Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Sep 20;9(9):CD009858.
doi: 10.1002/14651858.CD009858.pub2.

Rubber dam isolation for restorative treatment in dental patients

Yan Wang  1 , Chunjie Li, He Yuan, May Cm Wong, Jing Zou, Zongdao Shi, Xuedong Zhou
Affiliations
Review

Rubber dam isolation for restorative treatment in dental patients

Yan Wang et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Successful restorations in dental patients depend largely on the effective control of moisture and microbes during the procedure. The rubber dam technique has been one of the most widely used isolation methods in dental restorative treatments. The evidence on the effects of rubber dam usage on the longevity of dental restorations is conflicting. Therefore, it is important to summarise the available evidence to determine the effects of this method.

Objectives: To assess the effects of rubber dam isolation compared with other types of isolation used for direct and indirect restorative treatments in dental patients.

Search methods: We searched the following electronic databases: Cochrane Oral Health's Trials Register (searched 17 August 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 7) in the Cochrane Library (searched 17 August 2016), MEDLINE Ovid (1946 to 17 August 2016), Embase Ovid (1980 to 17 August 2016), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 17 August 2016), SciELO BIREME Virtual Health Library (1998 to 17 August 2016), Chinese BioMedical Literature Database (CBM, in Chinese) (1978 to 30 August 2016), VIP (in Chinese) (1989 to 30 August 2016), and China National Knowledge Infrastructure (CNKI, in Chinese) (1994 to 30 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform, OpenGrey and Sciencepaper Online (in Chinese) for ongoing trials. There were no restrictions on the language or date of publication when searching the electronic databases.

Selection criteria: We included randomised controlled trials (including split-mouth trials) assessing the effects of rubber dam isolation for restorative treatments in dental patients.

Data collection and analysis: Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. We resolved disagreement by discussion.

Main results: We included four studies that analysed 1270 participants (among which 233 participants were lost to follow-up). All the included studies were at high risk of bias. We excluded one trial from the analysis due to inconsistencies in the presented data.The results indicated that dental restorations had a significantly higher survival rate in the rubber dam isolation group compared to the cotton roll isolation group at six months in participants receiving composite restorative treatment of non-carious cervical lesions (risk ratio (RR) 1.19, 95% confidence interval (CI) 1.04 to 1.37, very low-quality evidence). It also showed that the rubber dam group had a lower risk of failure at two years in children undergoing proximal atraumatic restorative treatment in primary molars (hazard ratio (HR) 0.80, 95% CI 0.66 to 0.97, very low-quality evidence). One trial reported limited data showing that rubber dam usage during fissure sealing might shorten the treatment time. None of the included studies mentioned adverse effects or reported the direct cost of the treatment, or the level of patient acceptance/satisfaction. There was also no evidence evaluating the effects of rubber dam usage on the quality of the restorations.

Authors' conclusions: We found some very low-quality evidence, from single studies, suggesting that rubber dam usage in dental direct restorative treatments may lead to a lower failure rate of the restorations, compared with the failure rate for cotton roll usage. Further high quality research evaluating the effects of rubber dam usage on different types of restorative treatments is required.

PubMed Disclaimer

Conflict of interest statement

Yan Wang: none known. Chunjie Li: none known. He Yuan: none known. May CM Wong: none known. May CM Wong is an editor with Cochrane Oral Health. Jing Zou: none known. Zongdao Shi: none known. Xuedong Zhou: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Rubber dam versus cotton rolls, Outcome 1 Survival rate (6 months).
1.2
1.2. Analysis
Comparison 1 Rubber dam versus cotton rolls, Outcome 2 Survival rate (24 months).
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Ammann 2013 {published data only}
    1. Ammann P, Kolb A, Lussi A, Seemann R. Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents ‐ a randomized controlled clinical pilot study. International Journal of Paediatric Dentistry 2013;23(2):110‐5. - PubMed
Carvalho 2010 {published data only}
    1. Carvalho TS, Sampaio FC, Diniz A, Bönecker M, Amerongen WE. Two years survival rate of Class II ART restorations in primary molars using two ways to avoid saliva contamination. International Journal of Paediatric Dentistry 2010;20(6):419‐25. - PubMed
Kemoli 2010 {published data only}
    1. Kemoli AM, Amerongen WE, Opinya GN. Influence of the experience of operator and assistant on the survival rate of proximal ART restorations ‐ two‐year results. European Archives of Paediatric Dentistry 2009;10(4):243‐8. - PubMed
    1. Kemoli AM, Amerongen WE, Opinya GN. Short communication: Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years. European Archives of Paediatric Dentistry 2010;11(3):136‐9. - PubMed
Ma 2012 {published data only}
    1. Ma J. Influence of rubber dam isolation on the performance of restorations for teeth wedge‐shaped defects. Chinese Community Doctors 2012;14(309):164.

