
• Light-cured resin barrier
• Sealing rubber dam
leakage

85.
REMOVAL OF THE RUBBER DAM

86.
REMOVAL OF THE RUBBER DAM

87.
REMOVAL OF THE RUBBER DAM