10 - 4OOTH )SOLATION: THE 2UBBER $AM 22\

10
4OOTH )SOLATION: THE 2UBBER $AM
!2.!,$/ #!34%,,5##), -.$., $.$.3.

DAM.
4HE NEED TO WORK UNDER DRY CONDITIONS, FREE OF SALI-
VA, HAS BEEN RECOGNIZED FOR CENTURIES, AND THE IDEA
OF USING A SHEET OF RUBBER TO ISOLATE THE TOOTH
DATES AL- MOST 1Ç0 YEARS! 4HE INTRODUCTION OF THIS
NOTION IS AT- TRIBUTED TO A YOUNG !MERICAN DENTIST
FROM .EW 9ORK, 3ANFORD #HRISTIE "ARNUM, WHO IN
1865 DEMONSTRATED FOR THE lRST TIME THE ADVANTAGES
OF ISOLATING THE TOOTH WITH A RUBBER SHEET. !T THAT
TIME, KEEPING THE RUBBER IN PLACE AROUND THE TOOTH
WAS PROBLEMATIC, BUT THINGS SOON IMPROVED A FEW
YEARS LATER, WHEN IN 1882 3. 3. 7HITE INTRODUCED A
RUBBER DAM PUNCH SIMILAR TO THAT USED STILL NOW. )N
THE SAME YEAR, $R. $ELOUS 0ALMER IN- TRODUCED A SET
OF METAL CLAMPS WHICH COULD BE USED FOR DIFFERENT
TEETH.
4HIS SAID, IT SEEMS INCREDIBLE THAT EVEN TODAY, TWO
CEN- TURIES LATER AND LIVING NOW IN THE THIRD
MILLENNIUM, THE- RE ARE STILL DENTISTS WHO ARE NOT
CONVINCED OF THE USE- FULNESS OF THIS VERY SIMPLE
RUBBER SHEET. /N THE OTHER HAND, IT IS ALSO INCREDIBLE
THAT THE 3CIENTIlC !SSOCIATIONS WHO ARE IN CHARGE OF
LAYING DOWN THE h'UIDELINESv DO NOT SAY THAT THE USE
OF RUBBER DAM IS MANDATORY TO PERFORM ANY KIND OF
NONSURGICAL ENDODONTIC TREATMENT. 4HE 1UALITY !
SSURANCE 'UIDELINES OF THE !MERICAN
!SSOCIATIONS OF %NDODONTISTS 2 SAYS THAT hCLEANING, SHA-
PING, DISINFECTION AND OBTURATION OF ALL CANALS ARE
AC- COMPLISHED USING AN ASEPTIC TECHNIQUE WITH
DENTAL DAM ISOLATION WHENEVER POSSIBLEv. !CCORDING TO
THE AU- THOR’S OPINION, WHEN IT IS NOT POSSIBLE, THE
CLINICIAN HAS TWO OPTIONS: ONE IS TO MAKE IT POSSIBLE
AND THE OTHER IS TO EXTRACT THE TOOTH! 4HERE IS NO
OTHER CHOICE.
4HE OPERATIVE PROCEDURES THAT ARE PERFORMED IN THE
PATIENT’S MOUTH MUST BE SEEN AS LARGER OR SMALLER SUR-
GICAL PROCEDURES. )N DENTISTRY, AS IN GENERAL
SURGERY, ISOLATION OF THE OPERATIVE lELD IS IMPERATIVE,
EVEN FOR A SIMPLE lLLING.
%VEN MORE SO THAN IN RESTORATIVE DENTISTRY, THE RUBBER
DAM IS OBLIGATORY IN %NDODONTICS,1Ç SO MUCH SO THAT
%NDODONTICS SHOULD NOT BE PERFORMED WITHOUT A
2 %NDODONTICS

&URTHERMORE, AN ENDODONTIC TREATMENT SHOULD NOT

BE UNDERTAKEN UNLESS THE TOOTH n PARTICULARLY IF
DAMAGED n HAS NOT BEEN RECONSTRUCTED TO ALLOW EASY
POSITIONING OF THE RUBBER DAM. 4HERE SHOULD BE NO
EXCUSE FOR NOT USING THE RUBBER DAM IN
%NDODONTICS; THE LAW SHOULD SEVERELY PUNISH THE
DENTIST WHO CAUSES SERIOUS INJURY, INCLUDING DEATH,
TO A PATIENT BECAUSE HE DID NOT USE ONE.8,16,18,21,26
0ATICK 7AHL IN A RECENT ARTICLE SAYS THAT IN THE 5NITED
3TATES ANY LAW SUIT IS LOST IF THE RUBBER DAM HAS
NOT BEEN USED.27
4HE ONLY TOOTH THAT MAY BE TREATED WITHOUT THE
RUB- BER DAM IS THE TOOTH THAT IS SO SEVERELY
DAMAGED THAT THE ONLY INSTRUMENTS TO BE USED ARE THE
EXTRACTING FOR- CEPS. !S !IELLO 1 STATES, ONE MUST
RECALL THAT THE RUBBER DAM CLAMP OCCUPIES THE
FUTURE POSITION OF THE MAR- GINAL CLOSURE OF THE
PROSTHETIC CROWN. )T IS THEREFORE UNTHINKABLE TO
ENDODONTICALLY TREAT A TOOTH ON WHICH THE RUBBER
DAM CANNOT BE ASSEMBLED, SINCE IT IS NOT KNOWN
WHETHER AND HOW THE TOOTH WILL BE RESTORED.
! CONTRAINDICATION TO THE USE OF THE RUBBER DAM
IS A PATIENT’S ALLERGY TO THE CHEMICAL CONSTITUENTS OF
RUB- BER.Ç,11 )N THIS CIRCUMSTANCE, ALBEIT RARE, THE
TEETH MAY BE ISOLATED WITH POLYTHENE SHEETS,22
WHICH IMPOSE LI- MITATIONS RELATED TO THE LACK OF
ELASTICITY OF THIS MATE- RIAL AS COMPARED TO RUBBER.
4ODAY hNO-LATEXv DAM IS AVAILABLE,17 TO BE USED ON
ALLERGIC PATIENTS (&IG. 10.1). 4HERE ARE ODD RUMORS
ABOUT THE USE OF THE RUBBER DAM; FOR EXAMPLE, IT
IS CLAIMED THAT IT TAKES TOO MUCH TIME TO ASSEMBLE.
#RAGG 10 CORRECTLY STATES THAT hTHAT WHICH TAKES
MORE TIME, WITH RESPECT TO THE RUBBER DAM, IS
TRYING TO CONVINCE THE DENTIST TO USE ITv.
)T IS WORTH SPENDING A FEW SECONDS TO ASSEMBLE THE
RUBBER DAM FOR USE IN ENDODONTIC PROCEDURES
AND THUS IMPROVE THE ENTIRE TREATMENT.
)N %NDODONTICS, USE OF THE RUBBER DAM CONFERS THE
FOL- LOWING ADVANTAGES:
1. 4HE PATIENT ARE PROTECTED FROM THE INGESTION
26
(&IGS. 10.2, 10.3) OR, WORSE, THE ASPIRATION 16 OF
SMALL
&IG. 10.1. .O-LATEX RUBBER DAM, FOR ALLERGIC PATIENTS.

