Case Report/Clinical Techniques|Articles in Press

Rubber Dam Clamp May Cause Cortical Necrosis: A Case Report

Published:March 10, 2023DOI:



      Tooth isolation methods utilized during endodontic procedures are necessary to create an aseptic field and protect the patient’s alimentary tract from irrigate and instrument insult. This case details changes that can occur in mandibular cortical bone architecture following the use of a stainless steel rubber dam clamp during an endodontic procedure.

      Case Report

      A 22 year-old, otherwise healthy woman underwent non-surgical root canal therapy on tooth #31 (mandibular right second molar, symptomatic irreversible pulpitis and peri-apical periodontitis.) Cone beam computed tomographic (CBCT) imaging obtained between treatments revealed irregular erosive and lytic changes of the crestal-lingual cortical bone resulting in sequestrum formation with infection and exfoliation. Continued monitoring and six-month post-treatment CBCT revealed complete resolution without further intervention.


      When a stainless steel rubber dam clamp is placed onto gingiva overlying mandibular alveolar bone, bony changes can occur presenting with radiographic signs of cortical erosion and may result in necrosis of the cortical bone with sequestrum formation. Knowledge of this potential outcome improves our understanding of the normal course progression after dental procedures utilizing a rubber dam clamp for tooth isolation.


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