**Rubber Dam for**
**Endodontics**
**Prof. Paul V. Abbott AO**
BDSc, MDS, FRACDS(Endo), FPFA, FADI, FICD, FACD,
FIADT
Specialist Endodontist
Winthrop Professor of Clinical Dentistry
UWA Dental School
The University of Western Australia
![]()
Two dental images illustrating the use of a rubber dam for endodontics.
**Rubber Dam**
**A New Innovation ??**
$\diamond$ Most patients think so!!!
$\diamond$ First use was on 15th March 1864
$\rightarrow$ Dr. Sanford C. Barnum - New York, USA
$\star$ **154 years ago !!!**
## **Introduction and History**
### **A New Innovation?**
- Most patients think so!!!
- First use was on 15th March 1864
- Dr. Sanford C. Barnum - New York, USA
- **154 years ago !!!**
- ==It was developed over 155 years ago.==
**Dr. S. C. Barnum**
At the time when the idea of rubber dam dawned on my mind, I was practising in Monticalls, Sullivan Co., New York. It was the result of much persecution from the inroads of saliva. I had spent many an hour, weary and distracted, battling against its incursions. Many a sleepless night had I over sad failures ... with the one absorbing question ever before me unanswered. "How shall I keep the cavities dry?" The answer came ... on the 15th day of March 1864, a case presented itself of a cavity in a lower molar standing alone, on the left side, in a mouth, as wet — well as water gushing from every duct could make it. In a sort of half desperate way, and partly to try the new idea, I cut a hole in my napkin protector and over the tooth it went. There was the rubber dam.
Sanford C. Barnum 1877⁴
### **Dr. S. C. Barnum**
At the time when the idea of rubber dam dawned on my mind, I was practising in Monticalls, Sullivan Co., New York. It was the result of much persecution from the inroads of saliva. I had spent many an hour, weary and distracted, battling against its incursions. Many a sleepless night had I over sad failures ... with the one absorbing question ever before me unanswered. "How shall I keep the cavities dry?" The answer came ... on the 15th day of March 1864, a case presented itself of a cavity in a lower molar standing alone, on the left side, in a mouth, as wet — well as water gushing from every duct could make it. In a sort of half desperate way, and partly to try the new idea, I cut a hole in my napkin protector and over the tooth it went. There was the rubber dam.
Sanford C. Barnum 1877⁴
![]()
Historical classroom scene showing students in a practical training or clinic setting, University of Illinois, 1900.
**University of Illinois - 1900**
<img/> A historical black and white photograph depicting men receiving a shave or having work done in what appears to be a barbershop or medical-related setting, with close-up insets highlighting two different individuals. </img>
### **University of Illinois - 1900
> [!NOTE]
> Historical photographs, such as one from the student clinic at the University of Illinois in 1900, clearly show patients being treated with rubber dams in place. This demonstrates that its use was standard practice in dental education over 120 years ago.
**
# **Rubber Dam**
a) First reported use in 1864
$\rightarrow$ **Dr. S.C. Barnum – USA**
b) **Recommended by $\underline{ALL}$ teaching authorities and professional societies since the 19$^{\text{th}}$ Century for $\underline{ALL}$ endodontic procedures**
$\rightarrow$ **And for many other dental procedures!!**
### **Historical Recommendation**
- First reported use in 1864
- **Dr. S.C. Barnum – USA**
- **Recommended by ALL teaching authorities and professional societies since the 19$^{\text{th}}$ Century for ALL endodontic procedures**
- **And for many other dental procedures!!**
> [!NOTE]
> While that number may be extensive, there are at least nine critically important reasons to use a rubber dam.
In 1937, Dr. James M. Prime outlined 58 valid reasons for using the rubber dam. Many lecturers and authors have referred to these reasons over the years. It is interesting to review this outline 48 years later, and see what reasons do and do not apply to dentistry in 1985.
**Fifty-Eight Reasons for Using Rubber Dam**
*by James Mark Prime, DDS*
The use of the Rubber Dam is so tremendously important in operative procedures and because so many operators are failing to use it, it is considered advisable to enumerate some of the places where its use is strongly indicated. Habitual users will, no doubt, see other places than what are mentioned in the following fifty-eight reasons:
In 1937, Dr. James M. Prime outlined 58 valid reasons for using the rubber dam. Many lecturers and authors have referred to these reasons over the years. It is interesting to review this outline 48 years later, and see what reasons do and do not apply to dentistry in 1985.
**Fifty-Eight Reasons for Using Rubber Dam**
*by James Mark Prime, DDS*
The use of the Rubber Dam is so tremendously important in operative procedures and because so many operators are failing to use it, it is considered advisable to enumerate some of the places where its use is strongly indicated. Habitual users will, no doubt, see other places than what are mentioned in the following fifty-eight reasons:
**Reasons for Using RD**
1. Infection control
2. **Patient safety**
3. **Patient comfort**
4. **Moisture control**
5. Increased visibility
6. **Increased access**
7. Increased efficiency
8. **“Dento-legal” reasons**
9. **Improved treatment outcome**
## **Reasons for Using Rubber Dam**
> [!NOTE]
> The use of a rubber dam is critical for infection control, patient safety, and improving the quality and efficiency of dental treatment.