&IG. 10.3. 4HIS RADIOGRAPH SHOWS THE PRESENCE OF

AN ENDODONTIC INSTRUMENT AMONG THE INTESTINAL
LOOPS. &EW WEEKS LATER, THE PATIENT DIED!12

6. 4HE DENTISTS AND DENTAL ASSISTANTS ARE PROTECTED

AGAINST INFECTIONS WHICH CAN BE TRANSMITTED BY
THE PATIENT’S SALIVA.9
7. 4HE DENTISTS ARE MORE COMFORTABLE, AS THEY MAY
WORK AT A MORE LEISURELY PACE AND MAY BE
PERMIT- TED TO ANSWER AN IMPORTANT TELEPHONE
&IG. 10.2. 4HIS PHOTOGRAPH, TAKEN DURING GASTROSCOPY, SHOWS A LARGE ROOT CALL, LEAVING THE PATIENTS WELL PROTECTED WITH
CANAL REAMER AMONG THE FOLDS OF THE GASTRIC MUCOSA. THE RUBBER DAM AND THE DENTAL ASSISTANT CLOSE
TO THEM.
8. "ETTER TACTILE SENSITIVITY DURING THE CLEANING AND SHA-
INSTRUMENTS, DENTAL FRAGMENTS, IRRIGATING SOLUTIONS,
PING PROCEDURE. 7ITHOUT THE RUBBER DAM, THE DEN-
OR IRRITANT SUBSTANCES.
TISTS, AWARE OF THE RISK OF CAUSING THE PATIENTS TO
2. 4HE OPPORTUNITY TO OPERATE IN A CLEAN SURGICAL
IN- GEST OR ASPIRATE AN INSTRUMENT, HOLDS THE lLES
lELD.
IN SUCH AS WAY THAT THEY WILL NOT SLIP FROM THEIR
3. 2ETRACTION (VERY IMPORTANT FOR WORKING IN THE PO-
lNGERS. 4HE PRESSURE THEY APPLIE TO THE HANDLE OF
STERIOR AREAS) AND PROTECTION OF THE SOFT TISSUES
THESE INSTRU- MENTS REDUCES THE SENSITIVITY OF
(GUMS, TONGUE, LIPS, AND CHEEKS), WHICH ARE
THEIR lNGERS AND PRECLUDES THE USE OF THE
SHEL- TERED FROM THE CUTTING ACTION OF THE
INSTRUMENTS TO PERFORM DE- LICATE PROCEDURES. 7ITH
BUR.
THE RUBBER DAM IN PLACE, ON THE OTHER HAND, THEY
5. "ETTER VISIBILITY IN THE WORKING AREA. 4HE
MAY HOLD THE INSTRUMENTS DELI- CATELY, WITHOUT
ADVERTISE- MENT OF A FAMOUS MANUFACTURER OF
FEARING THAT THEY MAY SLIP FROM THEIR HAND.19
INSTRUMENTS FOR THE ASSEMBLY OF THE RUBBER DAM
9. 4HE PATIENTS ARE MORE COMFORTABLE, AS THEY DO
CORRECTLY READS: h$O BETTER WHAT YOU SEE AND SEE
NOT FEEL THAT THEIR MOUTH IS INVADED BY HANDS,
BETTER WHAT YOU DOv.
INSTRUMENTS, AND LIQUIDS.
Ç. 2EDUCTION OF DELAYS: THE PATIENTS, WITH
0ATIENTS INCREASINGLY APPRECIATE THE USE OF THE RUBBER
FORTUNATELY RARE EXCEPTIONS, CANNOT CONVERSE
DAM. /N OCCASION, THEY MAY ASK WHETHER IT IS A
EXCEPT WITH GREAT DIFlCULTY; BESIDES, THEY WILL NOT
NEW INVENTION,25 AND ONCE THEY HAVE TRIED IT, THEY
HAVE TO RINSE THEIR MOUTH EVERY lVE MINUTES.
DO NOT WANT TO DO WITHOUT IT IN THE FUTURE.
).3425-%.43 RUB- BER DAM IN THE DIFFERENT SECTORS OF THE MOUTH.

4O FACILITATE THE ASSEMBLY OF THE RUBBER DAM, IT IS

ADVI- SABLE TO HAVE THE APPROPRIATE INSTRUMENTS
WITHIN ARM’S REACH. 4HIS IS SIMPLER THAN IT MIGHT
APPEAR (&IG. 10.5).

1) 2UBBER DAM

4HE DAM COMES IN DIFFERENT SIZES (Çv X Çv INCHES

AND
6v X 6v INCHES, AS WELL AS ROLLS), COLORS (LIGHT,
BLUE, GRAY, AND GREEN), AND THICKNESSES (SPECIAL
HEAVY, EXTRA HEAVY, HEAVY, MEDIUM, AND THIN).
4HE 6v X 6v FORMAT IS USEFUL IN RESTORATIVE DENTISTRY,
WHERE IT IS NECESSARY TO ISOLATE SEVERAL TEETH AT
THE SAME TIME. )N %NDODONTICS, WHERE ONE TOOTH IS
ISO- LATED AT A TIME, THE Çv X Çv FORMAT IS MORE
THAN SUF- lCIENT, EVEN FOR WORKING IN THE POSTERIOR
SECTORS OF THE MOUTH.
3OME PREFER THE DARK COLORS, SINCE THE TOOTH STANDS
OUT BETTER, BUT IT IS REALLY A QUESTION OF HABIT. 4HE
LIGHT-CO- LORED DAM IS SLIGHTLY TRANSPARENT, UNLIKE THE
OTHER CO- LORS, WHICH MAY BE HELPFUL IN POSITIONING
THE INTRA- OPERATIVE RADIOGRAPH.
4HE QUALITY OF THE DAM SHEETS DETERIORATES WITH
TIME; IN PARTICULAR, THEY LOSE ELASTICITY. /NE SHOULD
THEREFORE STOCK THEM IN MODERATE QUANTITIES, KEEP
THEM REFRIGE- RATED, OBSERVE THE EXPIRATION DATE ON
THE BACK OF THE BOX, AND OBTAIN ONE’S SUPPLIES FROM A
DISTRIBUTOR THAT SELLS THEM AT HIGH VOLUME, SO AS TO
AVOID BUYING SUP- PLIES THAT HAVE ALREADY BEEN IN THE
WAREHOUSE FOR A LONG PERIOD OF TIME AND HAVE
THUS ALREADY EXPIRED.
4O TEST THEM, ONE CAN PERFORM THE SAME TEST AS THAT
TO CHECK THE ADEQUACY OF THE DAM PUNCH: JUST AFTER
PUN-

&IG. 10.4. -INIMUM SET OF INSTRUMENTS NECESSARY FOR THE ASSEMBLY OF THE
CHING A HOLE IN THE DAM, IT IS STRETCHED IN DIFFERENT
DI- RECTIONS TO CONlRM THAT IT DOES NOT TEAR.

