Isolation of the operatory field is essential for maintaining a clean, dry working area with optimal access, ensuring the success of clinical dental procedures. Rubber dam isolation, a widely recommended method, offers numerous advantages, making it a valuable tool in restorative dentistry.

Benefits of Rubber Dam Isolation

Using a rubber dam during dental procedures provides the following benefits:

Control of Moisture and Contamination: Rubber dams prevent contamination, enhancing the performance and longevity of restorative materials.
Improved Visibility and Access: Isolation allows the dentist to work with greater accuracy, especially important when using high-speed rotary instruments.
Patient Safety: Rubber dams protect patients from accidental swallowing or aspiration of debris or tools.
Operator Safety: Dentists benefit from reduced exposure to potential oral cavity infections.
Efficient Use of Clinical Time: With the patient’s mouth isolated, talking and expectoration are minimized, enabling a more focused and efficient procedure.

Indications for Rubber Dam Use

Rubber dam isolation is recommended for:

Deep cavity caries removal
Replacement of unsatisfactory restorations
Procedures involving amalgam (to prevent mercury exposure)
Adhesive procedures requiring moisture control
Cases where gingival retraction is needed
Patients with special needs, reducing the risk of swallowing instruments

Contraindications

Rubber dams may not be suitable for:

Patients with asthma or breathing difficulties, as the dam limits mouth breathing.
Teeth that have not fully erupted, as achieving a proper seal can be challenging.
Patients with latex allergies, although latex-free rubber dams are available.

Key Components of Rubber Dam Isolation

Several tools are required to effectively use a rubber dam:

Rubber Dam Sheet: Available in various thicknesses and colors, thicker sheets provide better gingival retraction and sealing. Latex-free options exist for allergic patients.
Young Frame: A U-shaped device that holds the rubber dam in place. Its concave side should face the rubber sheet.
Rubber Dam Punch: Used to make holes for each tooth, with various hole sizes for different teeth groups.
Clamp Forceps: For placing and removing clamps. The forceps should be well-fitted to avoid trauma to the teeth and gums.
Clamps: Clamps stabilize the rubber sheet and may retract gingival tissue. Specific clamps are suited to molars, premolars, incisors, and canines. Specialized clamps, such as the #212, provide gingival retraction for two adjacent teeth.
Water-Soluble Lubricant: Aids in passing the dam between teeth, unlike non-soluble Vaseline, which can compromise bonding.
Pen: Used to mark hole positions for accurate dam placement. Wet-tip markers are preferred for intraoral marking.
Dental Floss: Used to check and adjust proximal contact tightness, identify sharp edges, and assist in stabilizing the dam.
Abrasive Strips: Occasionally needed to smooth proximal surfaces for easier rubber dam placement.
Blunt Tip Spatula: Helps with invagination and looping of the rubber dam to secure it around teeth.
Scissors: Essential for cutting and removing the rubber dam after the procedure.

Selecting the Right Clamp

Different clamps are used depending on the clinical situation:

Molars: Clamps #200–205, or #26 for short or expulsive crowns.
Premolars: Clamps #206–209.
Incisors and Canines: Clamps #210 and 211.
Special Cases: The #212 clamp, and its variants #212L and #212R, are suitable for retraction of gingival tissue in anterior teeth.

Rubber dam isolation in the posterior segment

How to isolate?

Absolute isolation in the posterior segment

This sequence shows step by step details for implementing absolute isolation in the posterior segment. Although each situation has its particularities that eventually require modifications in the art, the general background and the steps involved are constant in all cases.

1. Preparation and Initial Setup

To ensure smooth and efficient rubber dam placement:

Select the Appropriate Clamp: Avoid placing the clamp directly on the tooth needing treatment. Instead, apply it to an adjacent tooth—in this example, the second molar—to maintain stability.
Set Up the Dam on the Frame: Attach the rubber dam to the frame and stretch it over the claws along the frame for stability.
Mark Teeth for Isolation: Press the dam against the teeth, marking each tooth to be isolated with a felt-tip pen. Begin with the last tooth in the arch (the second molar) and work toward the midline, ensuring all teeth are adequately marked for perforation.

2. Punching the Rubber Dam

To accommodate different tooth sizes:

Use the Correct Punch Size: Use varying punch sizes for different teeth: the largest for the clamped tooth, the second for molars, third for premolars and canines, fourth for incisors, and the smallest for mandibular incisors.
Precise Hole Punching: Use a firm motion to avoid tearing the dam. Floss the contacts before dam placement, and, if needed, adjust tight contacts with abrasive strips.

3. Placing the Clamp and Frame

After preparing the dam:

Stabilize the Clamp: Position the clamp carefully on the second molar, ensuring it doesn’t compress gingival tissues. A common choice for this step is clamp #26, which has no side wings and provides a stable fit.
Lubricate the Dam: Lightly coat the inner surface of the dam with a water-soluble lubricant (e.g., shaving cream) to ease placement. With slight tension on the dam, fit it over the clamp carefully to prevent rupture.

4. Stabilizing the Anterior Tooth

To secure the rubber dam:

Secure the Anterior Tooth: Insert a small piece of rubber or a floss loop between the canine and the dam to anchor it in place. This ensures the dam remains stable over the teeth, aligning with each perforation.
Tension for Interproximal Passage: Gently apply tension to pass the dam through interproximal contacts without tearing. Floss may be needed for tight contacts to ease the dam’s passage without damage.

5. Invaginating the Dam

For complete isolation:

Seat the Dam into the Gingival Sulcus: Once the dam is positioned, use dental floss and a spatula to press it gently into the gingival sulcus around each tooth. This action improves sealing and ensures comprehensive isolation.
Technique for Flossing the Dam: To avoid tearing, slide floss at an angle into each contact point rather than pressing it directly on the dam, which reduces stress on the material.

6. Removing the Rubber Dam

Upon completing the procedure:

Remove the Clamp First: Begin by carefully releasing the clamp. Next, cut the rubber dam with scissors and remove the entire assembly.
Check for Remaining Rubber Fragments: Inspect the interproximal areas to ensure no dam fragments remain between the teeth, as leftover pieces can cause discomfort or complications.

Alternative Method: Simultaneous Insertion of Clamp and Dam

For a more integrated approach:

Use a Winged Clamp (e.g., #200): Attach the clamp to the dam and frame assembly. Carefully position it over the tooth with the help of clamp forceps.
Displace the Dam from the Wings: After placing the clamp, use a spatula to slip the dam off the side wings, achieving better fit and isolation.