1. Infection control
2. **Patient safety**
3. **Patient comfort**
4. **Moisture control**
5. Increased visibility
6. **Increased access**
7. Increased efficiency
8. **“Dento-legal” reasons**
9. **Improved treatment outcome**
**1. Infection Control**
![]()
A dental professional and an assistant wearing full PPE, including masks, gowns, gloves, and protective eyewear/face shields, in a dental operatory, with simulated blood splatter representing aerosols.
### **1. Infection Control**
> [!NOTE]
> Working in a patient's mouth without a dam creates a significant aerosol of water and saliva, spreading microorganisms throughout the operatory.
- ==**Aerosol Contamination:** An experiment using a clear screen placed over a patient who had rinsed with a plaque-disclosing solution showed extensive red spatter covering the screen, the dentist, and the assistant after a procedure without a dam.==
- ==**Conclusion:** The rubber dam is a highly effective tool for cross-contamination control, protecting the dental team and the clinical environment.==
# **1. Infection Control**
Recovery of Microorganisms With and Without Use of the
Dental Dam During Cavity Preparations
| | **Without Dam** | **With Dam** |
|---|---|---|
| **AT DENTAL LIGHT UNIT** | | |
| **MEAN CFU** | **ACTUAL CAVITY PREPARATION** | **SIMULATED STUDY** |
| 50- | 41 | |
| 40- | | |
| 30- | | |
| 20- | 21 | 17 |
| 10- | 1 0 0 | 1 0 0 | 1 3 0.4 |
| 0- | **MAXILLARY** **ANTERIOR** **% REDUCTION** 100 | **MANDIBULAR** **ANTERIOR** **% REDUCTION** 100 | **MAXILLARY** **POSTERIOR** **% REDUCTION** 50 | **MANDIBULAR** **POSTERIOR** **% REDUCTION** 87 |
| | **Without Dam** | **With Dam** |
|---|---|---|
| **AT PATIENT'S CHEST** | | |
| **MEAN CFU** | **ACTUAL CAVITY PREPARATION** | **SIMULATED STUDY** |
| 500- | 500 | |
| 400- | 381 | |
| 300- | | 356 |
| 200- | 211 | |
| 100- | 120 | |
| 0- | 42 15 84 36 | 11 23 5 |
| | **MAXILLARY** **ANTERIOR** **% REDUCTION** 80 | **MANDIBULAR** **ANTERIOR** **% REDUCTION** 88 | **MAXILLARY** **POSTERIOR** **% REDUCTION** 78 | **MANDIBULAR** **POSTERIOR** **% REDUCTION** 70 | **MAXILLARY** **% REDUCTION** > 95 | **MANDIBULAR** **% REDUCTION** > 99 |
**Cochran et al**
**JADA 1989**
Recovery of Microorganisms With and Without Use of the Dental Dam During Cavity Preparations (Cochran et al, JADA 1989)
**At Dental Light Unit**
| Location | Without Dam (Mean CFU) | With Dam (Mean CFU) | % Reduction |
| :--- | :--- | :--- | :--- |
| **Actual Cavity Preparation** | | | |
| Maxillary Anterior | 21 | 0 | 100% |
| Mandibular Anterior | 1 | 0 | 100% |
| Maxillary Posterior | 41 | 21 | 50% |
| Mandibular Posterior | 1 | 0.4 | 87% |
| **Simulated Study** | | | |
| Maxillary Anterior | 17 | 0 | 100% |
| Mandibular Anterior | 3 | 0 | 100% |
**At Patient's Chest**
| Location | Without Dam (Mean CFU) | With Dam (Mean CFU) | % Reduction |
| :--- | :--- | :--- | :--- |
| **Actual Cavity Preparation** | | | |
| Maxillary Anterior | 211 | 42 | 80% |
| Mandibular Anterior | 120 | 15 | 88% |
| Maxillary Posterior | 381 | 84 | 78% |
| Mandibular Posterior | 500 | 36 | 70% |
| **Simulated Study** | | | |
| Maxillary | 356 | 11 | > 95% |
| Mandibular | 23 | 5 | > 99% |
**2. Patient Safety**
![]()
An image showing an X-ray of a patient's pelvic area with a small white object highlighted by an orange arrow. An inset image shows a dental file with a yellow handle, suggesting the white object is a foreign body like a swallowed dental device.
### **2. Patient Safety**
> [!NOTE]
> The rubber dam acts as a crucial barrier, preventing the accidental swallowing or inhalation of small instruments and materials.
## **2. Patient Safety**
**Bur in the Lung**
**Temporary Crown swallowed**
![]()
Chest X-rays showing swallowed objects.