2) 2UBBER DAM PUNCHES

)T IS USED TO MAKE ROUND HOLES OF DIFFERENT

DIAME- TERS (0,7 n 2 MM), DEPENDING ON THE TOOTH
TO BE ISOLA- TED. 3EVERAL BRANDS ARE AVAILABLE.
.ONETHELESS, IT IS NE- CESSARY TO CHECK WHETHER THE
DAM OPENING IS EXACTLY ROUND, WITHOUT IRREGULARITIES.
4O DETERMINE THIS, IT SUF- lCES TO PUNCH A HOLE IN A
DAM SHEET AND THEN ENLARGE THIS OPENING BY
STRETCHING THE SHEET IN DIFFERENT DIREC- TIONS. 4HE
DAM SHOULD NOT TEAR.

$) 2UBBER DAM CLAMPS

4HE lT OF THE RUBBER DAM ESSENTIALLY DEPENDS ON

THE CHOICE OF THE APPROPRIATE CLAMP AND ITS
CORRECT POSI- TIONING.
4HE CLAMPS ARE CLASSIlED AS WINGED OR WINGLESS.
4HE DENTIST MAY CHOOSE THOSE WITH WHICH HE FEELS
MORE COMFORTABLE (&IGS. 10.Ç-10.7). 4HE POSITIONING
TECHNIQUES VARY SLIGHTLY, BUT THE lNAL RESULT IS THE
SAME. 3OMETIMES WINGLESS CLAMPS ARE PREFERABLE,
INASMUCH AS THEY ARE LESS BULKY AND MAY BE USED EASILY
IN THE POSTERIOR SECTORS IN PATIENTS WITH
PARTICULARLY THICK CHEEKS.
4HE MOST COMMONLY USED ARE:

&2/.4 4%%4(:
)6/29 ....... ¤ 6
)6/29 ....... ¤ 9
)6/29 ....... ¤ 90.
)6/29 ....... ¤ 2123
)6/29.......¤ 1Ç

02%-/,!23:
)6/29 ....... ¤ 1
)6/29 ....... ¤ 2
)6/29 ....... ¤ 2!

-/,!23 4(!4 !2% #/-0,%4%,9 %2504%$, 7(/,

%,
/2 #/6%2%$ "9 &5,, #2/7.3:
)6/29 ....... ¤ 7

-/,!23 4(!4 !2% ).#/-0,%4%,9 %2504%$ /2

!,2%!$9 02%0!2%$ &/2 ! &5,, #2/7.:
)6/29 ....... ¤ 15
)6/29 ....... ¤ 15!
)6/29 ....... ¤ 7!
 10 - 4OOTH )SOLATION: THE 2UBBER $AM 229

&IG. 10.5. #LAMPS FOR THE FRONT TEETH. &IG. 10.6. #LAMPS FOR THE PREMOLARS

! "

&IG. 10.7. #LAMPS FOR THE MOLARS. !. 7INGED. " 7INGLESS.

!39--%42)#!, -/,!23, ). 0!24)#5,!2 4(% THE RUBBER DAM n IS ACHIEVED.

3%#/.$ !.$ 4()2$: 4HE ONLY DANGER IS FRACTURE OF THE RUBBER DAM CLAMP
)6/29 ....... ¤ 10 ONCE IT HAS BEEN POSITIONED IN THE MOUTH. )F THIS
OC-
)6/29 ....... ¤ 11 CURS, THE ELASTICITY OF THE DAM WILL CAUSE THE FRAGMENTS
)6/29 ....... ¤ 12! TO BE EJECTED FROM THE PATIENT’S MOUTH. )T IS
THEREFORE
)6/29 ....... ¤ 13! PRUDENT TO SECURE THE CLAMP WITH DENTAL mOSS AND
AN-
CHOR IT TO THE DAM FRAME.
7).',%33, 4/ "% 53%$ 7(%. 4(% 7).'3 ADAPTATION IS PERMIT- TED, AS LONG AS THE lNAL RESULT n
/"3425#4 CORRECT PLACEMENT OF
4(% 7/2+).' &)%,$:
)6/29 ....... ¤ 78!
)6/29 ....... ¤ 26.

4HE CLAMPS MAY ALSO BE MODIlED TO IMPROVE

THEIR GRIP AND ALLOW A MORE PRECISE lT. 13 -OREOVER,
THERE IS NO REASON NOT TO USE A PREMOLAR CLAMP ON A
SMALL MO- LAR OR FRONTAL TOOTH, OR A ¤ 9 CLAMP ON A
HEMISECTED ROOT OF A LOWER MOLAR; ANY SUCH
2$O %NDODONTICS

5) 2UBBER DAM CLAMP FORCEPS

4HIS INSTRUMENT IS NECESSARY TO OPEN THE CLAMP AND

POSITION IT AROUND THE TOOTH. 4HE )VORY FORCEPS ARE
PREFERABLE, BECAUSE THEY ALLOW THE DENTIST TO APPLY DI-
RECT PRESSURE TOWARD THE GUM, WHICH IS FREQUENTLY NE-
CESSARY TO POSITION THE CLAMP SECURELY BELOW THE
BUL- GE OF THE TOOTH CROWN.
Ç) 2UBBER DAM FRAME
4HIS IS NECESSARY TO MAINTAIN TENSION IN THE DAM
SO THAT THE LIPS AND CHEEKS MAY BE RETRACTED WELL.
3OME FRAMES, INCLUDING THE 9OUNG FRAME, ARE MADE
OF VE- RY THIN METAL; OTHERS, INCLUDING THE
.YGAARD-/STBY OR 3TARLITE FRAME, ARE PLASTIC. )N
COMPARISON TO THE 9OUNG FRAME, THE LATTER HAVE THE
ADVANTAGE OF BEING TRANSPA- RENT; ON THE OTHER HAND,
THEY ARE BULKIER.
$AM TENSORS SUCH AS THOSE OF 7OODBURG,23 #OGSWELL,
-ITCHELL, AND &ERNALD,3 (&IG. 10.8) WHICH ARE BASED
ON THE PRINCIPLE OF MAINTAINING TENSION IN THE DAM BY
THE USE OF CLIPS AND ELASTIC BANDS PASSING DIRECTLY OVER
THE
NAPE OF THE NECK, ARE OUT-DATED AND HAVE NO USE
IN MODERN %NDODONTICS.
&URTHERMORE, THEY HAVE NUMEROUS DISADVANTAGES: THEY
REQUIRE MORE TIME FOR POSITIONING; THEY COMPLETELY
COVER THE PATIENT’S NOSE AND MOUTH, GIVING HIM
THE UNPLEASANT SENSATION OF SUFFOCATION; AND THEY
DO NOT CAUSE THE LEAST BIT OF RETRACTION OF THE LIPS OR
CHEEKS, LIKE THE OTHERS.
.EW RUBBER DAMS RECENTLY INTRODUCED IN THE MARKET
ARE THE (ANDIDAM (!SEPTICO, 7OODINVILLE, 7!)
AND THE )NSTI-$AM (:IRC #OMPANY, "UFFALO, -.), TWO
RUB- BER DAM SYSTEMS WITH BUILT-IN FOLDABLE
RADIOLUCENT PLASTIC FRAME (&IG. 10.9).

