How to apply rubber dam more efficiently

Isolation is one of the most important aspects in dentistry, Rubber Dam isolation is mandatory during endodontic treatment, composite application, cementation of E-Max onlay or veneers.

Rubber Dam provide complete isolation of the tooth or teeth being treated keeping them away from saliva, tongue or any thing that delays the dentist during the treatment.

Advantages of using Rubber Dam

• It provides more retraction to the soft tissues as gingiva.
• Provides more infection control against diseased patients while coughing, sneezing, etc.
• It protects the patient against swallowing the Sodium hypochlorite irrigation or swallowing the clamps or the instruments that is accidentally ingested by them.
• It eliminates the need from the patient for rinsing of their mouth.
• More accuracy in dental treatments as it eliminate the tongue movements also reduce the fogging in the dental mirror also it eliminate the presence of the saliva in the area being treated.
• It protects the soft tissue from the accidental action of the burs and instruments.

Contraindications of Rubber Dam use

• Epileptic Patients
• People who are allergic to rubber dam material.

Parts of Rubber Dam kit

1. Punch
2. Clamps
3. Clamp Forceps
4. Rubber Dam Frame
5. Rubber Dam Template
6. Rubber Dam Sheet

1- Punch : It is used to make a hole in the RD sheet it has five sizes depending on which tooth you are punching for.

2- Clamps : It is used to retain the rubber dam sheet to the tooth and provide more retraction to the gingiva.

- Types of Dental Clamps

• Winged Clamps : Their jaws have wings.
• Wingless Clamps : Their jaws are short and rounded without wings.
• Double Arch Clamps : As the anterior clamp that have double bows on both sides.
• Active Clamps : It is used to provide more retraction to the gingiva and to provide firmer grip to the tooth, as the jaws is inclined to grip more apically.
• Passive Clamps : normal clamp that stay where they are placed but tend to dislodge more easily.

Rules should be known

1. Bow of clamp is directed distally 
2. Respect size of the tooth during punching by using the smallest possible one.
3. Respect tooth position
4. Use Dental Floss to Check the contact before rubber dam applicaition
5. Use lubricants to make the application of RD in the teeth contacts easier
6. Rubber Dam Inversion by floss knots

- Rubber Dam inversion is a very important step in the complete isolation to make sure that there is no saliva leakage.

- Inversion is done by floss knots as you make the sheet facing apically, this means you enter the floss tie in the gingival sulcus by plastic filling instrument.

How to tie floss for more retraction apically ?

Winged Clamp Application

Wingless Clamp Application

3- Clamp Forceps : It is used to hold the clamp while placing it in the tooth.

4- Frame : It provides more retraction to the RD sheet and more stretching to the sheet.

5- Template : It is used to mark the place of the holes on the sheet before punching them, usually it is used by the low-experienced dentist.

6- RD Sheet : The sheet that provides isolation of the selected teeth during the treatment.

Types of Rubber Dam Isolation

1- Single tooth isolation

• Endodontic treatment for single tooth.
• Class V Restoration.
• Class I restoration.

2- Multiple tooth isolation

• The most commonly used
• Class IV, V
• Multiple endo treatments.

Video Illustrates Rubber Dam Application