2. • Teeth with severe loss (particularly subgingival) of coronal tooth
structure compromise rubber dam placement. One of the following
can be used to ensure adequate isolation.
• 1. Use of a deep-reaching ("A" style or small beak) clamp often solves
the problem and is the first method attempted .
• 2. Adjacent teeth are clamped, giving multiple isolation. This is
slightly less effective
3. • The clamp beaks may be placed on anesthetized gingiva
• There must be sufficient gingival purchase to prevent the clamp from
cutting through the gingival sulcus and, in essence, performing a
crude, unplanned gingivectomy. Plastic clamps create less gingival
trauma. Patients experience minimal discomfort after clamp
placement on the gingiva.
4. • 4. Gingivectomy or flap reflection or crown lengthening can be
performed before isolation.
• 5. Build-up procedures are generally not recommended