! " #

$ %

&IG. 10.8. !. 7OODBURG’S RUBBER-DAM TENSORS, WHICH ARE NO LONGER USED (COURTESY OF $ENTAL 4REY, &ORLÖ). ". $R. #OGSWELL’S DAM HOLDER. #. $R. #OGSWELL’S DAM IN
PLACE.
$. $R. &ERNALD’S DAM HOLDERS. %. $R. "RASSEUR’S DAM HOLDER (FROM %. !NDREU: 4RAITÏ DE DENTISTERIE OPERATOIRE, 0ARIS, 1889).
2$2 %NDODONTICS

0/3)4)/.).' /& 4(% $!-

!FTER USING DENTAL mOSS TO CHECK THE NATURE OF THE CON-

TACTS (&IG. 10.10) AND DETERMINE WHETHER THERE IS WEL-
DING BETWEEN PROSTHETIC CROWNS OR WHETHER THERE ARE
IRREGULARITIES OF OLD RESTORATIONS THAT NEED TO BE ELIMI-
NATED, ONE SELECTS THE CLAMP THAT ONE THINKS MIGHT
BE APPROPRIATE FOR THE CASE AND TRIES IT IN THE MOUTH
(&IG. 10.11). )T IS ADVISABLE TO SECURE THE CLAMP WITH
DEN-

&IG. 10.9. 4HE )NSTI-$AM (LEFT) AND THE (ANDIDAM (RIGHT).

6) ,UBRICANT

"EFORE POSITIONING THE DAM, IT IS AN ADVISABLE TO

LU- BRICATE THE INNER SURFACES WELL WITH 6ASELINE OR,
MO- RE SIMPLY, SOAP, SO THAT THE SHEET WILL SLIDE BETTER
OVER THE CONTOURS OF THE TEETH, MORE EASILY &IG. 10.10. 4HE USE OF DENTAL mOSS PROVIDES INFORMATION ABOUT
OVERCOME THE CONTACT AREAS, AND CLOSE TIGHTLY AROUND THE CONTACT AREAS.
THE CERVIX OF THE TOOTH.

\) 2UBBER DAM NAPKINS

4HESE PREVENT DIRECT CONTACT BETWEEN THE RUBBER

SHEET AND THE PATIENT’S CHEEK. "Y ABSORBING THE SALI-
VA THAT ACCUMULATES BENEATH THE DAM BY CAPILLARY
AC- TION, THEY FACILITATE TREATMENT. 4HEIR USE IS NOT
MANDA- TORY; HOWEVER, THEY ARE PARTICULARLY INDICATED
IN CASES OF ALLERGY TO THE RUBBER OF THE DAM.
!

8) $ENTAL mOSS

!PART FROM PREVENTING THE INGESTION OR ASPIRATION OF

THE CLAMP, DENTAL mOSS IS PARTICULARLY USEFUL FOR
AS- SESSING THE CONDITION OF THE MESIAL AND DISTAL
CONTACT AREAS, AND THUS FOR FACILITATING THE PASSAGE OF
THE RUB- BER SHEET BENEATH THEM.

9) !SSISTANT "

4HE DENTIST MAY POSITION THE RUBBER DAM ON ANY
TOOTH USING ONLY HIS HANDS, BUT IT IS OBVIOUS THAT THIS
PROCE- DURE IS FACILITATED BY THE HELP OF AN
ASSISTANT.
&IG. 10.11. !. 4HE CLAMP IS POSITIONED AROUND THE TOOTH IN SUCH A WAY THAT IT
IS STABLE AND DOES NOT DAMAGE THE PERIODONTAL TISSUES. $ENTAL mOSS HAS
BEEN TIED TO THIS CLAMP FOR SECURITY REASONS. )F IT SLIPPED OFF DURING THE TRIAL
PLACE- MENT, IT COULD BE SWALLOWED OR ASPIRATED. )F IT BROKE WHILE BEING
OPENED WITH THE RUBBER DAM CLAMP FORCEPS, THE LINGUAL PART COULD EASILY
DISAPPEAR INTO THE PATIENT’S THROAT. ". 3AME PRECAUTION FOR A FRONT
TOOTH.
TAL mOSS, TO PROTECT THE PATIENT FROM THE INGESTION OR IN THE OPENING OF THE RUBBER SHEET (&IG. 10.12),
THE ASPIRATION OF THE CLAMP. )F IT COMES OFF EASILY, IT WHICH SHOULD ALREADY HAVE BEEN PREPARED.
SHOULD BE CHANGED. )F IT APPEARS STABLE, ONE INSERTS )NITIALLY, IT MAY BE DIFlCULT TO POSITION THE OPENING
IT

! "

# $

% &

' (

&IG. 10.12. !. 4HE RUBBER SHEET IS PUNCHED WITH THE RUBBER DAM PUNCH. ", #. 4HE RUBBER DAM IS STRETCHED OVER THE WINGS OF THE SELECTED CLAMP. $. 7ITH THE
HELP OF AN ASSISTANT, THE DAM AND CLAMP ARE PLACED IN POSITION IN THE PATIENT’S MOUTH. %. 4HE RUBBER DAM CLAMP FORCEPS POSITIONS THE CLAMP AROUND THE TOOTH TO
BE TREATED. &, '. 9OUNG’S FRAME IS POSITIONED TO PRODUCE TENSION IN THE DAM. (. 5SING AN INSTRUMENT, THE DAM IS SLIPPED BENEATH THE CLAMP WINGS ON THE BUCCAL
SIDE (CONTINUED).
2$5 %NDODONTICS

&IG. 10.13. )N DECIDING WHERE TO PUNCH THE OPENING IN THE RUBBER SHEET, ONE
CAN MENTALLY TRACE THREE VERTICAL AND THREE HORIZONTAL LINES. 4HE ELLIPSE
INSCRI- BED WITHIN THE CENTRAL RECTANGLE CORRESPONDS TO THE TWO DENTAL
ARCHES.

&IG. 10.12. (CONTINUED) ). 4HE SAME IS DONE ON THE LINGUAL SIDE. *, +. $ENTAL
mOSS IS USED TO FORCE THE DAM THROUGH THE INTERPROXIMAL
CONTACTS.

