Rubber Dam in Dental Procedures

• A rubber dam is a thin sheet made of latex or nitrile used to isolate the operative site. It can isolate one or more teeth from the rest of the mouth.
• Rubber dams control moisture and provide optimum accessibility and visibility

Soft Tissue Retraction

• Rubber dams retract the tongue and cheek.
• Rubber dams allow ideal application of adhesive systems and reduce the risk of injury and fogging.
• Using a rubber dam saves operation time.

Disadvantages

• It can be time-consuming for beginners
• Patient objection, and discomfort for some.
• Should not be used on asthmatic or psychological patients who cannot tolerate the rubber dam

Components of Rubber Dam System

• Main components include the RD sheet, frame, punch, clamps, and clamp holder.
• Accessories include lubricant, scissors, dental floss, and Teflon.

Rubber Dam Sheet

• Thickness options are thin, medium, heavy, and extra heavy.
• Thicker dams retract tissue, tear less, and are recommended for isolating Class V cavities.
• Thinner dams allow easier passing of tight contacts.
• Material options are latex and non-latex.
• Light and dark colors are available, with darker colors preferred for contrast.

Frame

• The Frame has small projections for securing borders of rubber dam.
• Frame types include frame and foldable frame.

Rubber Dam Punch

• It has a tapered, sharp-pointed plunger and a rotating metal disk with holes of varying size.

Hole-Positioning Guides

• Templates are used as hole-positioning guides.

Rubber Dam Clamp Forceps

• Used for placement and removal of clamps from the tooth
• Types of forceps include the Ivory-type and the Stokes-type.
• Ivory-type clamp forceps have stabilizers that prevent clamp rotation on the beaks.
• Their use is limited to teeth within the range of normal angulation.
• Stokes-type clamp forceps have notches near the tips of their beaks, which allow a range of rotation for the clamp.
• Stokes-type clamp forceps are used on teeth that are mesial or distally angled.

Clamps (Retainers)

• Clamps rest on the mesial and distal line angle of the tooth.
• Clamps consist of two jaws connected by a bow and two holes.
• Clamps anchor the dam to the tooth to be isolated and retract gingival tissue.
• Clamps come in various sizes depending on the tooth.
• Small clamps are designed for use on small single-rooted teeth.
• Larger clamps are for use with molar teeth.
• Clamps can be metal or non-metal, winged or wingless, normal or active.
• Any clamp may be used to retain the sheet if it is away from the retainer or in a Class I cavity.
• A wingless clamp is needed to put a band when working distal to the abutment tooth.

Specifically for Gingival Retraction

• Cervical retracting clamps have jaws with blades that are movable.
• Moving the blade apically retracts the gingiva.
• Disadvantages of cervical retracting clamps are that the jaws are fine, not particularly stable and may require support with a compound stick, and they have limited life.

Lubricant

• A water-soluble lubricant applied to both sides of the dam around the punched holes aids in passing it through the contacts.

Application of Rubber Dam

• Three techniques include:
  • Clamp first
  • Dam first
  • Dam & clamp together

Clamp First

• Clamp is positioned on the tooth, then the dam is positioned over the retainer.
• Stretch the anchor hole of the dam over the retainer and then under the jaws.
• The rubber dam is slipped over the wings of the rubber dam clamp.
• Indicated for posterior teeth in children & adults except 3rd molars
• Advantages: Tooth and gingival margins are clearly visible, and placement is precise with minimal risk of gingival trauma.
• Disadvantages: the procedure is difficult, and there are chances of dislodgement and aspiration of the clamp while placing the rubber dam.

Dam First

• Should be carried out with assistance.
• Restricted mostly to anterior teeth & possibly pre-molar because of limited access
• Assistant's hands position the dam directly around the tooth to be treated, then position the clamp.

Clamp & Dam Together

• Indicated for posterior, particularly 3rd molars
• Advantages: It is not a difficult procedure to perform, and there are very few chances of dislodgement of the clamp; this is the most commonly used technique.
• Disadvantage: limited vision.
• The rubber dam is stretched over the wings of the selected clamp.
• Dam & clamp are placed in position in the patient's mouth with assistance.

Inversion of the Rubber Dam Sheet

• The process ensures a secure seal around teeth, especially in multiple teeth isolation.
• It uses a flat instrument & dental floss to keep saliva, blood, and GCF (Gingival Crevicular Fluid) away.
• Use waxed dental floss to pass the dam through the contacts
• It retracts/displaces the rubber dam sheet more apically for greater retraction of soft tissue and visibility, especially in Deep Class II, Class V, and anterior teeth isolated for veneers.

Other Retainers

• Dental floss or dental tape is placed doubly through a contact and then cut to a short length that does not impede access.
• A short strip of rubber dam material is cut from the edge of the rubber dam, stretched and carried through the contact, and then allowed to relax to retain the dam.

Recent Advances in Rubber Dam

• Optidam
  • A rubber dam with a 3-dimensional shape designed to reduce tension, easier application and a low risk of clamps coming off.
• Optradam
  • Differs from optidam by having an embedded frame and printed dots.

Pre-Framed Dental Dams

• Have a built-in flexible frame which eliminates the use of a separate frame.
• A pre-punched hole helps eliminate tearing.
• Radiographs may be taken by bending the frame without removing the dam.
• Single-use and hence eliminates the need for sterilization

Opti Dam

• Has a 3-dimensional shape and nipple design, and is available in anterior and posterior versions.
• Advantages: easier rubber dam application and low risk of clamp displacement, less working time than for conventional rubber dam (no marking of the tooth position).
• It offers maximum patient comfort and allows them to breath with no pressure around the nasal area.

Optra Dam

• Combines the benefits of a lip and cheek retractor with the total isolation of a rubber dam.
• Placed without the need for clamps and there is no need for a separate rubber dam frame.
• More comfort to the patient and is easily placed
• Creates a large isolated field and complete isolation of both arches can be achieved at the same time