If you want to follow all the news, subscribe to our websiteIf you want to follow all the news, subscribe to our websiteIf you want to follow all the news, subscribe to our websiteThe rubber dam is an auxiliary means indicated in most of the restoration and endodontic techniques in Dentistry.It was invented by Sanford Christie Barnum (1838-1885), a dentist in the New York area, on March 15, 1864, by piercing a rubber cloth and placing it on a tooth, although he had already been experimenting with rubber rings and cloths since 1862. The manufacturer Samuel Stockton White (SS White or SSW) already built the first perforator in 1882 and a little later the one used today as the Ainsworth perforator.Professor Dr. Jesús Calatayud Professor Dr. José S. Carrillo Professor Dr. Carmen Álvarez1. Improves working conditions: — Maintains an operating field clean and dry of saliva, cough and blood, including bleeding from the gums caused by irritated and inflamed papillae due to the tension exerted by the dam on the gums.This aspect is very important in acid etching, adhesion and pulp therapy techniques.— Retracts the soft tissues (tongue, cheeks, lips) thereby improving access and the visual field, also protecting the soft tissues from mechanical, chemical or trauma injuries.— Helps keep the mouth open due to the tension exerted by the dam on the tissues.2. Prevents aspiration and swallowing of foreign bodies, and increases work efficiency by saving time.With a little experience, it can be placed in 2 minutes and if an assistant is not available, it helps to work with two hands.Disadvantages of the rubber dam 1. Breathing limitations.It can be solved by trimming the dam around the nose or by folding the top.2. Allergies to latex or to other components of the dam (antioxidants, powders, dyes...), producing contact dermatitis, hives, angioedema, bronchial asthma.It is overcome using vinyl or nitrile dams.3. Aspiration or swallowing of the staple.It is avoided by securing the staple with dental floss as we will see.4. Injuries to dental tissues, due to too strong staples that make notches or chip pieces of the enamel, or soft, due to pinching the tongue or cheeks with the staple….They are pre-cut squares of latex (there are also vinyl or nitrile for those allergic to latex) that, with their elasticity, allow them to hug the teeth and isolate them by providing a good seal.— Size: 12.7 x 12.7 cm (5 x 5 inches), for small children only (Figure 1A).15.25 x 15.25 cm (6 x 6 inches), is the most used as it fits all needs and all facebows.— Thickness.There are 5 thicknesses: • Thin (Thin), 0.15 mm.• Medium (Medium), 0.20 mm.• Heavy (Heavy), 0.25 mm.• Extra heavy (Xheavy), 0.30 mm.∑ • Special heavy (SPHeavy), 0.35 mm.The heavier, the less it tears, the greater soft tissue retraction it exerts and the greater retention of the dam it produces once it is placed, but the more difficult it is to place it to cross the interdental spaces.The ideal one, in most cases, is the heavy one, 0.25 mm thick.- Color.There are several colors, but dark colors (gray, green, blue) are preferred to have a greater contrast with the white of the teeth (Figure 1B).NOTE: It is recommended to keep them in the refrigerator and they have six months after opening the blister that preserves them under vacuum.There are two 5- or 6-perforation disc perforators of different sizes available on the market to meet all needs (Figure 2): — Ainsworth perforator.It has the hinge behind the disk.It has a disk with 5 holes, 0.5 mm the smallest and 2.5 mm the largest.— Ivory Piercer.It has the hinge in front of the disk.It has a disc with 6 holes, 1 mm the smallest and 2 mm the largest.The hole selected for each type of tooth according to the drill is represented in Table 1.There are many varieties of staple holders but they are all variants of two, the Ivory staple holder and the Palmer or Brewer staple holder.The Palmer and Brewer staple holders are very similar, they are almost the same model, but the Palmer one has a straight clamp and the Brewer one has a curved one.The Ivory carrier is the most flattened and is our favorite because it has two advantages: 1) it can be opened much wider than the Palmer and Brewer model, and 2) it has a stop at the tip over the staple retaining cone. that prevents the tip of the staple holder from passing through the staple hole and digging into the gingiva when the staple is forced apically when placed on the tooth (Figures 3 and 4).Staples are the main retention system of the rubber dam on the teeth, and are placed at the distal end.The staples are made of tempered stainless steel or chromed steel with great elasticity and resistance, which act like a steel spring due to the spring force they have.General types of staples: • With wings and without wings.The ones without wings have a “W” in front that indicates wingless.Those with fins allow the entire dam-arch-clamp and clamp-holder block to be carried in a single step, being the simplest system;They also allow the fingers to rest when the staple is placed.Examples, the 0, 1, 3, 7 and 8 fin staples (Figures 5 and 6).