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Rubber dam Application
Dr. M Arsalan Zubair
MDS Trainee (2nd semester)
Operative Dentistry
Dow Dental College
DUHS
Indications for rubber dam placement
• moisture control
• visibility
• patient protection
• patient treatment
Contraindications for rubber dam placement
• Claustrophobic patients
• Asthamatic patient
• Mouth breathers
• Partially erupted or hyperplastic gingiva
• Patients that need anesthesia to tolerate clamp
• Severe crowding
• Epileptic patient
Contents
• Armamentarium
• Methods of Application
•Errors during Placement and removal
Rubber Dam Sheet
• Light and Dark
• It has shiny and dull surface, dull should face the
occlusal side
• Thick Sheet- class V with butterfly clamps
• Thin Sheet- passing easily into tight contact
Patient Napkin
• Why important????
• Ivory- type Stokes-type clamp forceps
• Ivory type- limit rotation of retainer
• stokes type tip design- permits rotations
Rubber dam forceps
Lubricant
• Lubrication Of Dam
• Water soluble
• Vaseline should not be used why????
• Rather it can be applied as lubricant
for lips
Rubber Dam holders
• Strap holders
• Woodbury frames
• Frame holders
• Young’s frame
• Nygard-ostby frame
• Materials : Metals and plastic
• Teeth themselves or stone cast can
be used
• Rubber dam stamp
• Templates
Hole positioning guides
• Retainers- retract gingival tissue.
• Retainer should contact the tooth
on its four line angles
• The prongs of some retainers are
gingivally directed (inverted)
• Why????
Retainers
The jaws of the retainer should not extend beyond the mesial and distal line
angles of the tooth because :
(1) interfere with matrix wedge placement,
(2) gingival trauma
(3) a complete seal around the anchor tooth is more difficult to achieve.
• Wing or wingless Retainer .What is the use???
• Bow Should be tied with floss .Why?????
Basic Kit of Retainer should a Student
have with it self
Winged clamps:
• Butterfly-type clamp for anterior teeth
• Universal premolar clamp
• Mandibular molar clamp
• Maxillary molar clamp
S-G(Silker-Glickman) Clamp
Indication
• Severe Broken Down tooth
• Placed on a tooth proximal
to the one being treated.
Methods of tying floss
Rubber dam punch
The rubber dam
punch have:
a) rotating metal
table or anvils
(disk) with holes
of varying sizes
b) a tapered, sharp-
pointed plunger
Ivory type
Hygienic type
Rotating Table or Anvils
• incisors and mesial surfaces of
canines.
• canine
• posterior teeth
• premolars
• molars
• endodontic therapy
• first premolar to first premolar
• first molar to the opposite lateral
incisor
• anteriorly to include the lateral
incisor on the opposite side of the
arch
• one to two teeth distally, and
extend anteriorly to include the
opposite lateral incisor
• as far distally, and extend anteriorly
to include the opposite lateral
incisor.
• only the tooth to be treated is
isolated
Isolation according to Operation
Now Repeat it….
• For the maxillary central incisors. Holes are positioned
approximately 1 inch (25 mm) from the superior border of the
dam
• For the mandibular the posterior anchor tooth that is to receive
the retainer
Methods of Placement
• Applying the dam and retainer simultaneously
• Applying the dam before the retainer
• Applying the Dam after the retainer
• Cervical retainer placement
• Substitution of a retainer with a matrix
• Split Dam Technique
APPLYING THE DAM AND RETAINER
SIMULTANEOUSLY
• Bow being passed through the posterior anchor
hole from the underside of the dam
• Gathering the dam to facilitate placement of the
retainer
• Positioning the retainer on the anchor tooth
• Stretching the anchor hole borders over and
under the jaws of the retainer.
Rubber dam, clamp, and frame Dam, clamp, and frame carried to mouth as
one unit and placed
Clamp in place with four-point contact
and rubber tucked under the wings
Split Dam Technique
Indication
Insufficient coronal structure Single fix prosthesis
Abutment tooth for bridge Partially erupted tooth
Steps
•Two overlapping holes are punched in the dam
•Cotton roll is placed under the lip in the mucobuccal fold.
•Sheet is stretched over the three tooth, distal side each
•Clamp is placed on one side and other tied with ligature
Technique
Two overlapping holes are punched
in the dam.
The rubber dam is stretched over the
tooth to be treated and over one
adjacent tooth on each side. The edge of
the dam is carefully teased through the
contacts on the distal sides of the two
adjacent teeth.
APPLYING THE DAM BEFORE THE
RETAINER
Applying the Dam after the retainer
After the clamp is placed, the dam is
attached to the frame and gently
stretched over the clamped tooth
with the index finger of
each hand.
The clamp is tested for a secure fit with
gentle finger pressure (alternately) on
the buccal and lingual aspects of the
clamp apron.
