For those who want to seek simple and thorough understanding about the placement and application of the rubber dam and other isolation materials. TARGET AUDIENCE : DENTAL STUDENTS. REFRENCES : sturdevant and grossman

1. 1
Presented by : Rishi lakdawala
Rollno : 18
Batch c
Final year bds

2. 2
It is essential that there should be proper moisture control,
good accessibility and visibility as well as adequate room
for instrumentation around the working area . Such an
environment is necessary for easy manipulation and insertion of
restorative materials

3. 3
Isolation shall be studied under two heads:-
a)Isolation from moisture
b)Isolation from soft tissues

4. ISOLATION FROM MOISTURE
4
A)Direct methods:-
1.rubber dam.
2.cotton rolls and cotton roll holder. 3.guage pieces .
4.Absorbent wafers.
5.Suction devices.
6.gingival retraction cord.

5. B)Indirect methods:-
1.Local anesthesia
2.Drugs :-anti-sialogaogues, anti anxiety ,muscle relaxants
5

6. ISOLATION FROM SOFT TISSUES
6
1.Retraction of cheeks lips and tongue:-
• Rubber dam
• Cotton rolls and holder
• Tongue guards
• Tongue depressor
• Cheek and lip retractors
• Mouth mirrors
Retraction of gingiva can be done via retraction cords or by surgical means

7. 7
Rubber dam provides the best possible isolation by far.
In 1864 S.C.Barnum a New York city dentist introduced the rubber dam into
dentistry.
It is used to define the operating field by isolating one or more teeth from oral
environment.
When excavating a deep carious lesions and risking pulpal exposure, use of
the rubber dam is strongly recommended to prevent pulpal contamination
from oral fluids.
The dam eliminates saliva from the operating site and retract the soft tissue.

8. ADVANTAGES
8
• Provision of dry clean operating field.
• Improvement of access & visibility by eliminating tongue, lip, cheeks & saliva
from the operating field .
• Retraction & protection of soft tissues.
• Prevention of inhalation & ingestion of
foreign bodies.

9. •Improved properties of dental materials
•Aid to patient management.
•Aid to cross-infection control by reducing aerosol spread of micro-
organisms.
•Minimization of mouth breathing during inhalation sedation
procedure.

10. DISADVANTAGES
10
• Usage is low amongst private practitioners.
• Time consuming& patient’s objection.
• Cannot be used in case of extremely
malpositioned teeth.
• Children suffering from asthma ,some upper respiratory infections or
mouth breathing problems.

11. ARMAMENTARIUM
1. Rubber dam sheets
2. Rubber dam clamps
3. Rubber dam holders(frame)
4. Rubber dam retainer forceps
5. Rubber dam punch
6. Rubber dam templates or stamps 7.
Dental floss
8. Wedget
9. Wooden wedges, orthodontic elastics
& commercially available latex cord.
rubber-dam-9-638.jpg

12. 1.Rubberdam sheet
• Available as rolls or sheets
•Available in 5x5 inches or 6x6inches
•Thin --------------- 0.15mm
•Medium------------0.2mm
•Heavy--------------0.25mm
•Special heavy----0.35mm
•Shiny surface and dull surface.
•Dull surface in occlusal
12

13. • Colors - blue ,green colors preferred to provide good contrast with the
surrounding
and may be flavored for the children.

14. 2. Rubber dam clamps
• Used to secure the dam to the teeth
that are to be isolated & to minimally
retract the gingival tissue.
• Parts - 4 prongs that rest on the mesial
& distal line angle of the tooth and 2 jaws
connected by a bow.
14

15. TYPES-1) Winged retainers
15
• Retainers with wing like projections on the outer aspect of their jaws.
• Provide extra retraction of the rubber dam from the field of operation.
• The wings are passed through the punched holes in the dam and the
dam and the retainer placed together on the concerned tooth . After
placement, the dam is slipped carefully over the wings onto the tooth

16. 2).Wingless retainers
16
Having no wings. The retainer is first placed on the tooth and the dam then
stretched over the clamp onto the tooth.