• Retention and retraction.The retention ones exert the horizontal force and the retraction ones exert the force towards the apical, extending subgingivally.Apical force staples are used for teeth that are erupting or have the equator of the crown below the gingiva.Examples of 8A and 14A Apical Force Retraction Staples.• Butterfly or cervical or neck.They are special staples for neck caries (type V) in anterior teeth and premolars.Example, staple 212 (Figure 7).NOTE.Staple manufacturers Ivory, Hu-Friedy and Hygenic name their staples with numbers, Ash is the only manufacturer with letters.Currently the most important staple manufacturing company is Ivory.— Indicated staples for primary and permanent teeth are in Table 2. — There are currently plastic winged staples for molars, autoclavable at 134 ºC for 3 minutes (KerrHave SoftClamp) (Figure 8).— Other staples that can be used, although less popular than those already mentioned: 14 fi for molars;56 Ivory fi universal for molars;221 and 211fi butterfly or cervical.The dam-bearing arches are shaped like a "U", if they are open at the top, or an "O", if they are closed, and have several prongs to fulfill their function of supporting the rubber dam and keeping it stretched.Arches are much easier and faster to set up than the old brace systems, which is why they have become the norm today: — Arch sizes: • 12.7 x 12.7 (5 x 5 inches), just for small dikes.• 15.25 x 15.25 (6 x 6 inches) is most commonly used as it fits 6 x 6 rubber dams. — Arch types: 1. Young's arch.It is the first arch that was used, it is U-shaped and metallic, so it is radiopaque and is not used in endodontics.2. Visframe and Hygenic arch.They are U-shaped and made of plastic, so they are radiolucent to Rx.The Hygenic arch has the peculiarity of having the spikes oriented so that it is held under the dam, so the arch is not visible (Figure 9).3. Nygaard-Ostby arch.It is O-shaped, as it is closed at the top and is made of plastic, which is why it is radiolucent.This arch is used more in endodontics and is more difficult to adjust as it is closed at the top, so the height of the perforations must be done very well.4. Arch of Sauver.It is O-shaped, as it is closed at the top and is made of plastic, which is why it is radiolucent.It has the particularity of having a hinge, which allows it to bend when taking X-rays.It is mainly used in endodontics.5. Ahlers Safe-T-Frame Arch.It has a U shape and is made of plastic.It has no spikes and holds the dam by trapping it between the two sagittal halves that are formed, joined by a hinge at the base of the U. It has the advantage that it presents less tension when placing the dam.The most popular arch is the Higenic or Visframe, as it is a plastic U-shaped arch that is easier to fit and adjust.The Safe-T-Frame arch is easy to fit and comfortable, but hard to come by.1. Clamps, which we have already seen, are the primary method of dam retention.2. Waxed dental floss.It is used to isolate the teeth by helping to draw the dam between the teeth and to stabilize the dam by tying the floss around the neck of the teeth.4. Wedjets or a piece of latex rubber band from the dam (Figure 10).5. Other retention methods: — Low melting modeling compound (godiva green).After placing the dam, the godiva is heated and placed on the dental surface, manually compressing it in the interdental space until it cools and hardens.— Other cements such as periodontals (Peripac…).With this technique, relative dental isolation is achieved quickly and easily in most cases and when it is not possible, other techniques are used.It basically consists of bringing the entire assembled dam-arc-staple-staple-holder complex into the mouth in a single step.— ADVANTAGES: It is the easiest technique and does not require the help of an assistant.