"

CORRECTLY SO THAT THE DAM DISTURBS NEITHER THE DENTIST

NOR THE PATIENT. 4HE POSTERIOR TEETH MAY PRESENT
GREA- TER PROBLEMS. )N THESE CASES, IT IS ADVISABLE TO
PUNCH THE OPENING MORE CENTRALLY THAN SUGGESTED
BY THE COMMERCIALLY AVAILABLE STAMPS OR AT THE POINT
CORRE- SPONDING TO THE IMAGINARY ELLIPSE THAT
REPRESENTS THE DISTRIBUTION OF THE TEETH IN THE
PATIENT’S TWO ARCHES (&IG. 10.13). )N TREATING A
POSTERIOR TOOTH, IT IS PREFE- RABLE TO PLACE THE
TOOTH IN THE CENTER OF THE DAM, PLA- CING THE DAM #
ASYMMETRICALLY WITH RESPECT TO THE PA- TIENT’S FACE
(&IG. 10.15), RATHER THAN THE OPPOSITE (&IG. 10.1Ç). 4HE &IG. 10.14. !. 4HE OPENING HAS BEEN MADE MORE OR LESS WITHIN THE CENTER OF
THE DAM, WHICH IS ASYMMETRICAL WITH RESPECT TO THE PATIENT’S FACE. ". )N
MORE DISTAL THE POSITION OF THE TOOTH, THE CLOSER THE THIS WAY, THE METALLIC FRAME DOES NOT INTERFERE WITH THE 8-RAY MACHINE. #.
OPENING MUST BE TO THE CENTER OF THE RUBBER SHEET.2Ç )T IS 4HE PATIENT CAN ALSO BREATHE THROUGH THE MOUTH.
BETTER THAT THE TOOTH UNDER TREATMENT BE IN
 ! "

# $

&IG. 10.15. !. 4HE OPENING HAS BEEN MADE AT THE POINT INDICATED BY THE ELLIPSE RULE. 4HE DAM IS THEREFORE ASYMMETRIC WITH
RESPECT TO THE PATIENT’S FACE, WHILE THE TOOTH EMERGES AT A POINT CLOSE TO THE METALLIC FRAME. ", #. 4HE METALLIC FRAME INTERFERES
WITH THE 8- RAY MACHINE, CAUSING IT TO PROJECT THE FRAME’S SHADOW ONTO THE RADIOGRAPH. $. 4HE DAM ADHERES TO THE ENTIRE
CIRCUMFERENCE OF THE MOUTH, PRECLUDING ORAL RESPIRATION.

THE CENTER OF THE OPERATIVE lELD THAN THAT THE
RUBBER BE IN THE CENTER OF THE MOUTH.6
#ENTRAL POSITIONING OF THE OPENING HAS SEVERAL
ADVAN- TAGES IN TREATING THE MOLARS:
n /NCE POSITIONED, THE DAM WILL BE QUITE ASYMMETRI-
CAL WITH RESPECT TO THE PATIENT’S MOUTH, AND THEREFO-
RE FURTHER DISPLACED FROM THE SIDE BEING WORKED
ON. 4HIS INSURES GREATER RETRACTION OF THE LIPS AND
IPSILA- TERAL CHEEK.
n 3INCE THE DAM IS ASYMMETRICAL, THERE IS ENOUGH SPACE
FROM THE CONTROLATERAL PART TO PERMIT ORAL RESPIRATION
ON THE PART OF THE PATIENT, WHICH IS ESSENTIAL IN
PATIEN- TS WHO HAVE DIFlCULTY WITH NASAL RESPIRATION.
4HE DEN- TIST CAN ALSO EASILY INTRODUCE ANY
RADIOGRAPHS INTO THE PATIENT’S MOUTH THAT NEED TO BE
TAKEN INTRAOPERATIVELY WITHOUT HAVING TO DISMOUNT
THE FRAME OF THE DAM.
n 4HE SAME SPACE CAN BE USEFUL IN THE PATIENT WITH
ABUNDANT SALIVATION TO KEEP AN ASPIRATOR IN THE
MOUTH.
n "ECAUSE THE DAM IS DISPLACED FROM THE SIDE IN WHICH
ONE IS WORKING, THE RISK OF OBTAINING INTRAOPERATIVE
RADIOGRAPHS OBSTRUCTED BY THE METAL FRAME IS REDUCED.
"EFORE POSITIONING THE RUBBER DAM, IT IS A GOOD
IDEA TO ILLUSTRATE TO THE PATIENTS THE UTILITY AND
FUNCTION OF
THE DAM, ESPECIALLY IN VERY YOUNG PATIENTS; FOR EXAM-
PLE, WE CAN PLACE A lNGERTIP IN THE DAM OPENING
(&IG. 10.16). 4HE PATIENTS MUST ALSO BE TOLD THAT,
WITH THE DAM IN PLACE, THEY MAY SAFELY SWALLOW,
COUGH, OR YAWN AND THAT THEY MAY DO SO WITHOUT
PLACING THEIR HAND IN FRONT OF THEIR MOUTH! 4HE
ONLY THINGS THEY MUST NOT DO ARE TALK AND
RINSE.
0ATIENTS WITH AN EASILY-PROVOKED GAG REmEX SHOULD RE-
LAX SINCE THE RUBBER DAM WILL NOT TOUCH THE AREAS
THAT MAY PROVOKE THEIR REmEX; STILL, THE DAM IS
DElNITELY BETTER TOLERATED AND SAFER THAN
COTTON ROLLS.
4HERE ARE MANY METHODS OF PLACING THE DAM. 4HEY ARE
MORE OR LESS SIMPLE, AND THE DENTIST CAN CHOOSE THE
PREFERRED ONE. 4HE ASSISTANT CAN PLACE THE DAM AROUND
THE TOOTH (&IG. 10.17) AS THE DENTIST POSITIONS THE
CLAMP (&IG. 10.18) AND THEN THE FRAME (&IG. 10.19). 4HIS
PRO- CEDURE IS OFTEN DIFlCULT, IF NOT IMPOSSIBLE,
ESPECIALLY IN THE POSTERIOR AREAS OR PARTICULARLY
SMALL MOUTHS.
!NOTHER METHOD REQUIRES PLACING THE CLAMP WITHIN
THE OPENING OF THE DAM. "OTH THE CLAMP AND DAM
ARE PO- SITIONED AROUND THE TOOTH, EVEN WITHOUT AN
ASSISTANT. 4HE POSITIONING OF THE FRAME FOLLOWS.
/BVIOUSLY, IN THIS CASE THE TECHNIQUE VARIES SLIGHTLY,
DEPENDING ON WHETHER ONE USES WINGED (&IG. 10.20)
OR WINGLESS
 10 - 4OOTH )SOLATION: THE 2UBBER $AM
2$Ç

&IG. 10.16.4HE lNGERTIP IS INTRODUCED IN THE DAM OPENING TO BETTER

&IG. 10.17. 4HE ASSISTANT’S HANDS POSITION THE DAM DIRECTLY AROUND THE
ILLUSTRATE TO THE PATIENT THE FUNCTIONS OF THIS RUBBER SHEET.
TOOTH TO BE TREATED.

