Subgingival restorations in the front are a little different to a deep class 2 box. If the gingiva is in the way you can't just do a gingivectomy or you'll end up with an aesthetic nightmare. Fortunately, there are a few tricks to help rubber dam isolation for a deep anterior restoration.

Rubber Dam in the Anterior

Generally if you isolate more teeth you'll get a better seal and the dam tends to sit better. This is particularly true in the anterior. If you try to isolate 11-13 you'll find the rubber dam sits up around the 11 and its difficult to invert where necessary.
I find it's best to isolate 3-3 for upper anteriors, maybe more, especially if you're working on more than one tooth. With clamps on both 3's the dam tends to sit well assuming you've punched the holes in the right spot.

Floss Ties

A simple way to keep the rubber dam sitting tight around the gingva is to use a floss tie. You probably see them all the time on Facebook and Instagram. Ever wondered how to do it? It's actually dead simple.

Brinker B4 Clamp

Another great way is to use a Brinker B4 clamp. These can be used in addition to a regular clamp. The regular clamp actually holds the dam in place. The B4 works to keep the rubber dam down around single tooth. You can place it subgingivally and it holds well. I believe i first saw this on a post by Lincoln Harris.

An issue i've noticed with B4's is they can sit up and in the way. You can tie floss the the B4 and hold it back by tying this to the rubber dam clamp.

Brinker B4

 

Anterior rubber dam tips

  1. Punch holes in an arch form with enough space between them, otherwise you'll end up with it pulling away from the palatal
  2. Isolate more teeth, 3-3 or even 4-4, 5-5.
  3. Use floss ties
  4. Try a Brinker B4 clamp
David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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