have a securely placed ligature on the clamp. You are
now ready to place the clamp on the rubber dam
Hold the clamp with the bow facing upward and
away from the forceps. Place the small projections on
the working ends of the rubber dam forceps into the
corresponding holes on the rubber dam clamp.
Squeeze the handles of the forceps together to align
projections with the corresponding holes on the clamp.
Once the clamp is placed on the forceps, tilt the forceps
upright and slide the locking device on the forceps
downward to lock the handles in position. Locking the
forceps handles is necessary to continue the tension
required to keep the clamp attached to the forceps.
Now the clamp is ready for trial placement.
Pass the rubber dam forceps, with the working end
covered, with the palm of your hand and the clamp
pointed toward the placement position of the tooth. Be
sure to hold on to the ligature while the clamp is
checked for proper fitting. Normally, the clamp should
fit near or slightly below the cementoenamel junction.
To stabilize the clamp, all the tips of the clamp must be
in contact with the tooth to establish a facial lingual
balance. Exercise care to ensure that the clamp tips do
not impinge on the gingival tissues. If it does, it will
cause the patient to experience pain. If the clamp is not
placed properly, it may spring off the tooth and cause
injury. Caution is advised to stabilize the clamp firmly
on the tooth before the clamp forceps are loosened.
Once the trial placement is complete, remove the
forceps and attach the clamp until final placement.
To prepare the rubber dam material, you need the
rubber dam punch to make the appropriate number of
holes of varying sizes. The punch has an adjustable
wheel with holes of varying sizes. By adjusting the
wheel, holes of different sizes are produced in the
material when the cutting tip strikes the hole in the
wheel. The holes in the rubber dam material must be
punched firmly and cleanly. A ragged hole or tag will
tear easily as the dam is placed over the crowns of the
teeth. A ragged hole also may cause leakage of
moisture around the tooth.
Ideally, the rubber dam material is marked (fig.
4-24) with predetermined markings of an average arch
using a rubber dam stamp and ink pad. This makes
punching the rubber dam material easier because you
have a pattern to follow with the normal shape of the
arch and spacing alignment of the teeth. Before
punching the material, always check the oral cavity for
any missing, misaligned, or extra teeth. You will need
to make adjustments from the standard pattern for
these items. Punch the hole for the tooth to be treated
first. Then, determine what additional holes must be
punched. Normally, you will punch holes for the two
anterior and at least one tooth posterior to the tooth
being treated. An exception to this is root canal
therapy when only the involved tooth is exposed. After
the holes are punched, apply a slight amount of water
soluble (brushless shaving cream) lubricant to the back
of the material over the crowns and contact areas of the
exposed teeth. Now the rubber dam is ready for
placement into the oral cavity.
The rubber dam material and clamp can be placed
using several methods. The first method usually
requires assistance. Place the rubber dam frame on the
outside of the dam with the bow of the frame facing
out. Stretch the dam material from side to side to
secure the corners of the dam on the four projections at
the corner of the frame. The rubber dam material
should appear baggy on the frame rather than tight to
allow easier placement in the oral cavity. Pass the
rubber dam and attached frame to the dentist for
placement in the oral cavity. As the dentist stretches
the rubber dam material over each tooth to be isolated,
the assistant uses floss to slip the septum (rubber dam
material between the holes) between the teeth without
tearing the material. Always place the floss on the
tooth, never directly on the rubber dam itself.
Placement of the floss upon the tooth assists in
bringing a single thickness of the dam through the
Figure 4-24.Marked rubber dam material.