- Bur in the Lung
- Temporary Crown swallowed
**2. Patient Safety**
**Pin and chuck swallowed**
**Gates-Glidden bur in an Appendix**
<img src="https://i.imgur.com/gK9qS7m.png" alt="X-ray and image of ingested items and a cover of a book"> </img>
**Rubber Dam in Clinical Practice**
- Pin and chuck swallowed
- Gates-Glidden bur in an Appendix
- ==Endodontic files==
- ==**Soft Tissue Protection:** The dam retracts the tongue, cheeks, and lips, protecting them from injury by high-speed or low-speed handpieces if the patient moves unexpectedly.==
- ==**Material Ingestion:** It prevents small pieces of restorative material, such as amalgam, from being swallowed or inhaled during placement or carving.==
Rubber Dam in Clinical Practice
**2. Patient Safety**
![]()
Close-up images illustrating potential patient safety concerns in a dental context, showing tongue proximity to a rotating instrument and material remnants near a tool.
**3. Patient Comfort**
![]()
A person's mouth is shown with various dental tools and cotton rolls being used for comfort and moisture control.
### **3. Patient Comfort**
> [!NOTE]
> Contrary to some dentists' beliefs, most patients prefer the use of a rubber dam.
**3. Patient Comfort**
$\diamond$ **99% of patients accepted the use of RD**
* $\square$ **72% preferred RD**
* $\square$ **20% had no preference**
* $\square$ **8% preferred no RD**
$\diamond$ **When appointment was 45-60 minutes:**
* $\square$ **76% preferred RD**
* $\square$ **24% had no preference**
* $\square$ **0% preferred no RD**
<div style="text-align: right;">Gergely</div>
<div style="text-align: right;">BDJ 1989</div>
(Gergely, BDJ 1989)
- **99% of patients accepted the use of RD**
- **72% preferred RD**
- **20% had no preference**
- **8% preferred no RD**
- **When appointment was 45-60 minutes:**
- **76% preferred RD**
- **24% had no preference**
- **0% preferred no RD**
**3. Patient Comfort**
$\blacktriangleright$ **Favourable comments - 82% of patients:**
* Absence of things in the mouth
* Secure, comfortable, safe, relaxed, detached
* Tongue out of way, protected
* No dribbling, no bad tastes
* Can swallow any time & without fear of swallowing bits of filling, etc
**Gergely**
**BDJ 1989**
- **Favourable comments - 82% of patients:**
- Absence of things in the mouth
- Secure, comfortable, safe, relaxed, detached
- Tongue out of way, protected
- No dribbling, no bad tastes
- Can swallow any time & without fear of swallowing bits of filling, etc
**3. Patient Comfort**
♦ **Unfavourable comments - 18% of patients:**
- Disliked clamp placement
- Breathing difficulties
- Smell, colour
- Rubber irritated
- Apprehensive, claustrophobic
<div style="text-align: right;">
Gergely
BDJ 1989
</div>
- **Unfavourable comments - 18% of patients:**
- Disliked clamp placement
- Breathing difficulties
- Smell, colour
- Rubber irritated
- Apprehensive, claustrophobic
- ==**Managing Unfavorable Comments:**==
- ==**Clamp Discomfort:** This is a clinician issue, often due to poor clamp selection or placement.==
- ==**Breathing Difficulties:** Educate the patient to breathe through their nose. For true mouth-breathers, a portion of the dam can be left off the frame to create an opening over the mouth.==
- ==**Smell/Color:** Different colors and scented/flavored dams are available.==
- ==**Facial Irritation:** Proper placement and frame choice (e.g., an Ospy frame) can hold the dam away from the face.==
- ==**Apprehension/Claustrophobia:** Calmly explain the necessity of the dam and talk the patient through the placement process. For true claustrophobia, sedation or general anesthesia may be required, but the rubber dam must still be used.==
**4. Moisture Control**
![]()
Four images showing dental procedures related to moisture control, including the application of materials and the use of a rubber dam.
### **4. Moisture Control**
> [!NOTE]
> The rubber dam provides total moisture control, which is a two-way benefit.
1. **Protecting the Patient:** It prevents caustic and unpleasant-tasting irrigants used in endodontics (e.g., sodium hypochlorite, EDTA) from entering the patient's mouth.
2. **Protecting the Tooth:** It prevents saliva from contaminating the operating field, which is critical for disinfection and bonding procedures.
Saliva that pools under the dam can be managed by having the patient swallow or by lifting a corner of the dam to use an evacuator.
**5. Increased Access**
**6. Increased Visibility**
![]()
An image showing a person with a full beard on the left, and the same person with a dental dam applied, exposing the oral cavity, on the right.
### **5. Increased Access & 6. Increased Visibility**
> [!NOTE]
> The rubber dam transforms the operating field by retracting the lips, cheeks, and tongue.
- ==**Access:** It creates a clear, unobstructed path to the tooth, eliminating the need for constant retraction with mirrors or other instruments.==
- ==**Visibility:** The color contrast between the dam and the tooth structure enhances visibility, allowing for more precise and higher-quality work.==
**5. Increased Access**
**6. Increased Visibility**
*“You can do it better when you can see it better!”*
![]()
An image showing three close-up photos of dental procedures, likely demonstrating the concept of increased visibility and access.