&IG. 10.18. 4HE DENTIST POSITIONS THE CLAMP. &IG. 10.19. 7ITH ASSISTANCE, THE DENTIST POSITIONS 9OUNG’S FRAME.

! "

&IG. 10.20. 0OSITIONING OF THE DAM CAN BE PERFORMED WITHOUT THE HELP OF AN ASSISTANT. !. 4HE PERFORATED DAM HAS BEEN STRETCHED OVER THE WINGS OF THE CLAMP.
". 7HILE THE DENTIST’S LEFT HAND SUPPORTS THE UPPER MARGIN OF THE DAM, HIS RIGHT HAND POSITIONS THE CLAMP AROUND THE TOOTH.
CLAMPS (&IG. 10.21). /NE CAN ALSO PUT THE CLAMP ON A TH (&IG. 10.22). &INALLY, ONE CAN PLACE THE CLAMP ON
DAM THAT HAS ALREADY BEEN PLACED ONTO A FRAME AND THE TOOTH AND THEN SLIP THE FRAMED DAM AROUND IT
POSITION THE ENTIRE ASSEMBLY IN THE PATIENT’S MOU- (&IG. 10.23).

! "

# $

% &

'

&IG. 10.21. 0OSITIONING OF THE RUBBER DAM WITH A WINGLESS CLAMP. !. 4HE CLAMP’S ARCH IS PASSED THROUGH THE DAM’S OPENING. ". 4HE RUBBER DAM CLAMP FORCEPS
ARE INTRO- DUCED INTO THE CLAMP’S OPENINGS. #. 4HE DAM IS FOLDED WITH THE CLAMP AT THE TIP, WHILE THE CLAMP IS MOVED TOWARD THE TOOTH. $. 4HE CLAMP HAS BEEN
POSITIONED. %. 4HE DAM IS STRETCHED WITH 9OUNG’S FRAME. &, '. 4HE DENTIST IS SLIDING THE DAM COMPLETELY BELOW THE CLAMP WITH THE lNGERS.

&IG. 10.22. ! DAM WITH A WINGED CLAMP HAS BEEN STRETCHED
OVER 9OUNG’S FRAME. 4HE CLAMP, DAM, AND FRAME ARE POSITIONED
IN THE MOUTH AS A SINGLE UNIT.
! INTERFERE WITH THE FUTURE ACCESS CAVITY OR THE
"
&IG. 10.23. !. ! WINGLESS CLAMP HAS BEEN POSITIONED AROUND
THE TOOTH. ", #. 4HE RUBBER SHEET HAS BEEN SLID BELOW THE
CLAMP, WHICH IS ALREADY IN PLACE.
10 - 4OOTH )SOLATION: THE 2UBBER $AM 2$\
4HE TECHNIQUE MOST COMMONLY USED IS THAT DESCRI-
BED IN &IG. 10.12.
2EMOVAL OF THE DAM IS EASY, AS ALL ONE NEEDS TO DO
IS TO TAKE AWAY THE CLAMP. )F SEVERAL TEETH LIE
BENEATH THE DAM AND ONE OF THEM HAS A TEMPORARY OR
RECENT RESTO- RATION, IT IS PREFERABLE TO CUT IT AND
EXTRACT IT FROM BE- LOW RATHER THAN PASSING THE RUBBER
SHEET THROUGH THIS DELICATE CONTACT AREA (&IG. 10.25).
/NCE IT HAS BEEN RE- MOVED, THE DAM MUST ALWAYS
BE CHECKED SO THAT NO SMALL FRAGMENTS ARE LEFT
BELOW THE CONTACT AREAS.
)N THE CASE OF INCOMPLETELY ERUPTED TEETH THAT ARE
VE- RY CONICAL OR WHERE THE BULGE IS APICAL TO THE
GINGI- VAL CREST, THERE ARE NO UNDERCUTS TO PREVENT THE
CLAMP FROM SLIDING CORONALLY.
)N SUCH CASES, ONE CAN RESORT TO AN EXPEDIENT
THAT TAKES A FEW MINUTES BUT ALLOWS ONE TO WORK
AS ONE SHOULD. /NE CAN ACID ETCH THE ENAMEL
BUCCALLY AND PALATALLY OR LINGUALLY TO ALLOW THE
ADHESION OF TWO SMALL RIBBONS OF COMPOSITE RESIN,
WHICH SERVE AS AREAS WHICH THE CLAMP MAY GRIP.15,28
4HESE COMPOSITE RIBBONS MUST NOT INTERFERE WITH THE
PERIODONTIUM, BUT MUST BE POSITIONED 1 OR 2 MM
FROM THE GINGIVAL MARGIN TO ALLOW POSITIONING OF THE
CLAMP. 4HE LINGUAL OR PALATINE SPOTS SHOULD NOT
OCCLUSION. 4HEY WILL RE- QUIRE SMOOTHING, SO AS NOT TO
DAMAGE THE LIPS, ESPE- CIALLY IF, AS IN THE CASE OF
&IG. 10.2Ç, THEY MUST BE LEFT IN PLACE FOR SEVERAL
MONTHS AND MULTIPLE APPOINTMENT PROCEDURES.
)N THE CASE OF VERY DAMAGED TEETH WHICH REQUIRE
IM- MEDIATE ATTENTION, SUCH AS FOR ESTHETIC REASONS,
IT MAY BE USEFUL TO ANCHOR THE DAM TO THE ADJACENT
TEETH (&IG. 10.26).
&IG. 10.24. 4O FACILITATE ITS REMOVAL, THE DAM IS CUT RATHER THAN PASSED THROUGH
THE INTERPROXIMAL CONTACT.
4HE DAM’S STABILITY CAN ALSO BE MAINTAINED WITH
THE HELP OF SMALL RUBBER FRAGMENTS OF THE RUBBER
DAM IT- SELF, WHICH ARE PASSED BELOW THE CONTACT
AREAS OF THE ADJACENT TEETH (&IG. 10.27). )N
PARTICULARLY CROWDED
TEETH, SUCH FRAGMENTS MAY EVEN SUBSTITUTE FOR THE
DAM CLAMPS (&IG. 10.28). 3PECIAL ELASTIC WIRES ARE ALSO
AVAILABLE IN DIFFERENT THICKNESS (&IG. 10.29), TO
STABILIZE THE DAM IN THE SAME WAY.