— DISADVANTAGES: it does not allow a good view of the tooth and the adjacent tissues and there may be tension in the dam, when placing the staple in a very posterior tooth by pulling the archwire in one direction and the staple in another.1. Remove all appliances from the child's mouth (orthodontics...) or from the patient (removable prosthesis).2. Local anesthesia, and while it takes effect you can: — Check that the dental floss enters the interdental spaces of the area to be isolated.— Eliminate, if any, sharp edges on the teeth that could tear the dam when it is placed.— Remove the tartar on the teeth to be isolated in order to place the dam.1.Drill the dam so that it is in the perfect position — Drill orientation: • When drilling holes for several teeth, templates can be used.• When drilling holes for several teeth, the methods of (Figure 11) can also be used: 1. Division 3 x 2 parts.The cutting point marks the position of the first permanent molar and the rest of the molars at an angle of 45º inward.2. Central cross of 3 x 3 cm.The horizontal end of the cross marks the position of the first permanent molar and at an angle of 45º inwards the rest of the molars.3. Central square 3 x 3 cm.It can be made of thick cardboard and its corners mark the position of the first permanent molar and the rest of the molars at an angle of 45º inwards.NOTE.At the top there should be 2-3 cm between the incisors and the upper edge and at the bottom 3-4 cm, a little more to cover not only the lower lip but also the chin.• In single tooth drilling it is possible to: 1. Drill in the center, although a little off if it is right-left, upper-lower.2. Direct orientation method.The dam is placed on the arch and is centered on the patient's open mouth, the dam is pushed with the finger until it touches the tooth that we want to isolate and the point is marked there with a marker or ballpoint pen.— The separation between the perforations is 2-4 mm.If the perforations are too close, leaks are caused because the dam does not cover the entire space and if they are too far apart, folds are formed.2. Place the arch on the dam (Figure 12).— The open part of the “U” of the bow faces up (the nose will go below).— Make it tight and taut horizontally, but loose vertically so that the dam can be stretched to the most distal tooth.In other words, it is stretched at the top and bottom (held by the spikes) but loose in the middle (loosened from the spikes).3. Place the staple — Select the staple based on the teeth to be isolated.— Tie about 45 cm of dental floss to the arch of the staple to allow its recovery in case the patient accidentally swallows or aspires it (Figure 13).— Assemble the staple in the staple holder.— Bring it to the mouth to verify that it fits firmly and can hold the rubber dam perfectly.— Release the staple from the staple holder, after removing it from the mouth, in order to place it in the rubber dam mounted on the dam support arch.— Place the staple in the rubber dam in the most distal hole and correctly oriented, with the staple arch distal.To do this, stretch the hole in the dam with your thumb and forefinger, pass it over the arch of the staple and then over the wings, so that the central wings are under the dam and the previous ones and the arch above.4. Assemble the staple holder on the staple to now have the entire dam-arc-staple-staple-pot complex ready.1. The soft tissues (tongue, lips, cheeks) are separated with the mirror by the dentist to facilitate the work.2. The entire dam-arch-staple-staple holder complex is moved to place it on the most distal tooth to be isolated.NOTE: This method does not allow for good visualization, so a trick sometimes used is to look through the hole in the dam for the clamp.3. Open the staple with the staple holder at the moment of inserting it into the tooth.Do not open excessively since the staple may break or lose retention quickly.When inserting the tip, first the contact point lingually and then tilt it on the vestibular side, taking care not to injure the soft tissues or the substance of the tooth.NOTE: If the dam pulls too much, an assistant can loosen the rubber dam from the arch, but from the corner opposite the treatment side, if it is the lower left part, it is released from the upper right.4. Carefully release the staple so that it hugs the tooth tightly, but without removing the staple holder from the staple.5. The Ivory staple holder, with its stopper, allows the staple to be compressed against the