17. 3. Rubber dam holder (frame)
• Used to maintain the borders of the rubber
dam in position.
• Types:
• a).Young’s holder-It is a U-
shaped metal frame with small
metal projections for securing
borders of the rubber dam.
17

18. b). Ash pattern - most suitable for children.
• ). SweCnska N-Ǿ frames are suitable for
taking radiographs with the dam.
18

19. 4. Rubber dam retainer forceps
• Used for placement and removal of retainer
from the tooth.
Stockes
Brewer
19

20. Beaks of some patterns of forceps
• Grooves on their outer surfaces to
ensure positive location of the clamp
during expansion & placement.
PALMER
20

21. 5. Rubber dam punch
• Used for making holes in the dam
• Parts
• a). Rotating metal disc bearing 5 to 6 holes
of different sizes according to size of teeth.
• b). A sharp pointed plunger.
21

23. 6. Rubber dam template
(stamp)
• Both have positions of the
teeth marked on them and are
used to transfer them to the
rubber dam sheet for holes to
be punched.
23

24. 7. Dental floss
Tied around the retainer before carried to
the oral cavity to
prevent accidental aspiration of clamp.
8. Wedget
An elastic used to secure the dam around
the teeth farthest away from the clamp.
24

25. PREPARATION OF THE PATIENT
FOR RUBBER DAM.
25
The dam can be presented as
a‘raincoat’ that keeps the tooth dry and held
on by a button (clamp) & kept straight by a
coat hanger (frame).
Local analgesia should be administered
where a clamp may impinge on the gingiva.

26. Step1:- Testing and lubricating the
proximal contacts
26
Dental floss is used to test the inter proximal
contact and remove debris from the tooth to
be isolated

27. Step 2 :- Punching the holes
27

28. Step 3:- Lubricating the dam:-
28
The assistant lubricate both side of the
rubber dam in the area of punched hole
using a cotton role or gloved finger tip
to apply the lubricant.
The lips and corner of the mouth may
be lubricated with petroleum jelly or
cocoa butter to prevent irritation

29. Step 4:- Selecting the retainer
29
The operator receive the rubber dam retainer
forceps with the selected retainer and floss
tie in
position .The free end of tie should exit from
cheek side of the retainer.

30. Step 5:- Testing the retainers stability and
retention:-
30
Test the retainers stability and retention by
lifting gently in an occlusal direction with a
finger tip under the bow of the retainer . An
improperly fitting retainer rocks or easily
dislodged .

31. Step 6:- Positioning the dam over the
retainer
31
With the fore finger , stretch the anchor hole
of the dam over the retainer and then under
the jaws.

32. Step 7 :- Apply the napkin
32
The operator gathers the dam in the left hand
while the assistance insert the finger and
thumb of right hand through the napkin
opening and grasp the bunched dam held by
the operator.

33. Step 8 :- Positioning the napkin
33
The assistant pulls the bunched dam through
the napkin and positioned it on the patient
face

34. Step 9:- Attaching the frame
34

35. Step 10 :-Attaching the nap strap:-
35
The assistant attaches the neck strap to the
left side of the frame and passes it behind
the patients neck .the operator attaches it to
the rt. Side of frame .

36. Step 11 :-
36
If there is a tooth distal to the retainer , the
distal edge of the posterior anchor hole
should be passed through the contact to
ensure a seal around the tooth .

37. Step 12:-
37
If the stability of the retainer is questionable
,low fusing modeling compound can be used
.

38. Step 13 :-
38
The operator passes the septa through as
many contacts as possible without the use of
dental tape by stretching the septal dam
forefingers . Each septum must not be
allowed to bunch or fold .

39. Step 14:-
39
Use waxed dental tape to pass the dam
through the remaining contacts .tape is
preferred over floss because its wider
dimension more effectively carries the rubber
septa through contacts.

40. Step15:-
40
Invert the dam into the gingival sulcus to
complete the seal around the tooth and
prevent leakage .

41. Step 16:-
41
With the edges of dam invert inter
proximally, complete the inversion facially
and lingually using an explorer while the
assistant directs a stream of air onto the
tooth.

42. Step 17:-
42
The use of a saliva ejector is optional
because most patient are able and usually
prefer to swallow the saliva.

43. Step 18 :-
43
The properly applied rubber dam is securely
positioned and comfortable to the patient .
The patient should be assured that the
rubber dam does not prevent swallowing or
closing the mouth when there is a pause in
the procedure .