! "

&IG. 10.25. !. 4HE FRACTURED TOOTH REQUIRING ENDODONTIC TREATMENT STILL HAS NOT COMPLETELY ERUPTED, AND ITS HEIGHT OF CONTOUR IS
STILL APICAL TO THE GINGIVAL MARGIN. 4O POSITION THE RUBBER DAM CLAMP, IT WAS NECESSARY TO POLYMERIZE TWO SPOTS OF COMPOSITE RESIN
ON THE BUCCAL AND PALATAL ENAMEL. ". !CCESS CAVITY CREATED ON THE FRACTURE RIM. .OTE THE TWO COMPOSITE SPOTS THAT HOLD THE
CLAMP IN POSITION.

&IG. 10.26. 4HE DAM HAS BEEN PLACED ON THE CANINE AND
CENTRAL INCISOR TO ALLOW ENDODONTIC THERAPY OF THE ROOT OF
THE LATERAL IN- CISOR.

&IG. 10.27. 4HE DAM IS KEPT IN PLACE BY A CLAMP POSITIONED ON

&IG. 10.28. 3INCE THE FRONT TEETH OF THIS PATIENT WERE SO
THE MESIAL TOOTH AND BY A FRAGMENT OF THE DAM WHICH HAS
CROWDED, THERE WAS NO SPACE FOR THE CLAMPS. 4HE DAM IS KEPT
BEEN PAS- SED BENEATH THE DISTAL CONTACT AREA OF THE
IN PLACE BY TWO FRAGMENTS OF THE DAM WHICH HAVE BEEN
DISTAL TOOTH.
PASSED UNDER THE DI- STAL CONTACT AREAS OF THE LATERAL
INCISORS.
 10 - 4OOTH )SOLATION: THE 2UBBER $AM 2$9

" #

&IG. 10.29. !. %LASTIC WIRES OF DIFFERENT THICKNESS TO KEEP THE RUBBER DAM IN PLACE. ", #. 4HE CLAMP WAS INTERFERING WITH THE MIRROR USED IN THIS PARTICULAR
CASE FOR DOCUMENTATION PURPOSES, THEREFORE THE ELASTIC WIRES WERE USED.

7HEN TREATING ENDODONTICALLY A BRIDGE ABUTMENT OR

A TOOTH WITH AN INTRACORONAL SPLINTING OR ORTHODONTIC
WIRE, ONE CAN USE VARIOUS TECHNIQUES TO ENSURE THAT
THE DAM ISOLATES THE lELD FROM SALIVA WELL:
n 3UTURING OF THE DAM BELOW THE CONNECTIONS OF THE
PROSTHESIS OR SPLINTING.5,20
n 5SE OF CAVITY VARNISHES (FOR SMALL DEFECTS), CAVIT,
/RABASE,2Ç ORAL ADHESIVES, PERIODONTAL DRESSING,29
2UBBER BASE ADHESIVE,7 MIXTURE OF DENTURE ADHESI-
VE AND ZINC OXIDE POWDER (0':), 30 OR /RASEAL
(&IG. 10.30-10.32). 4HE LAST MENTIONED IS THE
MATERIAL OF CHOICE, BECAUSE IT IS VERY EASY
TO USE.
)N THE CASE IN WHICH THE TOOTH UNDER TREATMENT IS
CON- NECTED TO THE ADJACENT TEETH BY ORTHODONTIC WIRE, &IG. 10.30. /RALSEAL IS THE MATERIAL OF CHOICE TO IMPROVE THE SEALING OF
ONE CAN TRY TO POSITION THE CLAMP ABOVE THE LEAKING RUBBER DAMS.
ORTHODONTIC AT- TACHMENT AND WIRE (&IG. 10.33).
)F THE TOOTH REQUIRING ENDODONTIC TREATMENT IS PARTICU-
LARLY DAMAGED, SO THAT THE CLAMP CANNOT BE POSITIO-
NED STABLY, IT MUST BE PRE-TREATED (SEE #HAPTER 12) SO
AS TO ALLOW ADEQUATE POSITIONING OF THE RUBBER DAM.
!N EASY AND FAST WAY TO PRE-TREAT THE DAMAGED TOOTH
IS CURING A hCOLLARv OF DENTIN BONDING, AFTER ACID
ETCHING
THE DENTIN (&IG. 10.35). !NOTHER SUGGESTION COULD
BE POSITIONING THE CLAMP ON A DISTAL TOOTH, SO THAT
THE ELA- STICITY OF THE DAM DOESN’T INTERFERE WITH THE
TOOTH TO BE TREATED, WHERE A SECOND CLAMP CAN BE
GENTLY POSITIO- NED (&IG. 10.3Ç).

! "

&IG. 10.31. !. 4HE ORTHODONTIC WIRE PRECLUDES TIGHT SEALING OF THE RUBBER SHEET. ". ! TIGHT SEAL HAS BEEN
ACHIEVED WITH /RASEAL.

! "

&IG. 10.32. !. 4HE PRESENCE OF THE WELDING HAMPERS THE DAM FROM PASSING BELOW THE CONTACT AREA. ". /RASEAL HELPS TO OBTAIN AN EQUALLY GOOD SEAL.
 10 - 4OOTH )SOLATION: THE 2UBBER $AM 251

! "

# $

% &

&IG. 10.33. 4HE LOWER LEFT SECOND PREMOLAR REQUIRES ENDODONTIC THERAPY. !. /CCLUSAL VIEW. ". "UCCAL VIEW. #, $. 0OSITIONING THE CLAMP BELOW THE
ORTHODONTIC ATTACHMENT, THE DAM STRADDLES THE WIRE AND THEREFORE DOES NOT SEAL. %, &. 4HE CLAMP HAS BEEN POSITIONED ABOVE THE ORTHODONTIC ATTACHMENT
AND WIRE; THUS, THE DAM SEALS PERFECTLY.
! "

&IG. 10.34. !. 4HE UPPER LEFT CUSPID HAS NO CROWN. 4HE PATIENT
HAD ESTHETIC PROBLEMS, WHICH PRECLUDED A CROWN LENGHTENING
PROCE- DURE TO BE DONE BEFORE THE ENDODONTIC RETREATMENT.
", #. 4HE CLAMP HAS BEEN POSITIONED ON THE ADJACENT PREMOLAR
AND AL- SO THE TWO CENTRAL INCISORS HAVE BEEN ISOLATED. ! SMALL
hCOLLARv OF COMPOSITE HAS BEEN CURED ON THE BUCCAL ASPECT OF
THE ROOT OF THE CUSPID. $, %. 4HE SAME KIND OF PRETREATMENT
WAS DONE TO THE lRST MOLAR, TO HAVE A MORE STABLE
RUBBER DAM CLAMP.

&IG. 10.35. 4HE UPPER RIGHT SECOND PREMOLAR HAS A 45² CROWN FRACTURE AND
THE
90. CLAMP KEEPS SLIDING UNDER THE TENSION OF THE RUBBER SHEET. /NE CLAMP
HAS BEEN POSITIONED ON THE SECOND MOLAR AND ANOTHER ONE (90.) ON THE SE-
COND PREMOLAR TO BE TREATED. .OW THE ELASTICITY OF THE DAM IS PULLING ON
THE MOLAR AND NOT AT ALL ON THE PREMOLAR.

