Chapter 6. Application of the rubber dam system in private clinical cases

Learning objectives

• To consolidate the methods of isolation of the operating field in dental practice on the example of individual clinical cases.
• To systematize the approach to treatment planning in the conditions of isolation of the working field in endodontic treatment, restoration of the frontal or chewing group of teeth, prosthetic treatment, the presence of fixed prosthetic constructions.

Control questions

1. Requirements for isolation of the working field in endodontic treatment.
2. Requirements for isolation of the working field in dental restorations.
3. A method of isolating a tooth with a severely fractured coronal part.
4. A method of isolating teeth in the presence of a bracket system.

Lesson content

In this chapter, private clinical cases of operating field isolation will be reviewed, depending on the treatment chosen and the initial clinical data.

Isolation of the working field during endodontic treatment (Fig. 6.1).

Fig. 6.1. Clinical case of local isolation of tooth 2.6 during endodontic treatment: A — creation of endodontic access to the root canals of tooth 2.6; B — root canals of tooth 2.6 after mechanical and medical treatment

Isolation of the working field in the restoration of the chewing group of teeth (Fig. 6.2).

Fig. 6.2. Clinical case of tooth isolation in direct composite restoration: A — clinical photograph of teeth 3.5, 3.6, 3.7 before treatment — on the chewing surface of the teeth there are old fillings with a violation of the marginal fit; B — removal of old fillings and infected hard tissues of teeth 3.6 and 3.7; C — isolation of the working field with a rubber dam system; D — restoration of the masticatory surface of teeth 3.6 and 3.7 by anatomical stratification method

Isolation of the working field in the restoration of the anterior group of teeth (Fig. 6.3).

Fig. 6.3. Clinical case of isolation of the working field during direct aesthetic restoration of the frontal group of teeth: A — clinical photograph of the smile before treatment; B — pigmented hard tissue defects are present on the vestibular surface of teeth 1.1, 1.2, 2.1, 2.2; the patient complains of unsatisfactory aesthetics of the frontal group of teeth of the upper jaw

Fig. 6.3, end. Clinical case of isolation of the working field in direct aesthetic restoration of the frontal group of teeth: C — isolation of the working field using the rubber dam system and preparation of the hard tissues of teeth 1.1, 1.2, 2.1, 2.2; D — restoration of the aproximal surfaces of teeth 1.1 and 2.1 using metal matrices, additional retraction of the marginal gingiva in the area of teeth 1.1 and 2.1 using Brinker B4 clamps; E — aesthetic restoration of teeth 1.1, 1.2, 2.1, 2.2 by anatomical stratification method; F — clinical photograph of the smile after treatment

Isolation of teeth in Black’s Class V cavity restoration (Fig. 6.4).

Fig. 6.4. Clinical case of field isolation in direct composite restoration of Black’s class V cavities: A — clinical photograph before treatment; B — field isolation with the rubber dam system, Brinker B4 clamps were used for gingival retraction and isolation of the apical region of teeth 3.4, 3.5

Fig. 6.4, end. Clinical case of field isolation in the direct composite restoration of Black’s class V cavities: C — restoration of cervical defects of hard dental tissues 3.4, 3.5 with the direct composite restoration technique; D — clinical photoprotocol after treatment

Isolation of the working field in the split-dam technique (Fig. 6.5).

Fig. 6.5. Clinical case of isolation of the working field in the split-dam technique in the presence of a bracket system in the patient’s oral cavity: A — installation of SoftClamps on teeth 1.6 and 2.6 to eliminate the risk of trauma to the marginal gingiva and orthodontic structure by a metal clamp; B — fixation of a rubber dam sheet, isolation of the teeth of the upper jaw in the split-dam technique

Retention of the rubber dam sheets rubber dam without clumpers (Fig. 6.6).

Fig. 6.6. Clinical case of field isolation in a direct composite restoration without the use of clumpers: A — pre-treatment clinical photograph, old untenable fillings are present on the chewing surface of teeth 1.4, 1.5, 1.6; B — field isolation with the rubber dam system, inversion of the sheets and retention of the rubber sheet without clumpers