operative Dentistry

A novel rubber dam system for the simultaneous isolation of

teetb and gingival tissues
E. Kontakiotis*

The present article introduces a rttbber dam system developed for the simultarteotts
isolation of teeth and gingival tissues. The rubber dam device is fabricated from sitnple,
easy-to-ftnd. and inexpensive materials, such as iron-core elastic tube, latex sheets, expanding
screiis, dental acrylic resin, and glue. Measurements of the ditnensions of the maxillas and
mandibles of 100 patients indicated that three prefabricated sizes of the device (small,
medium, and large) can be applied in the majority of individuals.
(Quintessence Int ¡995.26.-395-398).

Introduction bleeding and dispersion of saliva. The existence of a

The isolation of the operating field was first proposed
and subsequently widely accepted for the endodontic
therapy of teeth.'"^ Although the original purpose of
the common rubber dam system was to create an
aseptic environment, experience has shown that it
possesses other advantages such as patient protection
fromthe aspiration or swallowing of small instruments,
tooth debris, fragments of dental materials, irrigation
solutions, and medicaments; a surgically clean opera-
ting field; retraction and protection of soft tissues; and
improved visibility of the working area.
It would be desirable for ail dental procedures to be
performed under the above-mentioned conditions.
Unfortunately, the common rubber dam system can
isolate only one or, at best, a few tooth crowns, and it
can be used effectively only in endodontics and
operative dentistry. This method cannot be used in
dental procedures that require the simultaneous isola-
tion of gingiva, eg, periodontal treatment, fixed partial
denture constructions, placement of orthodontic ap-
pliances, and tooth extraction. In patients undei^oing
these procedures, there invariably exists mild or severe
* Departmeni of Endodonticb, University of Athens. Dental School.
Athens. Greece.
Reprint requests: Dr E. Kontakiotis, E>epartment of Endodontics.
t/niversily of Athens, Dental School. Thivon 2 Goudi, 115 27 Athens.
Greece.
satisfactory method for the isolation of the working
field during these procedures would, undoubtly, aid
the operator. Furthermore, it could considerably
reduce the risk of contamination with various viruses
such as the hepatitis B and human immunodeficiency
viruses and other contagious diseases, because the
removal of blood is much more efficient in an isolated
operating field.
The present article introduces a rubber dam system
developed for the simultaneous isolation of teeth and
gingival tissues.
Technique
The rubber dam device is fabricated from simple,
easy-to-find, and inexpensive materials, such as iron-
core elastic tube, latex sheets, expanding screws,
dental acrylic resin, and glue (Fig 1).
The device is designed to isolate the gingiva and all
teeth of one arch simultaneously (Figs 2 and 3). This is
accomplished by an elastic sheet mounted on a frame
made from elastic iron. The frame has two aspects: one
lingual and one labial. The two parts of the frame rest
on the alveolingual and aiveolabial sulci, respectively.
An expanding screw connects the two parts of the
frame behind each third molar. Each expanding screw
is stabilized on the frame with dental acrylic resin. A
straight line opening is made in the middle of the
elastic sheet and the frame is glued to it.

QuintessenceJnlenialiaQaJ—Vnli imR ^ii., Number 6/1995 395

operative Dentistry
Fig 1 Materials necessary for construction of the device.
Fig 3 Application of the 0.1 a mandibular cast.
To construct a custom-made isolation system, the
following information regarding the dimensions of the
arch to be isolated are needed:
1, The thickness of the alveolar ridge at the level of the
alveolingual suicus. This value determines the
distance between the two aspects of the frame, as
well as the length of the expanding screw that
connects the two parts of the frame,
2, The depth of the alveolingual and alveolabial suici.
This measurement determines the difference in
height between the labial and lingual parts of the
frame,
3, The distance between the distal cusps of the two
third molars of the arch. This measurement deter-
mines the posterior opening of the frame,
4, The distance between the incisai edge of the central
incisor and the distal cusp of the third molar, on
396
Fig 2 Application of the device on a maxillary cast
each side of the arch. These values determine the
length and the curvature of the frame.
For each of the cases described below, individual
measurements were made on each arch to be isolated.
Trial of the isolation device on casts
Casts of the maxillas and mandibles of 10 buman
volunteers were made, the above-mentioned measure-
ments were individually taken, and isolation devices
were constructed for all 20 arches (see Figs 2 and 3),
It was evident from the ftrst pilot devices that the
expanding screws played an important role in effective
isolation. During the placement of the device, the
screws are open. After placement, the screws are slowly
closed, so that the elastic frame comes in close contact
with the soft tissues, producing effective isolation.
In all cases, the isolation seemed mac rosco picaüy
very effective. In ftve cases, the edge of the elastic sheet
was given the form of a weil and was ftlled with water
for 20 minutes. No or very slight leakage was observed
beneath the isolation system.
Trial of the Uolation device on humans
Individualiy made isolation devices were constructed
and used on 15 human volunteers. The placement of
the device in the mouth did not cause significant
discomfort in any of the patients (Figs 4 and 5).
Ultrasonic scaling of the teetb was perfonned on all
patients under the rubber dam device. The overall
experience was satisfactory. All patients easily tolerat-
ed the device during the 30 minutes of the session. The
device, like all existing isolation methods, did not
Quintessence International Volume 26, Number 6/iqa=
 Operative Dentistry

