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RUBBER DAM Dr.Nilesh RathiIntroduction Dr Sanford Christie Barnum in 1864.

Rubber dam method application by Dr Hodson in 1870.S C Barnum connecticut valley dental society in 18642Advantages 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 usesAfter periodontal surgery along with periodontal packRoot planningThermal testElectric pulp testingDisadvantages 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 sheetRubber dam frameRubber dam clampRubber dam clamp holderAinsworth rubber dam punchFloss or wedges or wood stickRubber dam templateRubber dam lubricantNapkin

Armamentarium

Clamp forcepPunch forcepRubber dam frameRubber dam clampArmamentarium Armamentarium

Rubber dam SheetRubber dam templateLubricant Armamentarium Steps of Rubber Dam Application Cleaning of teethSelection of clampPunching of hole in rubber damFlossing the clampApplication of the rubber damApplication of lubricant & flossing through contact with lubricantApplication of napkin and holder

Pre Operative Assessment Patient`s mouth calculus or any sharp edges of instrumentContact pointsRinse and dry mouthLocal anesthesia before applicationSelection of clampFour point contact below the maximum coronal diameter.Try bland type first followed by retentiveMeasure M-D crown length at gingival margin and select clamp just smaller to it.For sub gingival restoration use-Ferrier 212 clampThick rubber dam

Always keep the rubber dam inverted in the sulcus for complete isolation.The clamp should be fixed below the height of contour of the teeth.15Clamp selection S NoClamp Teeth 1#8 A, #14 AFor irregularly shaped, structurally compromised or partially erupted molars2#9, #212Anteriors 3#00, #1,

#2Maxillary Premolars, Primary incisors and CanineLarge Bicuspids, Primary first molar 4#3, #4, #8, #7, #W56Molars 5#12A #13ALower right, Upper right molarsLower left & upper left molarsRubber Dam SheetSr NoType Thickness (mm)Thickness (inches)1Thin 0.15 0.006 2Medium 0.200.0083Heavy 0.250.0104Extra heavy 0.300.0125Super heavy0.350.014Colour of sheet Sr NoColour Special Uses1Blue/ GreenPhotography2Black For contrast with enamel for fillings3Grey Alternative for black colour4Transparent Endodontics Punch holesS NoHole Teeth 1AMandibular 1 molar, Large maxillary molar

2BMaxillary molar small, Second primary molar

3CCanine , Premolars, First primary molar

4DUpper incisors5ELower incisors

Floss Method

Rubber dam fixationSingle tooth isolationMultiple teeth isolationFissure sealantsClass I and Class V cavity restorationEndodontics Bleaching Class II restorationMultiple restorationsPreferably winged clamp for retainingPreferably wingless clamp for retainingPosterior most tooth or operating toothPremolar to premolar , premolar to contra lateral lateral incisorMethod of ApplicationSr NoMethods Utility1Clamp before rubber dam

Posterior teeth in children and adults 2Clamp along with rubber dam

Third molars 3Clamp after rubber dam placement

Anteriors and Premolars Guidelines Sr NoTeeth OperatingTeeth applied with rubber dam1Incisors Canine to canine (Clamp not compulsory)2Canines1st premolar to 1st premolar3Posteriors Two teeth distal to lateral incisors of contralateral side4Any otherAt least one tooth distal and one tooth mesialSterilization Autoclave Hot Air OvenClamps, frame, forcepsPunches Punches made up of carbon steel.24

References: Sturdevent. Textbook of Operative Dentistry.Raymond Braham. Rubber Dam in Clinical Practice.

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