Casemasters has reached 500 restorative cases completed with the aid of rubber dam isolation.

Rubber dam has proven useful in a number of dental procedures; however, its worldwide usage is not as common as it worth. Dental schools setup guidelines to uniformly apply rubber dam usage among dental students and as a standard of care at dental practices. The use of rubber dam has evolved in the past years as more dental training programs are organized and more educational events are run because it gives better visualization and contrast.

The unpopularity of rubber dam could be explained as a result of improper undergraduate training; however, more dental practitioners nowadays seek professional training on using rubber dam and other isolation techniques, especially those working in endodontic and restorative dentistry. Many dentists claim that using rubber dam is time/money waste, there is no rational for its use and many dentists complete their daily procedures without it.

Rubber dam acts as barrier against saliva contamination and thus enhances longevity of restoration and adhesion. In addition, it works on soft tissues’ retraction and protects them from potential trauma during dental treatment; also, rubber dam prevents potential ingestion or inhalation of clamps, crowns and endodontic files. The use of rubber dam provides a clear access to the area of interest in the oral cavity so that a clinician can complete his work efficiently and timely. Both dentist and patient will feel comfortable getting dental treatment using rubber dam; that is, the dentist will have an easy access to the targeted tooth, while the patient will be unstressed as fewer hands and instruments will be stuck inside his mouth; rubber dam will eliminate the need for frequent rinsing while treatment and should replace cotton rolls that cause confusion and compromise performance.

Sanford Barnum was the first dentist to apply rubber dam and since then it has been recognized as the single most effective way for isolation. Rubber dam is applied on the cervical margin of the targeted tooth at the sulcus to provide a large dry working field with minimal interference with restorative work. The rubber dam is firstly punched into a number of holes, each corresponding to one particular tooth, and then inverted over the gingival margins of teeth. At this step, the rubber dam must be handled gently by the operator, slipped along the long axes of teeth and placed passively onto the cervical area into the sulcus.

There are a number of techniques for adapting the rubber dam onto the cervical margins but the most common techniques are: placing a dental floss around the teeth, placing knots and ligatures and using Teflon tape. Choosing one technique rather than other is not based only on the dentist’s familiarity with the technique but also on the proposed dental treatment. For example, complete isolation of marginal gingiva in root canal treatment is not as mandatory as when preparing a tooth for crown or filling. Also, tooth preparations for different dental procedures require variable isolation protocol, that is, supra-gingival preparation differs from sub-gingival preparation and from Class II cavities.