References to studies excluded from this review

Daudt 2013 {published data only}
    1. Daudt E, Lopes GC, Vieira LCC. Does the isolation method influence the performance of direct restorations? 89th General Session of the International Association for Dental Research. San Diego (CA): International Association for Dental Research, 2011:Abstract no: 1697.
    1. Daudt E, Lopes GC, Vieira LCC. Does operatory field isolation influence the performance of direct adhesive restorations?. Journal of Adhesive Dentistry 2013;15(1):27‐32. - PubMed
Fontes 2009 {unpublished data only}
    1. Fontes ST, Corrêa FOB, Cenci MS, Jardim PS, Pinto MB, Masotti AS. Influence of operatory field isolation techniques on the clinical performance of class V restorations. clinicaltrials.gov/ct2/show/NCT01506830 Date first received 30 December 2011.
Ganss 1999 {published data only}
    1. Ganss C, Klimek J, Gleim A. One year clinical evaluation of the retention and quality of two fluoride releasing sealants. Clinical Oral Investigations 1999;3:188‐93. - PubMed
Huth 2004 {published data only}
    1. Huth KC, Manhard J, Hickel R, Kunzelmann K. Three‐year clinical performance of a compomer in stress‐bearing restorations in permanent posterior teeth. American Journal of Dentistry 2003;16(4):255‐9. - PubMed
    1. Huth KC, Manhard J, Selbertinger A, Paschos E, Kaaden C, Kunzelmann K, et al. 4‐year clinical performance and survival analysis of Class I and II compomer restorations in permanent teeth. American Journal of Dentistry 2004;17(1):51‐5. - PubMed
Raskin 2000 {published data only}
    1. Raskin A, Setcos JC, Vreven J, Wilson NHF. Clinical evaluation of a posterior composite 10‐year report. Journal of Dentistry 1999;27:13‐9. - PubMed
    1. Raskin A, Setcos JC, Vreven J, Wilson NHF. Influence of the isolation method on the 10‐year clinical behaviour of posterior resin composite restorations. Clinical Oral Investigations 2000;4(3):148‐52. - PubMed
Sabbagh 2011 {published data only}
    1. Sabbagh J, Dagher S, El‐Osta N, Souhaid P. One year clinical evaluation of vertise flow. 45th Meeting of the Continental European Division of the International Association of Dental Research; 2011 Aug 31‐Sept 3; Budapest, Hungary. Alexandria, VA: International Association for Dental Research, 2011:Abstract no: 232.
Smales 1993 {published data only}
    1. Smales RJ. Effect of rubber dam isolation on restoration deterioration. American Journal of Dentistry 1992;5(5):277‐9. - PubMed
    1. Smales RJ. Rubber dam usage related to restoration quality and survival. British Dental Journal 1993;174(9):330‐3. - PubMed
Straffon 1985 {published data only}
    1. Straffon LH, Dennison JB, More FG. Three‐year evaluation of sealant: effect of isolation on efficacy. Journal of the American Dental Association 1985;110(5):714‐7. - PubMed
van Dijken 1987 {published data only}
    1. Dijken JWV, Hörstedt P. Effect of the use of rubber dam versus cotton rolls on marginal adaptation of composite resin fillings to acid‐etched enamel. Acta Odontologica Scandinavica 1987;45:303‐8. - PubMed

References to studies awaiting assessment

Alhareky 2014 {published data only}
    1. Alhareky MS, Mermelstein D, Finkelman M, Alhumaid J, Loo C. Efficiency and patient satisfaction with the Isolite system versus rubber dam for sealant placement in pediatric patients. Pediatric Dentistry 2014;36(5):400‐4. - PubMed