Figs 4 and 5 Application of the device for dental procedure in the mouth

h A

']\ / •
B
•' 0 ^

Vi /
E f /r
\ / \

zl
•

"1

N1N2 X - 6 309 3 D - 0 84 SE = ),tB4 6 019 SD = 1008 0.32

AN, x = 5.77 0.74 SE- .t61 AM, x = 5.480 S D - 0 755 S E - 0.16
Oi7l| X - 1.79 3 D - 0 206 SE = .044 OTT X ' 1 58 S D - 0 222 SE = 0 048
K,l, X - 2.20 0 384 3E = 062 Kl x = 1.904 SD = 0 895 SE = 0.195
H,A, x = 1.65 0 059 SE = .013 HA X - 1 28 S D - 0 220 S E - 0 048
A,B, Ct 0 183 AB x = 1 74 3D = 0 171 SE = Ü037
-E,Z, 1 27 SE- 040 EZ X - 0 98 S D - 0 19 S E - 0 043
^'
Va Cl

Fig 6 Mean maxiiiary measurements. Fig 7 Mean mandibular measurements.

allow the patient to completely close the mouth during
treatment. However, in most cases the maxilla and
mandible during maximal closing were at the resting
position. Furthermore, the set screws were resting on
the opposite retromolar pad, thus enabling the patient
to keep the mouth open without effort. The treatment
was greatly facilitated by the absence of the usual
obstructions such as the tongue, lips, and cheeks.
Furthermore, the aspiration of water and blood was
very convenient and etfective. In all patients, the
isolation unit prevented the contattiination of the
operating field with saliva.
Measurements of maxillary and mandibular
dimensions in humans
To investigate whether a universal rubber dam isolation
unit can be used on any given patient, measurements
were made of the dimensions of the maxillas and
mandibles of 100 patients, aged 12 to 65 years, who
had been referred to the Department of Endodontics
of the University of Athens (Figs 6 and 7}. According
to these measurements, it seems unlikely that one sized
device can be used universally on every patient. It
appears that at least three sizes (small, medium, and

Qui -Number 6 / 1 9 9 5 397

Operative Dentistry
large} of the device should be available lor the isolation
of the majority of maxillas and mandibles. However,
such a decision should be based on measurements of a
much larger sample.
Discussion
The newly designed isolation system Is intended to
isolate all the teeth and gingival tissue simultaneously.
The Initial in vitro and in vivo experimentation has
yielded promising results.
All 15 patients tested easily tolerated the device.
During scaling, no passage of fluid across the device
was observed. The degree of retraction of obstructing
soft tissues, such as tongue, cheeks, and lip, was
satisfactory and the operator's access and visibility
seemed to be improved.
The isolation system was constructed from simpie,
easily purchased and inexpensive materials, and thus
its cost was low. The device can be used several times,
because it can be sterilized in an autociave. At present,
an individually made isolation device was used for each
patient; therefore, its construction was time con-
suming. According to the measurements of 100
subjects, the availability of the device in the different
sizes should cover the majority of the population.
It is widely accepted today that the isolation of the
operating field is necessary, not only for the con-
Moving Soon?
Please notify us promptly of any change of address to assure an unlnferrupled subscription.
Cofnplele the form below and send to; 0 ' Subscription Department, Quintessence Publishing Co,
Inc., 551 North Kimberiy Drive, Carol Stream, IL 60188
NAME.
NEW ADDRESS.
CITY, STATE, ZIP.
NOTE: To expedite delivery, senti Ihe change of address as soon as you know it, and allow 6 weeks for processing.
398
venienceofthe clinician but also asa hindrance to the
inadvertent transmission of contagious diseases via
blood and saliva and the inhalation of small dental
instruments and fragments of dental materials by the
patient.'"'
At present for a variety of dental procedures, such as
periodontal therapy, prosthodontics, orthodontics,
and minor oral surgery, no isolation system exists. The
proposed isolation system is only a preliminary effort
in manufacturing an effective system for isolation of an
entire arch and associated soft tissues simultaneously.
However, it appears to have the potential, with certain
engineering modifications and improvements, to fill
the needs of suitable isolation for a variety of restora-
tive, prosthodontic, and orthodontic procedures.
Acknowledgments
The author wishes lo Ihank Associate Professor P. Panopoulos for his
contribution in preparing the manuscript.
References
1. Ingle Jl, Tainlor JF. Endodontlcs. ed 3. Philadelphia: Lea & Febiger.
1985:30-35.
2. Weine SF. Endodontie Therapy, ed 4. St Louis: Mosby, 1989:2-
4,275.
3. Cohen S, Burns R. Pathways of the Pulp, ed 5. St Louis: Mosby,
I99I:S3-S8. D
MOVING FROM:
(OLD ADDRESS)
(CITY, STATE, ZIP)
Quintessence International Volume 26. Numhw R/inr