*“You can do it better when you can see it better!”*
7. Increased Efficiency
$\diamond$ **Saves significant operating time**
$\diamond$ **Quick to apply - mean:** **1.9 minutes**
$\quad \blacksquare$ Gergely BDJ 1989
$\quad \rightarrow$ BUT - they were general dentists
$\quad \quad \oplus$ **Only used RD 5% of the time**
$\quad \rightarrow$ Regular users likely to be much faster
$\diamond$ **NB: Local Anaesthesia needs**
$\quad$ **3-5 minutes to be effective**
![]()
A close-up of a clock with Roman numerals
### **7. Increased Efficiency**
- **Saves significant operating time**
- **Quick to apply - mean: 1.9 minutes**
- Gergely BDJ 1989
- BUT - they were general dentists
- **Only used RD 5% of the time**
- Regular users likely to be much faster
- ==An experienced user can place a dam in **20-30 seconds**.==
- **NB: Local Anaesthesia needs 3-5 minutes to be effective**
> [!NOTE]
> The time spent waiting for local anesthesia to become effective can be used to place the rubber dam, allowing treatment to begin immediately once the patient is numb.
**8. “Dento-Legal” Reasons**
<img src="embedded_image.png"/>
* **Recommended by ALL teaching authorities and professional societies since the 19th Century for ALL endodontic procedures**
* **And for many other dental procedures!!**
### **8. “Dento-Legal” Reasons**
> [!NOTE]
> Failure to use a rubber dam for endodontic treatment is a significant departure from the accepted standard of care and poses a major legal risk.
- ==**Standard of Care:** Its use has been recommended by all major authorities since the 19th century.==
- ==**Liability:** In the event of an accident, such as an inhaled file, a case against a dentist who did not use a rubber dam would be virtually indefensible. An article in the *Journal of Endodontics* stated that in such a case, there would be
![]()
Dental-related radiographs showing foreign objects in body (highlighted with red circles), possibly indicating malpractice or procedural accidents. Includes labeled x-rays and scanned article covers related to legal issues in dental practice.
# Reported Use of Rubber Dam
<div style="color:red; font-size: 1.25em;">**United Kingdom:** Gergely - BDJ 1989</div>
- 5% of the time
<div style="color:red; font-size: 1.25em;">**United Kingdom:** Whitworth et al - IEJ 2000</div>
- Never for Endodontics - 60%
- Always or frequently - < 20%
<div style="color:red; font-size: 1.25em;">**Denmark:** Bjøndal & Reit - IEJ 2005</div>
- “Often” for Endo. - 4%
- “Occasionally” - 14%
**Reported Use of Rubber Dam**
&diams; **Australia:** **Abbott - ADJ 1994**
* **Endo. cases started by GP’s in WA - 13%**
&diams; **New Zealand:** **Koshy & Chandler - NZDJ 2002**
* **Routinely for Endo. - 57%**
* **More often if a:**
&rightarrow; **Graduate of < 10 years**
&rightarrow; **Dentist in group practice**
&rightarrow; **Regular attendee of CE courses**
**8. “Dento-Legal” Reasons**
* “One of the most obvious departures
from the accepted standard of care
(during endodontic treatment)
is the failure to use rubber dam”
* “There would be no argument regarding
liability and the only question would
be the amount of the settlement”
Cohen & Schwartz
JoE 1987
![]()
Magazine article titled "Riskwise Australia" with dental images and x-rays
**9. Improved Treatment Outcome**
$\diamond$ **Assessed 100 cases where pain continued**
after commencement of root
canal treatment
by general dentists
$\diamond$ **Rubber ram was NOT used in**
**87% of cases**
Abbott - Aust Dent J 1994
* **Likely to still have infected root**
**canal systems**
* **Or pulpitis cases became**
**9. Improved Treatment Outcome**
$\diamond$ A review of the outcome of
endodontic
**treatment in 50 studies**
$\diamond$ **Two studies stated that Rubber
Dam was NOT used:**
- $\blacksquare$ **Jokinen et al 1978** - **53%**
Friedman - Essential Endodontology 1998
**favourable**
- $\blacksquare$ **Barbakow et al 1981** - **59%
favourable**
**9. Improved Treatment Outcome**
|% of Cases with a Favourable Outcome|No. of Studies|
|---|---|
|< 60|5 **|
|60 – 69|0|
|70 – 79|8|
|80 – 89|22|
|90 – 100|15|
**Friedman - Essential Endodontology 1998**
**9. Improved Treatment Outcome**
**Survival of teeth when rubber dam used for root canal treatment**
$\diamond$ Assessed survival of 517,234 teeth after RCT
$\diamond$ Adjusted for all other factors
- Univariate & multivariate Cox proportional hazards models
$\diamond$ **Stat. significant difference in survival after 3.4 years when rubber dam was used**
Lin et al - J Endod 2014;40:1733-1737
**9. Improved Treatment Outcome**
$\diamond$ **Assessed 612 Endo. re-treatment cases**
$\diamond$ **Significant difference in treatment outcome when Rubber Dam was used (p=0.0001)**
$\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }$■ **Compared to use of cotton rolls**
$\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }\text{ }$**Van Nieuwenhuysen et al - Int Endod J 1994**
**9. Improved Treatment Outcome**
**Use of rubber dam during post placement**
* Assessed for periapical healing two years after RCT, post and restoration
* Healing:
* **93.3% when RD used** (30 teeth)
* **73.6% when no RD used** (174 teeth)
* **Statistically significant difference**
**Goldfein et al - J Endod 2013**
9. **Improved Treatment Outcome**
$\diamond$ Dye penetration in teeth with composite resins
- placed clinically and then extracted
$\checkmark$ **Rubber dam isolation:**
$>$ **ALL 30 teeth had NO dye penetration**
$\times$ **Cotton rolls:**
$>$ Only **16** of 30 teeth had no dye penetration
- Statistically significant difference
**Knight et al - Int J Prosthod 1993**
**9. Improved Treatment Outcome**
**Rubber dam during Restorative Dentistry**
**Cochrane Review – 4 studies, 1,270 patients**
- Highly significantly HIGHER SURVIVAL RATE when
RD used compared to cotton roll “isolation”
- RD usage - Significantly lower rate of failure at 2
years for proximal atraumatic restorations in
primary molars
- RD shortened treatment time for fissure sealing
- No adverse effects of using RD reported in the
studies
**Wang et al - Cochrane Review 2016**
**Rubber Dam Equipment**
- Rubber Dam
- **Medium body**
- **Green**
HYGENIC
DENTAL DAM
PURE LATEX
**STORE IN A COOL PLACE**
ONE SQUARE YARD - 36 PIECES
6" x 6"
CAUTION: FOR PROFESSIONAL DENTAL USE ONLY
THE HYGENIC CORPORATION / AKRON, OHIO 44310, U.S.A.