SUBSTITUTION OF A RETAINER WITH A
MATRIX
• Complete preparation of the terminal tooth with
the retainer in place.
• Stretch the dam distally and gingivally as the clamp
is being removed.
• The clamp is removed before placement of the
matrix (Toffelmire)
• To maximize access and visibility the mouth mirror
is used to reflect the dam distally and occlusally
Example Isolation: From Molar to
opposite Lateral Incisor
Step 1: Testing and
Lubricating the Proximal
Contacts
Step 2: Punching Holes
Step 3: Lubricating the Dam Step 4: Selecting the
Retainer
Step 5: Testing the Retainer’s
Stability and Retention
Step 6: Positioning the
Dam over the Retainer
Step 8: Positioning the
Napkin
Step 7: Applying the
Napkin
Step 9: Attaching
the Frame
Step 10:Passing the Dam through the
Posterior Contact
Step11:Applying the Anterior
Anchor (If Needed)
Step 12:Passing the Septa through
the Contacts
without Dental Tape
Step 13:Passing the Septa
through the Contacts
with Dental Tape
Step 14:Inverting the Dam
Interproximally
Step 15:Inverting the Dam
Faciolingually
Step 16:Confirming Proper
Application of
the Rubber Dam
Step 18:Inserting the
Wedges
Step 17: Checking for
Access and Visibility
Removal of Rubber Dam
• Step 1: Cutting the Septa Step 2: Removing the
Retainer
Step 3: Removing the Dam Step 4: Wiping the Lips
Step 5: Rinsing the Mouth
and Massaging the Tissue
Step 6: Examining the
Dam
In Children
• Isolation is from posterior tooth to the canine on
the same side.
• Rubber dam sheet-Small, attach to frame
• Napkin should not be use
• Prongs engaged more gingivally
• Retainers:No. 27 and Ivory No. W14
Errors in Rubber dam application
• An off-center dam- occlude the
patient’s nasal airway.
• punched arch form is too small,the
holes are stretched open around the
teeth, permitting leakage
• If the punched arch form is too large-
the dam wrinkles around the teeth and
may interfere with access
• Inappropriate retainer: may be too small
(1) Breakage (2) Unstable on the anchor tooth
(3) Impinge on soft tissue (4) Impede wedge placement
• Safe to tissues
• Be careful sheet should not tear
• Scissors can hurt tissue during removal of dam
THANK YOU

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Rubber dam application

  • 1.
  • 2. Rubber dam Application Dr. M Arsalan Zubair MDS Trainee (2nd semester) Operative Dentistry Dow Dental College DUHS
  • 3. Indications for rubber dam placement • moisture control • visibility • patient protection • patient treatment Contraindications for rubber dam placement • Claustrophobic patients • Asthamatic patient • Mouth breathers • Partially erupted or hyperplastic gingiva • Patients that need anesthesia to tolerate clamp • Severe crowding • Epileptic patient
  • 4. Contents • Armamentarium • Methods of Application •Errors during Placement and removal
  • 5. Rubber Dam Sheet • Light and Dark • It has shiny and dull surface, dull should face the occlusal side • Thick Sheet- class V with butterfly clamps • Thin Sheet- passing easily into tight contact Patient Napkin • Why important????
  • 6. • Ivory- type Stokes-type clamp forceps • Ivory type- limit rotation of retainer • stokes type tip design- permits rotations Rubber dam forceps
  • 7. Lubricant • Lubrication Of Dam • Water soluble • Vaseline should not be used why???? • Rather it can be applied as lubricant for lips Rubber Dam holders • Strap holders • Woodbury frames • Frame holders • Young’s frame • Nygard-ostby frame • Materials : Metals and plastic
  • 8. • Teeth themselves or stone cast can be used • Rubber dam stamp • Templates Hole positioning guides • Retainers- retract gingival tissue. • Retainer should contact the tooth on its four line angles • The prongs of some retainers are gingivally directed (inverted) • Why???? Retainers
  • 9. The jaws of the retainer should not extend beyond the mesial and distal line angles of the tooth because : (1) interfere with matrix wedge placement, (2) gingival trauma (3) a complete seal around the anchor tooth is more difficult to achieve. • Wing or wingless Retainer .What is the use??? • Bow Should be tied with floss .Why?????
  • 10. Basic Kit of Retainer should a Student have with it self Winged clamps: • Butterfly-type clamp for anterior teeth • Universal premolar clamp • Mandibular molar clamp • Maxillary molar clamp
  • 11. S-G(Silker-Glickman) Clamp Indication • Severe Broken Down tooth • Placed on a tooth proximal to the one being treated.
  • 12.
