Rubber Dam Isolation Application

Application of Rubber Dam Isolation

• Step 1 involves testing and lubricating the proximal contacts
• Examine the interproximal area with floss before starting
• Address any composites bonded to each other, like Class II restorations
• Handle open contacts with a disk
• Step 2 involves punching holes
• The easiest method uses a template
• Ensure the template is aligned correctly

Hole Placement

• Punch an identification hole in the upper left, relative to the patient to help locate the dam
• Isolation of a minimum of three teeth is recommended
• In endodontic therapy, isolate only the tooth being treated
• The number of teeth and tooth surface influence the isolation pattern
• The distance between holes equals distance from center of one tooth to the center of the adjacent tooth, measured at the gingival level, about 5mm
• Excessive distance between holes leads to excessive material and wrinkles
• Insufficient distance between holes causes stretching, leading to gaps around the teeth and leakage
• The dam should adapt to teeth and cover the interdental tissue when the distance is correct = optimal + easy.
• When using a thinner rubber dam, punch smaller holes to seal the teeth, this is because the thinner dam has greater elasticity

Tooth Isolation Based on Tooth Type

• When operating on incisors and mesial canines, isolate from first premolar to first premolar
• Metal retainers are not usually needed
• Retainers can be added over the dam if additional access is needed
• A more balanced extension is needed to establish stability
• When working on a canine, isolate from the first molar to the opposite lateral incisor to reduce tension
• For a Class V lesion on a canine, isolate to include the first molar to provide space to place the cervical retainer
• When operating on molars, punch holes as far distally as possible and isolate anteriorly to include the lateral incisor on the opposite arch
• Anterior teeth included in the isolation provide finger rests and increased access for the operator and the assistant
• Clamp the tooth you are working on
• When operating on premolars, punch holes to include one to two teeth distally
• Extend anteriorly to include the opposite lateral incisor

Hole Placement for Maxillary & Mandibular Teeth

• For maxillary teeth, the first holes are punched for the central incisors, about 1 inch (25 mm) from the superior border of the dam
• For patients with a large upper lip or mustache, position the holes more than 1 inch off the edge
• For children/adults with a small upper lip, position the holes less than 1 inch from the edge
• For mandibular teeth, punch the first hole for the posterior anchor tooth that receives the retainer
• Mentally divide the rubber dam into thirds to locate this location
• The anchor tooth (usually the mandibular first molar) get a hole punched halfway from the superior to inferior edge, at the junction of right (or left) and middle thirds
• Step 3 includes lubricating the rubber dam
• Use a water-soluble lubricant applied at the punched holes to reduce infection risk
• Avoid oil-based lubricant

Selecting the Retainer: Retentive Clamps

• Retentive clamps include winged and wingless clamps
• Passive and active clamps exist
• Differentiate between partially erupted teeth

Testing and Stabilizing the Dam

• Test the retainer's stability by gently lifting in an occlusal direction using a fingertip under the bow of the retainer
• Pressure is needed on both paints
• The retainer on the anchor tooth must feel stable

Rubber Dam Applications Steps

• Step 6 involves positioning the dam over the retainer, or applying the dam and retainer simultaneously
• Steps 7 applies the napkin (optional)
• Step 8 involves positioning the napkin (optional)
• Step 9 needs attaching the frame, position the frame outside the dam, the curvature should be concentric with the patient's face
• Step 10 passing the dam through the posterior contact
• Convexity must be directed along to to the patient's chin
• Step 11 passes the septa through contacts without dental tape by passing it the the contacts by stretching the septal dam faciogingivally/lingogingivally w/ fingers
• Step 12, if step 11 doesn't work, pass septa thought the contacts w/ tape, use waxed dental tape to pass the dam thought the contacts
• Step 17 must invert the dam

Rubber Dam Removal

• Follow chronological order
• First, cut the Septa
• Second, remove the retainer
• Third, remove the dam
• Lastly, examine the dam

Isolation Errors

• An off-center arch form will have a dam punched off center.
• In this case it may not shield the patient's oral cavity adequately, causing the eyes/nose to be covered + matter to enter the oral cavity

Isolation Errors in Application and Removal

• Inappropriate retainers may result in dislodgment/trauma to tissues
• The retainer may be too small, causing breakage when the retainer jaws are overspread
• The retainer may be unstable on the anchor tooth
• Soft tissue impinge and impedes wedge placement, causing paint
• The prongs of retainers generally shouldn't pitch tissue
• Errors in hole placements often can result in the holes being the wrong distance apart

Isolation Techniques

• Cotton roll isolation is an isolation alternative for when rubber dam application is impractical or hard.
• They're only preferred if you have assistance
• When using cotton rolls should be replaced when saturated with saliva

Cotton Roll Placement

• For maxillary teeth place a cotton roll in the facial vestibule
• For mandibular teeth, place a cotton roll in the vestibule and another between teeth and the tongue.
• Floor of this mouth must be under the tongue

Additional Isolation Methods

• Use throat shields when the rubber dam is not being used and there is a risk of aspirating/swallowing small objects
• For example, while placing implants involving the use of small screws
• Throat shields are important treating teeth in the maxillary arch
• High-volume evacuators preferred for suctioning water/debris from the mouth
• Due to saliva ejectors slowly removing water + it having little capacity for solids
• Don't obstruct the operator's access or vision when working with dental instruments
• Mouth props aid posterior teeth during lengthy appointments.
• These help relieve muscle fatigue and pain by stabilizing the patient's mouth

Retraction Cords

• Come in different sizes, and are placed between gums and teeth (subgingivally).
• Retraction cord is often good for isolation/retraction within subgingival/gingival margins

Drugs

• The use of drugs to control salivations is rarely indicated in restorative dentistry, atropine is generally used if possible
• Avoid using atropine if the patient is a nursing mom/ has glaucoma