MEDIUM GAUGE
GREEN
![]()
Image showing boxes of Dental Dam and individual sheets of different colors.
**Rubber Dam Equipment**
- **Rubber Dam**
>**Medium body**
![]()
A green, square piece of rubber dam material next to its packaging showing the product name "progress RUBBER DAM".
# **Rubber Dam Equipment**
* **Rubber Dam**
> **Medium body**
A package of non-latex rubber dam squares.
**Rubber Dam Equipment**
* **Punch**
$\times$ **Holes are too large**
$\times$ **Difficult to position RD**
![]()
A comparison of two types of dental rubber dam punches, one showing a checkmark indicating approval and the other showing arrows pointing to issues with hole size and difficulty of positioning.
**<span style="color:yellow">Rubber Dam Equipment</span>**
* **<span style="color:white">Punch</span>**
* **<span style="color:yellow">Use the largest</span>**
**<span style="color:yellow">hole ONLY</span>**
**<span style="color:blue">- one size fits all !!!</span>**
![]()
Image showing a rubber dam punch tool, its operation, and examples of correctly and incorrectly punched holes in a rubber dam sheet.
**Rubber Dam Equipment**
* Clamp Forceps
![]()
Dental Clamp Forceps
**Rubber Dam Equipment**
* **Clamps**
**Keep it Simple !!!**
![]()
A photographic array of various dental rubber dam clamps.
**Rubber Dam Equipment**
* **Clamps** $\rightarrow$ *Winged clamps preferred*
![]()
Rubber Dam Clamp
**Rubber Dam Equipment**
- **Clamps** $\rightarrow$ **Anterior teeth**
<img src="Rubber Dam Equipment with clamps labeled 9, 9T, 2T, and 2, which are typically used for anterior teeth isolation."> </img>
**Rubber Dam Equipment**
* **Clamps $\rightarrow$ Premolar teeth**
#### **Premolar teeth**
### **Rubber Dam Sheets**
- ==**Material:** While latex is still available, **non-latex** dam is now the standard to prevent allergic reactions. It typically comes in single-use vacuum packs.==
- ==**Thickness:** **Medium body** is the preferred thickness.==
- ==*Light body* is prone to tearing.==
- ==*Heavy body* is difficult to stretch over teeth.==
- ==**Color:** Various colors are available (green, blue, pink). Green provides excellent color contrast with the tooth and is visually pleasant for the operator.==
### **Rubber Dam Punch**
> [!NOTE]
> A good punch is critical for creating clean, round holes that will not tear when stretched.
- ==**Punch Style:** The turntable style is preferred over the slot style, as it is easier to use.==
- ==**Hole Size:** Using the **largest hole** on the punch is sufficient for all teeth, including small lower incisors. There is no need to switch between different hole sizes.==
- ==**Technique:** To ensure a clean cut without tags, use a **
# **Rubber Dam Equipment**
* **Clamps** $\rightarrow$ **Molar teeth**
Four rubber dam clamps are shown:
* 4
* 12A
* 13A
* 2A
#### **Molar teeth**
- ==**#2T:** A versatile single-bowed clamp suitable for premolars, anterior teeth, and even some small molars. Its single bow provides better visual and physical access than the #9T.==
- ==**#0:** A smaller clamp suitable for very small premolars or lower anterior teeth.==
Four rubber dam clamps are shown:
- 4
- 12A
- 13A
- 2A
> [!NOTE]
> **Lower Molars:** The **#4** clamp is the go-to clamp for virtually all lower molars. It is flat and provides a stable fit.