gum, for a more secure fit.This is especially useful in Apical Force Retraction Staples (8A and 14A), which extend subgingivally to fit below the largest diameter of partially erupted teeth.NOTE: Once installed, the staple can also be tightened by finger tightening more apically for a more secure fit.6. Release the staple holder from the staple.7. Release the flaps of the staple with your fingers or with a plastic instrument, stretching the dam so that the entire area is well sealed.This maneuver is carried out once the dam is secured by the clamp.1. The portion is stretched buccolingually interproximally with the fingers to reduce the mass of dam that passes through the interdental points and the holes are positioned on the teeth.2. The waxed dental floss is passed between the teeth so that the rubber of the dam penetrates the interproximal spaces and adapts to each isolated tooth.NOTE.If the interdental space is very narrow and the rubber dam does not fit, you can ask an assistant to gently stretch the dam between the teeth, to facilitate the entry of dental floss, or you can even try to open the interdental spaces by inserting a wedge wooden or spatula.There are several methods: 1. Ligation of the teeth with dental floss.2. Pass a piece of dental floss, about 40 cm, around each tooth, below the point of contact, so that the two ends come out through the vestibular.Gently stretch the ends and using a rocking or sawing motion stretch one end then the other to invert the rubber edge.NOTE.If the rubber edge is not inverted, the positive pressure causes the saliva to come out and the teeth to be adequately isolated.3. Tie the ends by vestibular.4. Ensure that the ends of the dental floss are long and remain under the dam arch.In addition, the staple ligature is tied to one end of the archwire to ensure easy retrieval if accidentally popped off.NOTE.Most of the time it is not necessary to tie all the teeth, only the most mesial, and in primary teeth the dam is often held well without any ligature, only by the pressure of the dam itself under the equator of the tooth.5. Other methods: — A wooden wedge between the teeth, at the most proximal end, when there is a larger space.— A Wedjet or a small piece of silicone dam stretched between the teeth.Also at the most proximal end (Figure 14).— Inverted staple on the most proximal tooth.This only with permanent teeth.— Should be below the nose and above the upper lip (small dams 5 x 5 inches).If it is above the nose and the patient complains, it can be trimmed around the nose or folded.If it is too high, above the eyes, it bothers and too low, below the upper lip, saliva enters.Below it will be above the chin and covering the lower lip.— If it is not correctly positioned, the dam can be released from the dam-porting arch and readapted so that it is better oriented.1. Eliminate all the remains of the seals... that are on the dam, and check that the dam is not subjected to great tension since then when it is released the clip will jump violently.In this case, hold it firmly when removing it.2. Using scissors, cut the dental floss ties, if they are in place, and the interdental gum of the dam after stretching the holes buccal to facilitate cutting.This maneuver is important in interproximal silver amalgam fillings since otherwise the contact point can be broken when the dam is removed.3. Hold the arch of the dam with one hand so that it does not jump when the clamp is released.4. Remove the staple after holding it correctly with the staple holder and first pushing apically and then widening (gently, not too much) by removing the staple.5. Raise the rubber dam and dam arch assembly and check that there are no pieces of rubber between the teeth.There are variants of the basic single-step method that use multiple steps and are very similar, but with advantages and disadvantages.It is a variant of the one-step technique.- Technique.First, the staple is placed on the dam but without the arch and it is carried in the mouth with the staple holder, placing it on the tooth.Second step, the staple holder arch is placed.— Indication: when it is difficult to secure the staple because it facilitates the visualization of the tooth.— Disadvantages: the rubber dam has to be stretched a lot over the clamp wings and increases the risk of the dam breaking.Also called the “large hole” or elongated opening technique.This technique is widely used in children's dentistry.It is the easiest technique (Fig 15).