Chapter 7. Common mistakes in use of the rubber dam system and their solutions

Learning objectives

• To study tactical and technical mistakes and complications in working field isolating with rubber dam system.

Control questions

1. Tactical and technical mistakes in isolating of the working field.
2. Causes of mistakes while working with the rubber dam system.
3. Ways to eliminate mistakes and complications while working with the rubber dam system.

Lesson content

The main mistakes in the isolation of the working field using the rubber dam system can be divided into two groups: technical and tactical. Technical mistakes include the following.

1. The junction between holes of the latex sheet does not pass through the interdental spaces.

Causes

• The space between the teeth is closed by a filling material that is placed in one portion on two neighboring teeth.
• Tight contact point.

Correction of the mistake

• Before placing the rubber dam system, it is necessary to check the patency of the contact points between the teeth by using a floss. If the space between the teeth is covered by a filling material that is placed in one portion on two adjacent teeth at the same time, it is necessary to remove the old filling material and smooth the edges of the teeth first for unobstructed application of the rubber dam system. Use lubricant for better sliding of the rubber dam sheet.
• To push the sheet junction through the contact point dental floss is inserted into the interdental space from the occlusal surface and it pushes the rubber dam apically, sliding it along the ridge of the tooth. One end of the dental floss is placed in the adjacent interdental space, and then the floss is drawn into the “tight” interaproximal contact and pulled it all the way to the vestibular side. These actions are performed until the sheet is pushed to the vestibular part of the tooth. At first, the sheet is introduced into wide interdental spaces, then in the narrow ones. If necessary, it is possible to fix the clamps on the anchor tooth to keep the latex sheet in the mouth first, and then apply the rubber dam system on the remaining teeth. It is also possible to widen the interdental space using a dental smoother.

2. The rubber dam sheet slips off the tooth during treatment.

Cause

• The perforation holes in the rubber sheet are too large.

Correction of the mistake

• The perforation of the holes of a smaller diameter will help. In addition, it is necessary to secure the sheet with floss cervical ligatures. For this purpose, you can also use wedges, cord, liquid rubber dam or flowable composite.

4. Leakage of oral liquid into the working field area.

Causes

• The perforation holes in the rubber sheet are too large.
• Mistake is made in the marking of the perforation holes.
• Using a rubber sheet that is too thin.
• No inversion of the sheet.

Correction of the mistake

• Perforating holes of smaller diameter, replacing the sheet.
• Using a rubber dam template when marking and perforating holes, replace the sheet.
• Replacing thin rubber sheets with thicker ones.
• Performing sheet inversions, using additional means of isolation, for example, liquid rubber dam.

4. Damage to the rubber sheet.

Causes

• Damage to the sheet during preparation with a dental bur.
• Use of too thin sheets or expired sheets.
• Incorrect operation of the perforator.

Correction of the mistake

• The perforation can be filled with a liquid rubber dam. If the perforation is large, the rubber sheet should be replaced.
• Check the expiration date of the rubber sheet and replace the sheet with a thicker one.
• Replace the perforator (puncher) with a new one.

The tactical mistakes when working with the rubber dam system include the following.

1. Slipping of the clamp when applying the rubber dam system.

Causes

• The clamp is improperly selected.
• The jaws of the clamp have become blunt.

Correction of the mistake

• Choose a smaller-sized clamp or replace it with one of a different design. It’s important to check that the clamp has a four-point contact with the tooth’s neck and that there is no rocking. To prevent aspiration or swallowing of the clamp, it is strongly advised to tie a piece of floss to the bow of the clamp during the preparation stage.
• Replacement of the clamp with a new one. Sharpening of the clamp’s cheeks is not recommended by the producers.