**Upper Molars:**
- ==**#12A and #13A:** These are serrated, mirror-image clamps designed for upper molars. The longer beak goes to the buccal side.==
- ==**#13A:** For the upper right (Quadrant 1 - odd number).==
- ==**#12A:** For the upper left (Quadrant 2 - even number).==
- ==**#2A:** This clamp is slightly larger than the #2T and works well on smaller upper molars (e.g., second or third molars).==
**Rubber Dam Equipment**
- **Clamps** $\rightarrow$ **Keep the choices simple!!**
![]()
A display of several rubber dam clamps with corresponding labels: 9T, 2T, 0, 4, 12A, 13A, and 2A.
- **Keep the choices simple!!**
#### **General Principles and Clamp Selection**
- ==**Winged vs. Wingless:** **Winged clamps** are highly recommended. They allow the dam to be stretched over the wings before placement, enabling the clamp and dam to be seated on the tooth in a single, efficient step.==
- ==**Serrated (
**Rubber Dam Equipment**
| Single Tooth Isolation | Tooth Type | RD Cuff Technique |
| :--- | :--- | :--- |
| Clamp \# 9T | Upper Incisors | Clamp \# 2T on the $1^{st}$ Premolar tooth on the same side of the mouth. |
| Clamp \# 9T or \# 2T | Upper Canines | Clamp \# 2T on the $1^{st}$ or $2^{nd}$ Premolar tooth on the same side of the mouth. |
| Clamp \# 2T | Upper Premolars | Teeth 14, 15: Clamp \# 13A on tooth 16. <br> Teeth 24, 25: Clamp \# 12A on tooth 26. |
| Teeth 16, 17: Clamp \# 13A <br> Teeth 26, 27: Clamp \# 12A <br> Teeth 18, 28: Clamp \# 2A | Upper Molars | Tooth 16: Clamp \# 13A on tooth 17. <br> Tooth 26: Clamp \# 12A on tooth 27. <br> Teeth 17, 27: Clamp \# 2A on tooth 18 or 28 respectively, if present. |
| Clamp \# 9T | Lower Incisors | Clamp \# 2T on the $1^{st}$ Premolar tooth on the same side of the mouth. <br> Alternatively for Teeth **31, 41** - Clamp \# 00 on the 32 or 42 respectively. |
| Clamp \# 9T or \# 2T | Lower Canines | Clamp \# 2T on the $1^{st}$ or $2^{nd}$ Premolar tooth on the same side of the mouth. |
| Clamp \# 2T | Lower Premolars | Clamp \# 4 on the $1^{st}$ Molar on the same side of the mouth. |
| Clamp \# 4 | Lower Molars | $1^{st}$ Molars: Clamp \# 4 on the $2^{nd}$ Molar on the same side of the mouth. <br> $2^{nd}$ Molars: Clamp \# 4 on the $3^{rd}$ Molar on the same side of the mouth, if present. |
#### **Clamp Selection Guide**
> [!NOTE]
> The lecturer recommends a minimal set of clamps for most procedures, primarily used with the
| Isolation Type | Tooth Type | Clamp Selection |
| :--- | :--- | :--- |
| **Single Tooth Isolation** | Upper Incisors | Clamp # 9T |
| | Upper Canines | Clamp # 9T or # 2T |
| | Upper Premolars | Clamp # 2T |
| | Upper Molars | Teeth 16, 17: Clamp # 13A <br> Teeth 26, 27: Clamp # 12A <br> Teeth 18, 28: Clamp # 2A |
| | Lower Incisors | Clamp # 9T |
| | Lower Canines | Clamp # 9T or # 2T |
| | Lower Premolars | Clamp # 2T |
| | Lower Molars | Clamp # 4 |
| **RD Cuff Technique** | Upper Incisors | Clamp # 2T on the 1st Premolar tooth on the same side of the mouth. |
| | Upper Canines | Clamp # 2T on the 1st or 2nd Premolar tooth on the same side of the mouth. |
| | Upper Premolars | Teeth 14, 15: Clamp # 13A on tooth 16. <br> Teeth 24, 25: Clamp # 12A on tooth 26. |
| | Upper Molars | Tooth 16: Clamp # 13A on tooth 17. <br> Tooth 26: Clamp # 12A on tooth 27. <br> Teeth 17, 27: Clamp # 2A on tooth 18 or 28 respectively, if present. |
| | Lower Incisors | Clamp # 2T on the 1st Premolar tooth on the same side of the mouth. <br> Alternatively for Teeth **31, 41** - Clamp # 00 on the 32 or 42 respectively. |
| | Lower Canines | Clamp # 2T on the 1st or 2nd Premolar tooth on the same side of the mouth. |
| | Lower Premolars | Clamp # 4 on the 1st Molar on the same side of the mouth. |
| | Lower Molars | 1st Molars: Clamp # 4 on the 2nd Molar on the same side of the mouth. <br> 2nd Molars: Clamp # 4 on the 3rd Molar on the same side of the mouth, if present. |
**Rubber Dam Equipment**
* Frames
![]()
A collection of various types of rubber dam frames and associated equipment displayed on a blue background.
### **Frames**
**Rubber Dam Equipment**
- **Frames** **Young's frame (metal)**
- **Young's frame (metal)**
> [!NOTE]
> Not recommended for endodontics as it is radiopaque and must be removed for radiographs.