  • 14. Rubber dam punch The rubber dam punch have: a) rotating metal table or anvils (disk) with holes of varying sizes b) a tapered, sharp- pointed plunger Ivory type Hygienic type
  • 16. • incisors and mesial surfaces of canines. • canine • posterior teeth • premolars • molars • endodontic therapy • first premolar to first premolar • first molar to the opposite lateral incisor • anteriorly to include the lateral incisor on the opposite side of the arch • one to two teeth distally, and extend anteriorly to include the opposite lateral incisor • as far distally, and extend anteriorly to include the opposite lateral incisor. • only the tooth to be treated is isolated Isolation according to Operation
  • 17. Now Repeat it…. • For the maxillary central incisors. Holes are positioned approximately 1 inch (25 mm) from the superior border of the dam • For the mandibular the posterior anchor tooth that is to receive the retainer
  • 18. Methods of Placement • Applying the dam and retainer simultaneously • Applying the dam before the retainer • Applying the Dam after the retainer • Cervical retainer placement • Substitution of a retainer with a matrix • Split Dam Technique
  • 19. APPLYING THE DAM AND RETAINER SIMULTANEOUSLY
  • 20. • Bow being passed through the posterior anchor hole from the underside of the dam • Gathering the dam to facilitate placement of the retainer • Positioning the retainer on the anchor tooth • Stretching the anchor hole borders over and under the jaws of the retainer.
  • 21. Rubber dam, clamp, and frame Dam, clamp, and frame carried to mouth as one unit and placed Clamp in place with four-point contact and rubber tucked under the wings
  • 22. Split Dam Technique Indication Insufficient coronal structure Single fix prosthesis Abutment tooth for bridge Partially erupted tooth Steps •Two overlapping holes are punched in the dam •Cotton roll is placed under the lip in the mucobuccal fold. •Sheet is stretched over the three tooth, distal side each •Clamp is placed on one side and other tied with ligature
  • 23. Technique Two overlapping holes are punched in the dam. The rubber dam is stretched over the tooth to be treated and over one adjacent tooth on each side. The edge of the dam is carefully teased through the contacts on the distal sides of the two adjacent teeth.
  • 24. APPLYING THE DAM BEFORE THE RETAINER
  • 25. Applying the Dam after the retainer After the clamp is placed, the dam is attached to the frame and gently stretched over the clamped tooth with the index finger of each hand. The clamp is tested for a secure fit with gentle finger pressure (alternately) on the buccal and lingual aspects of the clamp apron.
  • 26. SUBSTITUTION OF A RETAINER WITH A MATRIX
  • 27. • Complete preparation of the terminal tooth with the retainer in place. • Stretch the dam distally and gingivally as the clamp is being removed. • The clamp is removed before placement of the matrix (Toffelmire) • To maximize access and visibility the mouth mirror is used to reflect the dam distally and occlusally
  • 28. Example Isolation: From Molar to opposite Lateral Incisor
  • 29. Step 1: Testing and Lubricating the Proximal Contacts Step 2: Punching Holes
  • 30. Step 3: Lubricating the Dam Step 4: Selecting the Retainer
  • 31. Step 5: Testing the Retainer’s Stability and Retention Step 6: Positioning the Dam over the Retainer
  • 32. Step 8: Positioning the Napkin Step 7: Applying the Napkin Step 9: Attaching the Frame Step 10:Passing the Dam through the Posterior Contact
  • 33. Step11:Applying the Anterior Anchor (If Needed) Step 12:Passing the Septa through the Contacts without Dental Tape
  • 34. Step 13:Passing the Septa through the Contacts with Dental Tape Step 14:Inverting the Dam Interproximally
  • 35. Step 15:Inverting the Dam Faciolingually Step 16:Confirming Proper Application of the Rubber Dam
  • 36. Step 18:Inserting the Wedges Step 17: Checking for Access and Visibility
  • 37. Removal of Rubber Dam • Step 1: Cutting the Septa Step 2: Removing the Retainer
  • 38. Step 3: Removing the Dam Step 4: Wiping the Lips Step 5: Rinsing the Mouth and Massaging the Tissue Step 6: Examining the Dam
  • 39. In Children • Isolation is from posterior tooth to the canine on the same side. • Rubber dam sheet-Small, attach to frame • Napkin should not be use • Prongs engaged more gingivally • Retainers:No. 27 and Ivory No. W14
  • 40. Errors in Rubber dam application • An off-center dam- occlude the patient’s nasal airway. • punched arch form is too small,the holes are stretched open around the teeth, permitting leakage • If the punched arch form is too large- the dam wrinkles around the teeth and may interfere with access
  • 41. • Inappropriate retainer: may be too small (1) Breakage (2) Unstable on the anchor tooth (3) Impinge on soft tissue (4) Impede wedge placement • Safe to tissues • Be careful sheet should not tear • Scissors can hurt tissue during removal of dam