- Technique.The staple is placed first on the most distal tooth.Once the holes are made in the rubber dam, only the most distal and the most proximal tooth, they are joined by cutting with scissors (you can also drill with the perforator to join them but it is too open).A continuous hole is achieved that goes from the most distal piece to the most mesial.In this situation, in a second step, the arch is carried with the dam to place it very easily on the teeth as it has a large and elongated hole.— Indication.To carve preformed crowns in temporary teeth or in those situations where a very easy and fast dental isolation is sought.— Drawbacks.The insulation is less and some saliva always leaks, although it removes and separates the soft tissues and the leaking is not excessive.- Technique.The dam-arch assembly is placed first on the most distal tooth.It may be necessary to use dental floss to pass the dam between the interproximal spaces.Second step, the staple is placed on the tooth that already has the dam in place, but you have to be holding the rubber dam with your fingers on the tooth.— Indication.This method allows for good visibility and is also required when butterfly or cervical (staple 212) staples are placed for neck caries.Because these staples have such a large arc, they cannot pass through the holes in the dam without the dam breaking.— Drawbacks.An assistant is needed to hold the dam with the fingers, pulling buccal and lingual to the tooth to lower the dam apically, since there is a great tendency for dislocation.- Technique.The wingless staple is placed on the tooth first.Second step, the dam is placed over the staple by first passing over the arch of the staple.Note that it is important that it does not have fins to facilitate the passage of the dam over the staple.Third step, the dam support arch is placed on the dam.— Indication.It is indicated when there are great difficulties in placing the staple as it allows good visibility and control of the tooth and soft tissues.— Drawbacks.The dam can be torn when passing through the staple in the mouth.The OptraDam, from Ivoclar Vivadent, is a new latex rubber dam that tries to simplify the traditional method.This dam comes with the tooth positions printed on the material in the form of a template.In addition, it does not require an archwire or generally staples (with few exceptions in the posterior molar region).This dam has two integrated rings: an external one, which is extraoral and which performs the functions of the arch;and another more flexible one, which remains intraoral and allows the dentist to insert the dam into the patient's mouth (Figure 16) and place it quickly and comfortably on the tooth or teeth to be isolated (Figure 17).Figure 17 shows the fully adapted breakwater without an arch.It comes in two sizes, "Regular" (normal) and "Small" (small for children).Both can be used in the upper and lower arches.KerrHave's OptiDam is another new rubber dam isolation system that incorporates a latex dam that is three-dimensionally shaped, to aid placement by reducing dam stress, and has a tooth pattern as an imprint preformed so that instead of drilling you only have to cut the preforms with scissors as lugs.1. Medium-heavy thickness latex rubber dam.— That it has two special characteristics (Figure 18): 1. It has a three-dimensional shape instead of being flat to reduce up to five times the tension created by the dam when placed on the posterior teeth, thus facilitating its placement and avoiding traction excessive pressure on the staple, preventing it from jumping and reducing breakage of the dam.2. It has a drawing with the preformed imprints of the teeth, so it is not necessary to mark their positions or make holes, they can be cut with scissors to make the holes.— The dam has two forms or versions (Figure 18): • Dam for anterior teeth.Designed not to use staples initially, and allows simultaneous isolation of the maxillary and mandibular teeth.It consists of 12 preformed impressions for maxillary teeth (from 16 to 26) and another 12 for mandibular teeth (from 36 to 46).