**Rubber Dam Equipment**
* **Frames** $\rightarrow$ **Star "Visi" frame**
![]()
Image showing a U-shaped frame (likely the "Star 'Visi' frame") and a patient with a rubber dam system in place, highlighting the mouth area with a red arrow.
- **Star
> [!NOTE]
> Can be uncomfortable, pressing on the upper lip and nose, potentially causing breathing difficulty for the patient.
"Visi" frame**
**Rubber Dam Equipment**
* **Frames** $\rightarrow$ **Star “Visi” frame**
![]()
Image showing two different views of a rubber dam frame in use on a patient. The view on the left is a side profile showing the frame holding the rubber dam material near the nose, and the view on the right is a frontal view of a patient with a Star "Visi" frame rubber dam in place.
**Rubber Dam Equipment**
* **Frames** $\Rightarrow$ **Nygaard-Östby frame**
![]()
A picture of two different types of rubber dam frames.
- **Nygaard-Östby frame**
> [!NOTE]
> The **Ospy Frame** is recommended instead. It is a four-sided, plastic, contoured frame.
- ==It is designed to fit the contours of the face, with the top portion arching *over* the patient's nose rather than blocking it.==
- ==The frame is placed *underneath* the rubber dam, which holds the dam away from the patient's face for increased comfort.==
**Rubber Dam Equipment**
- Frames $\rightarrow$ **Nygaard-Östby frame**
**Rubber Dam Equipment**
- **Frames** $\rightarrow$ **Nygaard-Östby frame**
![]()
A close-up image showing a rubber dam in place on a patient's mouth, with the rubber dam stretched over a Nygaard-Östby frame.
**Nygaard-Östby Frame**
![]()
A pair of images showing dental procedures using a rubber dam and clamps, with instruments visible in the right image.
**Nygaard-Östby Frame**
![]()
A series of images demonstrating the Nygaard-Östby frame for dental work, including an image of the frame itself, two illustrations of incorrect and correct usage, and two images of the frame in use on a patient.
**Nygaard-Östby Frame**
![]()
close-up of a Nygaard-Östby rubber dam frame and a patient with a rubber dam applied
**Endodontic “Working”**
**Radiography**
**Lower Posterior**
**Teeth**
![]()
A figure illustrating the use of a holder for a small radiography film in the mouth with a rubber dam in place for endodontic working and a large red X indicating an incorrect or disallowed technique in the smaller bottom right image.
### **Lower Posterior Teeth**
**Endodontic “Working”**
**Radiography**
![]()
A slide showing two dental radiographs with instruments still in place and a photo indicating a rubber dam should not be removed to take the radiograph, with a large pink arrow pointing from the photo to the radiographs.
**Endodontic “Working”**
**Radiography**
**Upper Posterior**
**Teeth**
<img Endodontic “Working” Radiography image depicting a patient with a rubber dam in place and a hand holding the dam. </img>
### **Upper Posterior Teeth**
**Endodontic "Working" Radiography**
**Upper Anterior Teeth**
![]()
Radiography setup for an endodontic working length on an upper anterior tooth
### **Upper Anterior Teeth**
**Endodontic “Working”**
**Radiography**
**Lower Anterior**
**Teeth**
![]()
A close-up image showing a dental procedure on the lower anterior teeth with an endodontic working radiograph being taken.
### **Lower Anterior Teeth**
# **Rubber Dam Equipment**
> [!NOTE]
> Using high-quality, appropriate equipment is essential for easy and effective rubber dam placement.
## **Extra Items**
-
# **Rubber Dam Equipment**
- **Extra Items $\rightarrow$ OraSeal**
![]()
A box of OraSeal and syringe along with a dental application example being performed on a tooth.
**Rubber Dam Equipment**
* **Extra Items $\rightarrow$ Wedjets**
![]()
Two boxes of Wedjets Dental Dam Stabilizing Cord and two cords (yellow and orange) laid on a blue surface.
**Rubber Dam Equipment**
- **Extra Items $\implies$ Wedjets**
**Rubber Dam Equipment**
- **Extra Items $\rightarrow$ Wedjets**
![]()
Close-up of teeth isolated with a rubber dam using yellow Wedjets and two colored tubes (yellow and orange) used as Wedjets.
# **Rubber Dam Equipment**
* **Extra Items $\rightarrow$ Wedjets + OraSeal**
![]()
Two close-up images showing teeth isolated with a rubber dam and yellow Wedjets placed interdentally, with the second image also showing a white material, OraSeal, used to seal the edges of the rubber dam.
