The benefits of rubber dam

A case report by Dr  Sahil Soni

The use of rubber dam for routine restorative dentistry provides numerous benefits to the dental practitioner and increases comfort for the patient. Not only does it improve access and help maintain moisture control, it also prevents small objects such as sectional bands, wedges and indirect restorations from falling down the patient's throat. Another advantage of using a rubber dam is presented in the following case, where the subgingival margins and inflamed tissues posed a difficult situation for accurate scanning to fabricate an indirect CAD-CAM restoration.



The upper right first molar (tooth 16 FDI notation) had a broken complex amalgam restoration needing replacement. Given the size of the restoration, an indirect restoration was planned for the tooth. The tooth was isolated using a rubber dam to prevent the patient from swallowing the amalgam debris as it was removed.




After amalgam removal, there is recurrent decay and staining evident on the tooth




The decay is removed and most of the tooth preparation is done under the rubber dam. The distal tooth margin extends subgingivally and as such, the rubber dam is starting to tear whilst the margins are being polished.




The rubber dam is removed to polish the tooth margins and to take a digital scan with a CEREC Omnicam to fabricate a CAD-CAM restoration. However, as soon as the rubber dam is removed, the inflamed gingiva start bleeding profusely; attempts to stop the bleeding with retraction cord and TCA prove to be futile.




After several failed attempts to achieve haemostasis using local measures, the rubber dam is replaced in an attempt to control the bleeding and provide a clean field for the digital scanning.




With the bleeding under control and the gingiva out of the way, a digital scan is taken using the CEREC machine.




An indirect restoration is fabricated using a hybrid ceramic-resin material (Cerasmart). The restoration is bonded to the tooth with the rubber dam already in place. All excess cement is removed, and the restorative margins are polished. Occlusion is checked and the restoration is completed.

As demonstrated by this case, using a rubber dam complements restorative dentistry because it makes it easier to work in subgingival areas without worrying about moisture control.