• Dam for posterior teeth.This dam respects the anatomical contour of the molar area.It consists of seven preformed impressions for the teeth of the maxillary hemiarch and another seven for the teeth of the same hemiarch but mandibular.2. The anatomical arch made of thermoplastic material that allows it to be sterilized in an autoclave at 134 ºC for three minutes (Figure 9).First we select the dam, if it is anterior or posterior, depending on the area to be isolated.1. Mount the dam on the anatomical arch so that the three-dimensional shape protrudes behind the arch, since it is the part that will be inserted into the mouth and will facilitate its adaptation.2. Cut with scissors the traces of the preforms of the teeth that we are going to isolate.The preforms make relief towards the protruding part of the dam.NOTE.Observe the differences with the conventional technique, here the dam is first mounted on the arch and then drilled and with the traditional method it is just the opposite.3. Place the staple if a posterior dam is used.For previous ones, initially no staple is needed.4. Place the rubber dam in the mouth perfectly oriented.• If it is for the anterior teeth, we will use dental floss.• If it is for posterior teeth, we will use the staple holder to adjust the staple on the tooth that will retain the dam in the most posterior part.5. Finish adjusting the isolated teeth with dental floss.The technique with OptiDam allows variations.Thus: • On the posterior teeth, first place the staple (without wings) and then the rubber dam.• In anterior teeth, the technique is first the dam and then the staple (with cervical staples).In Figure 19, the dam is in place and it can be seen that there is no tension due to its three-dimensional shape.1. Winkler R. Rubber Dam Theory and Practice.Mosby/Doyma Books.Barcelona, ​​1994.2. Latimer JS.Little thinks-Barnums rubber dam.Dent Cosmos 1865;6:13.3. Francis CE.The rubber dam.Dent Cosmos 1866;7: 185.4. Jinks GM.Rubber dam technique for dentistry for children.J Dent Child 1950;17(4):2-13.5. Jinks GM.Rubber dam in pedodontics.Dent Clin N Am 1966;July, 327-340.6. Ahlers MO.A new rubber dam frame design – Easier to use with a more secure fit.Quintessence Int 2003;34 (3): 203-210.7. Gurnish GM.Use of rubber dam.Chapter 6. In: Snawder KD.Manual of clinical pediatric dentistry.Editorial Labor, SA Barcelona, ​​1984, 97-111.8. Bence R. The rubber dam and its application.Chapter 7. In: Bence R. Clinical endodontic manual.Editorial Mundi SAICyF, Buenos Aires, 1977, 89-104.9. Baum L, Phillips RW, Lund MR.Isolation of the field of work.Chapter 8. In: Baum L, Phillips RW, Lund MR.Treatise on dental surgery.3rd ed.McGraw-Hill Interamericana.Mexico, 1996, 189-221.10. Scott GL.Isolation.Chapter 8. In: Walton RE, Torabirejad M. Endodontics.Principles and practice.2nd ed.McGraw-Hill Interamericana.Publishers, SA de CV, 1997, 126-139.11. Sim JM, Finn SB.Dental surgery for children.Chapter 8. In: Finn SB.Pediatric dentistry.4th ed.Interamerican.Mexico, 1976, 120-148 (123-127).12. Calabrese M, Graiff L Masson N. Easy and fast, for optimal isolation.The first “comfortable” kofferdam for the patient, without metal clamps from Ivoclar-Vivadent.Reflect (Ivoclar-Vivadent) 2006;2, 4-6.13. Heise AL.Time required in rubber dam placement.J Dent Child 1971;38(2): 116-117.14. Cochran MA, Miller CH, Sheldrake MA.The efficacy of the rubber dam as a barrier to spread of microorganisms during dental treatment.JADA 1989;119 (1): 141-144.15. Christensen GJ.Using rubber dams to increase quality, quantity of restorative services.JADA 1994;125 (1): 81-82.Save my name, email, and website in this browser the next time I comment.Do you want to be the first to receive news?SUBSCRIBE TO THE DENTAL GAZETTE NEWSLETTERThe dental sector is in full transformation.In order to offer the best patient care and not be left behind, professionals need to constantly recycle themselves and incorporate technology into their clinical practice.In this context, Gaceta Dental is the reference source of training and essential information for dentists, prosthetics and hygienists.We use cookies to offer you the best experience on our website.You can get more information about the cookies we use or disable them in the settings.This website uses cookies so that we can offer you the best possible user experience.Cookie information is stored in your browser and performs functions such as recognizing you when you return to our website or helping our team understand which sections of the website you find most interesting and useful.Strictly Necessary Cookies must always be enabled so that we can save your cookie setting preferences.If you disable this cookie we will not be able to save your preferences.This means that every time you visit this website you will have to activate or deactivate cookies again.