Wedjets
[[L13 Rubber Damns for Endodontics.pdf#page=2|L13 Rubber Damns for Endodontics, p.2]]
[[L13 Rubber Damns for Endodontics.pdf#page=3|L13 Rubber Damns for Endodontics, p.3]]
[[L13 Rubber Damns for Endodontics.pdf#page=4|L13 Rubber Damns for Endodontics, p.4]]
[[L13 Rubber Damns for Endodontics.pdf#page=5|L13 Rubber Damns for Endodontics, p.5]]
[[L13 Rubber Damns for Endodontics.pdf#page=6|L13 Rubber Damns for Endodontics, p.6]]
[[L13 Rubber Damns for Endodontics.pdf#page=7|L13 Rubber Damns for Endodontics, p.7]]
[[L13 Rubber Damns for Endodontics.pdf#page=8|L13 Rubber Damns for Endodontics, p.8]]
[[L13 Rubber Damns for Endodontics.pdf#page=9|L13 Rubber Damns for Endodontics, p.9]]
[[L13 Rubber Damns for Endodontics.pdf#page=10|L13 Rubber Damns for Endodontics, p.10]]
[[L13 Rubber Damns for Endodontics.pdf#page=11|L13 Rubber Damns for Endodontics, p.11]]
[[L13 Rubber Damns for Endodontics.pdf#page=12|L13 Rubber Damns for Endodontics, p.12]]
[[L13 Rubber Damns for Endodontics.pdf#page=13|L13 Rubber Damns for Endodontics, p.13]]
[[L13 Rubber Damns for Endodontics.pdf#page=14|L13 Rubber Damns for Endodontics, p.14]]
[[L13 Rubber Damns for Endodontics.pdf#page=15|L13 Rubber Damns for Endodontics, p.15]]
[[L13 Rubber Damns for Endodontics.pdf#page=16|L13 Rubber Damns for Endodontics, p.16]]
[[L13 Rubber Damns for Endodontics.pdf#page=17|L13 Rubber Damns for Endodontics, p.17]]
[[L13 Rubber Damns for Endodontics.pdf#page=18|L13 Rubber Damns for Endodontics, p.18]]
[[L13 Rubber Damns for Endodontics.pdf#page=19|L13 Rubber Damns for Endodontics, p.19]]
[[L13 Rubber Damns for Endodontics.pdf#page=20|L13 Rubber Damns for Endodontics, p.20]]
[[L13 Rubber Damns for Endodontics.pdf#page=21|L13 Rubber Damns for Endodontics, p.21]]
[[L13 Rubber Damns for Endodontics.pdf#page=22|L13 Rubber Damns for Endodontics, p.22]]
[[L13 Rubber Damns for Endodontics.pdf#page=23|L13 Rubber Damns for Endodontics, p.23]]
[[L13 Rubber Damns for Endodontics.pdf#page=46|L13 Rubber Damns for Endodontics, p.46]]
[[L13 Rubber Damns for Endodontics.pdf#page=47|L13 Rubber Damns for Endodontics, p.47]]
[[L13 Rubber Damns for Endodontics.pdf#page=48|L13 Rubber Damns for Endodontics, p.48]]
[[L13 Rubber Damns for Endodontics.pdf#page=49|L13 Rubber Damns for Endodontics, p.49]]
[[L13 Rubber Damns for Endodontics.pdf#page=50|L13 Rubber Damns for Endodontics, p.50]]
[[L13 Rubber Damns for Endodontics.pdf#page=51|L13 Rubber Damns for Endodontics, p.51]]
[[L13 Rubber Damns for Endodontics.pdf#page=52|L13 Rubber Damns for Endodontics, p.52]]
[[L13 Rubber Damns for Endodontics.pdf#page=53|L13 Rubber Damns for Endodontics, p.53]]
[[L13 Rubber Damns for Endodontics.pdf#page=54|L13 Rubber Damns for Endodontics, p.54]]
[[L13 Rubber Damns for Endodontics.pdf#page=55|L13 Rubber Damns for Endodontics, p.55]]
[[L13 Rubber Damns for Endodontics.pdf#page=56|L13 Rubber Damns for Endodontics, p.56]]
[[L13 Rubber Damns for Endodontics.pdf#page=57|L13 Rubber Damns for Endodontics, p.57]]
[[L13 Rubber Damns for Endodontics.pdf#page=58|L13 Rubber Damns for Endodontics, p.58]]
[[L13 Rubber Damns for Endodontics.pdf#page=59|L13 Rubber Damns for Endodontics, p.59]]
[[L13 Rubber Damns for Endodontics.pdf#page=65|L13 Rubber Damns for Endodontics, p.65]]
[[L13 Rubber Damns for Endodontics.pdf#page=66|L13 Rubber Damns for Endodontics, p.66]]
[[L13 Rubber Damns for Endodontics.pdf#page=67|L13 Rubber Damns for Endodontics, p.67]]
[[L13 Rubber Damns for Endodontics.pdf#page=68|L13 Rubber Damns for Endodontics, p.68]]
[[L13 Rubber Damns for Endodontics.pdf#page=69|L13 Rubber Damns for Endodontics, p.69]]
[[L13 Rubber Damns for Endodontics.pdf#page=60|L13 Rubber Damns for Endodontics, p.60]]
[[L13 Rubber Damns for Endodontics.pdf#page=61|L13 Rubber Damns for Endodontics, p.61]]
[[L13 Rubber Damns for Endodontics.pdf#page=62|L13 Rubber Damns for Endodontics, p.62]]
[[L13 Rubber Damns for Endodontics.pdf#page=63|L13 Rubber Damns for Endodontics, p.63]]
[[L13 Rubber Damns for Endodontics.pdf#page=64|L13 Rubber Damns for Endodontics, p.64]]