Additional references

Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck‐Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. - PMC - PubMed
Begg 1994
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50(4):1088‐101. - PubMed
Bhuva 2008
    1. Bhuva B, Chong BS, Patel S. Rubber dam in clinical practice. Endodontic Practice Today 2008;2(2):131‐41.
Cajazeira 2014
    1. Cajazeira MR, Sabóia TM, Maia LC. Influence of the operatory field isolation technique on tooth‐colored direct dental restorations. American Journal of Dentistry 2014;27(3):155‐9. - PubMed
Carrotte 2000
    1. Carrotte PV. Current practice in endodontics: 3. Access is success, and rubber dam is easy. Dental Update 2000;27(9):436‐40. - PubMed
Carrotte 2004
    1. Carrotte P. Endodontics: Part 6 Rubber dam and access cavities. British Dental Journal 2004;197(9):527‐34. - PubMed
Cochran 1989
    1. Cochran MA, Miller CH, Sheldrake MA. The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment. Journal of the American Dental Association 1989;119(1):141‐4. - PubMed
Cohen 1987
    1. Cohen S, Schwartz S. Endodontic complications and the law. Journal of Endodontics 1987;13(4):191‐7. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Elderton 1971a
    1. Elderton RJ. A modern approach to use of rubber dam. 1. Dental Practitioner and Dental Record 1971;21(6):187‐93. - PubMed
Elderton 1971b
    1. Elderton RJ. A modern approach to use of rubber dam. 2. Dental Practitioner and Dental Record 1971;21(7):226‐32. - PubMed
Elderton 1971c
    1. Elderton RJ. A modern approach to use of rubber dam. 3. Dental Practitioner and Dental Record 1971;21(8):267‐73. - PubMed
GRADE 2004
    1. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ 2004;328(1490):1‐8. - PMC - PubMed
GRADEproGDT [Computer program]
    1. GRADE Working Group, McMaster University. GRADEproGDT. Version accessed August 2016. Hamilton (ON): GRADE Working Group, McMaster University, 2014.
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924‐6. - PMC - PubMed
Halbach 2008
    1. Halbach S, Vogt S, Köhler W, Felgenhauer N, Welzl G, Kremers L, et al. Blood and urine mercury levels in adult amalgam patients of a randomized controlled trial: interaction of Hg species in erythrocytes. Environmental Research 2008;107(1):69‐78. - PubMed
Harrel 2004
    1. Harrel SK, Molinari J. Aerosols and splatter in dentistry: a brief review of the literature and infection control implications. Journal of the American Dental Association 2004;135(4):429‐37. - PMC - PubMed
Hickel 2007
    1. Hickel R, Roulet JF, Bayne S, Heintze SD, Mjör IA, Peters M, et al. Recommendations for conducting controlled clinical studies of dental restorative materials. Clinical Oral Investigations 2007;11(1):5‐33. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hill 2008
    1. Hill EE, Rubel BS. Do dental educators need to improve their approach to teaching rubber dam use?. Journal of Dental Education 2008;72(10):1177‐81. - PubMed
Koshy 2002
    1. Koshy S, Chandler NP. Use of rubber dam and its association with other endodontic procedures in New Zealand. New Zealand Dental Journal 2002;98(431):12‐6. - PubMed
Kremers 1999
    1. Kremers L, Halbach S, Willruth H, Mehl A, Welzl G, Wack FX, et al. Effect of rubber dam on mercury exposure during amalgam removal. European Journal of Oral Sciences 1999;107(3):202‐7. - PubMed
Lynch 2003
    1. Lynch CD, McConnell RJ. The use of microabrasion to remove discolored enamel: a clinical report. Journal of Prosthetic Dentistry 2003;90:417‐9. - PubMed
Mamoun 2002
    1. Mamoun J. A prosthesis for achieving dry‐field isolation of molars with short clinical crowns. Journal of the American Dental Association 2002;133(8):1105‐7. - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta‐analysis of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. - PubMed
Perrine 2005
    1. Perrine GA. A simplified rubber‐dam technique for preparing teeth for indirect restorations. Journal of the American Dental Association 2005;136(11):1560‐1. - PubMed
Reid 1991
    1. Reid JS, Callis PD, Patterson CJW. Rubber Dam in Clinical Practice. 1st Edition. London: Quintessence Publishing, 1991.
Reuter 1983
    1. Reuter JE. The isolation of teeth and the protection of patient during endodontic treatment. International Endodontic Journal 1983;16(4):173‐81. - PubMed
Stewardson 2002
    1. Stewardson DA, McHugh ES. Patients' attitudes to rubber dam. International Endodontic Journal 2002;35(10):812‐9. - PubMed
Susini 2007
    1. Susini G, Pommel L, Camps J. Accidental ingestion and aspiration of root canal instruments and other dental foreign bodies in a French population. International Endodontic Journal 2007;40(8):585‐9. - PubMed
Sutton 1996
    1. Sutton J, Saunders WP. Effect of various irrigant and autoclaving regimes on the fracture resistance of rubber dam clamps. International Endodontic Journal 1996;29(5):335‐43. - PubMed
Tiwana 2004
    1. Tiwana KK, Morton T, Tiwana PS. Aspiration and ingestion in dental practice: a 10‐year institutional review. Journal of the American Dental Association 2004;135(9):1287‐91. - PubMed

LinkOut - more resources