")",)/'2!0(9
1 !)%,,/, '.: #OME METTERE LA DIGA SUI DENTI DIFlCILI. )L
$ENTISTA
-ODERNO 6:108Ç, 1986.
2 !-%2)#!. !33/#)!4)/. /& %.$/$/.4)343:
!PPROPRIATENESS OF CARE AND QUALITY ASSURANCE GUIDELINES. 3RD
ED., 1998, P16.
3 !.$2)%5, %.: 4RAITÏ DE $ENTISTERIE /PERATORIE. /CTAVE $OIN,
%DITEUR, 0ARIS, 1889.
5 !.42)-, $.$.: 2UBBER DAM ISOLATION OF lXED PROSTHESES.
*.
%NDOD., 8:Ç21, 1982.
Ç "%!5$29, 2.*.: 0REVENTION OF RUBBER DAM HYPERSENSITIVITY. *.
%NDOD. 10:Ç55, 1985.
6 "%.#%, 2.: (ANDBOOK OF CLINICAL ENDODONTICS. 2ND ED. 3T.
,OUIS, 4HE #.6. -OSBY #OMPANY, 1980. PAG. 80.
7 "2!-7%,,, *.$., ()#3, -.,.: 3OLVING ISOLATION PROBLEMS
WITH
RUBBER BASE ADHESIVE. *. %NDOD., 12:363, 1986.
8 #!-%2/., 3.-., 7()4,/#+, 7.,., 4!"/2, -.3.: &OREIGN
BODY ASPIRATION IN DENTISTRY: A REVIEW. *. !M. $ENT. !
SSOC. 127:1225, 1996.
9 #/#(2!., -.!., -),,%2, #.(., 3(%,$2!+%, -.!.: 4HE EFl-
CACY OF THE RUBBER DAM AS A BARRIER TO THE SPREAD OF
MICROOR-
GANISMS DURING DENTAL TREATMENT. *. !M. $ENT. !SSOC. 119:151,
1989.
10 #2!'', 4.+.: 4HE USE OF RUBBER DAM IN ENDODONTICS. *.
#AN.
$ENT. !SSOC., 38:376, 1972.
11 $)!3 $% !.$2!$%, %., 2!.!,), *., 6/,0!4/, -.#., -/44!
-!)! $% /,)6%)2!, -.: !LLERGIC REACTION AFTER RUBBER DAM
PLACEMENT. *. %NDOD. 26:182, 2000.
12 &2%3!, 2.: )L CONSENSO INFORMATO IN /DONTOIATRIA. .'. %DIZ.
-EDICO 3CIENTIlCHE, 4ORINO, 1998, P 230.
13 '!,,/, '.'.: ,A DIGA. 6)) #ONGRESSO )NTERNAZIONALE
DEL-
LA 3OCIETÌ )TALIANA DI %NDODONZIA. 4AVOLA CLINICA. #HIAVARI.
.OVEMBRE 1986.
15 '2%%.%, 2.2., 3)+/2!, &.!., (/53%, *.2.: 2UBBER DAM
APPLI- CATION TO CROWNLESS AND CONE-SHAPED TEETH. *.
%NDOD., 10:82, 1985.
1Ç (%,).', "., (%,).', ).: %NDODONTIC PROCEDURES MUST
NE- VER BE PERFORMED WITHOUT THE RUBBER DAM. /RAL 3URG.
53:565,
1977.
10 - 4OOTH )SOLATION: THE 2UBBER $AM 25$
16 )32!%,, (.!., ,%"!., 3.'.: !SPIRATION OF AN ENDODONTIC
IN-
STRUMENT. *. %NDOD. 10:5Ç2, 1985.
17 +./7,%3, +.)., )"!22/,!, *., ,5$,/7, -./., !.$%23/.,
*.2., .%7#/-", ".%.: 2UBBER LATEX ALLERGY AND THE ENDODON-
TIC PATIENT. .%NDOD. 25:760, 1998.
18 ,!-"2)!.)$)3, 4:, "%,4%3, 0.: !CCIDENTAL SWALLOWING OF
EN- DODONTIC INSTRUMENTS. %NDO. $ENT. 4RAUMATOL. 12:301,
1996
19 ,!6!'./,), '.: ,A CAVITÌ D’ACCESSO. $ENTAL #ADMOS,
1:17, 1985.
20 ,)%$%."%2', 7.(.: -ANIPULATION OF RUBBER DAM SEPTA:
AN AID TO THE METICULOUS ISOLATION OF SPLINTED PROSTHESES. *.
%NDOD. 21:208, 199Ç.
21 -%*)!, *.,., $/.!$/, *.%., 0/3!$!, !.: !CCIDENTAL SWAL-
LOWING OF A DENTAL CLAMP. *. %NDOD. 22:619, 1996.
22 0!44%23/., #.*.7.: 0OLYDAM-POLYTHENE SHEET, A PRACTICAL AL-
TERNATIVE TO RUBBER DAM FOR PATIENTS ALLERGIC TO RUBBER
COM- POUNDS. )NT. %NDOD. *. 22:2Ç2, 1989.
23 0%##()/.) !.: %NDODONZIA. -ANUALE DI TECNICA OPERATIVA.
)6
ED. ).#.!., 1986, P. 36.
25 2%54%2, *.&.: 4HE ISOLATION OF TEETH AND THE PROTECTION OF THE
PATIENT DURING ENDODONTIC TREATMENT. )NT. %NDOD. *., 16:173,
1983.
2Ç 3#(7!24:, 3.&.: 0REPARATION FOR THERAPY. )N: #OHEN 3.
AND
"URNS 2.#. EDS. 0ATHWAYS OF THE PULP. 3RD ED. 3T. ,OUIS,
4HE #.6. -OSBY #OMPANY, 1985, P. 93.
26 4!).4/2, *.&., ")%34%2&%,$, 2.#.: ! SWALLOWED ENDODONTIC
lLE: CASE REPORT. *. %NDOD. 5:2Ç5, 1978.
27 7!(,, 0.: )SOLAMENTO DEL CAMPO E RADIOLOGIA.
,’)NFORMATORE
%NDODONTICO. 1(1):19, 1997.
28 7!+!"!9!3(), (., /#(), +., 4!#()"!.!, (., -!
435-
-/4/, +.: ! CLINICAL TECHNIQUE FOR RETENTION OF A RUBBER DAM
CLAMP. *. %NDOD. 12:522, 1986.
29
7%).%, &.3.: %NDODONTIC THERAPY. 3RD ED. 3T. ,OUIS, 4HE
#.6.
-OSBY #OMPANY, 1982, P. 2ÇÇ.
30 7%)3-!., -.).: 2EMEDY FOR DENTAL DAM LEAKAGE PROBLEMS. *.
%NDOD. 17:88, 1991