44. Step 19 :-
44
Check to see that the completed rubber dam
provides maximal access and visibility for the
operative procedure.

45. Step 20 :-
45
For the proximal surface preparations many
operators consider the insertion of inter
proximal wedges as the final step in rubber
dam application . Wedges are generally
round tooth pick ends about half inch in
length that are snugly inserted into the
gingival embrasures from the facial or lingual
embrasure , which is greater , using no.110
pliers .

46. REMOVAL OF RUBBER DAM
46
Step 1:-
Stretch the dam facially , pulling the septal
rubber away from the gingival tissue an tooth
.protect the under lying tissue by placing the
finger tip beneath the septum .

47. Step 2:-
47
Engage the retainer forceps . It is
unnecessary to remove any compound,if
used ,because it will break free as the
retainer is spread and lifted from the tooth .

48. Step3 :-
48
After the retainer is removed ,release the
dam from the anterior anchor tooth and
remove the dam and frame simultaneously .

49. 49
Step4 :-
Wipe the patient lip with the napkin
immediately after the dam and frame are
removed .

50. 50
Step 5 :-
Rinse the teeth and the high volume
evaculator .

51. 51
Step 6 :-
Lay the teeth of rubber dam over a light -
coloured flat surface or hold it it up to the
operating light to determine that no portion of
the rubberdam has remained between or
around the teeth . Such a remnant would
cause gingival inflammation .

53. Cotton rolls & cellulose wafers
53
Available in different diameters, cut to
variant lengths & have plain or woven
surfaces Stabilized & held sublingually
with specific holders or with an anchoring
rubber dam clamp
• Can be applied without holders, over or lateral to
salivary gland orifices
 Cellulose wafers provide additional absorbency

54. 54
Advantage – Slight retraction of cheeks
aiding in visibility & access
Precaution:
 Moisten the cotton rolls & cellulose
wafers while removing to prevent inadvertent
removal of epithelium from cheeks, floor of
mouth or lips

55. Gauze piece or throat shields
55
 Indicated when there is danger of
aspirating or swallowing small objects, when
rubber dam is not being used
Used in pieces of 2”x2” or larger
 Particularly important when treating teeth
in maxillary arch
Gauze sponge unfolded & spread over the
tongue& posterior part of the mouth
Advantage –
 Better tolerated by delicate tissues
 Less adherence to dry tissues compared
to cotton

56. Dri – angle
56
 A thin, absorbent, cellulose triangle
 Unique replacement on the cotton roll
in the parotid area
 Covers the parotid or Stensen's duct
and effectively restricts the flow of saliva
Provides the required Dri-Field for
 Composites
 Bonding
 Cementing
Comes in twot ypes: plain and silver
coated

57.  Saliva ejector & high volume
evacuating equipment
57
 Saliva ejector prevent pooling of saliva in
the floor of the mouth
 High volume evacuating equipment
removes solid debris along with water
 Types of saliva ejectors :
 Metallic –
 Autoclavable
 Rubber tip to avoid irritating delicate
tissues on floor of the mouth
 Plastic – Disposable & inexpensive

58. Plastic saliva ejector
58
• PLASTIC SALIVA
EJECTOR
METAL
SALIVA
EJECTOR

59. Retraction cords
Size Quality Diameter
0 Super thin 0.45
1 Thin 0.55
2 Medium 0.8
59
 Used for isolation & retraction in direct
procedures of treatment of accessible sub
gingival area
 Diameter of cord should be selected
such that it is gently inserted into gingival
sulcus, producing lateral displacement of
the free gingiva without blanching
Cord may be moistened with a non
caustic styptic before insertion
(Hemodent)

60.  Advantages –
60
May help restrict excessive restorative
materials from
entering the gingival sulcus
 Provide better access for contouring &
finishing the restorative material
Prevent abrasion of gingival tissue during
tooth preparation
 Used primarily to push the gum tissue
away from the prepared margins of the
tooth, in order to create an accurate
impression of the teeth

61.  Indirect methods :
61
Local anaesthesia
Drugs –
 Anti sialogogues (Atropine)
Anti anxiety ( Diazepam)

62. A thorough knowledge of the preliminary proced
62

63. 63