Rubber Dam Use in Endodontic Versus Adhesive Restorative Procedures Among General Dental Practitioners: A Multiregional Cross-Sectional Survey

Introduction: Effective moisture control and prevention of microbial contamination are essential for predictable outcomes in endodontic and adhesive restorative dentistry.Rubber dam (RD) isolation is recommended for these procedures, but its use in general dental practice remains inconsistent.This study aimed to describe self-reported RD use during endodontic and adhesive restorative procedures among surveyed general dental practitioners in Europe, the Middle East, and Africa; compare routine use between regional groups; examine years of professional experience across endodontic RD-use categories; and characterize reported barriers to non-routine use.Methods: A multicenter cross-sectional survey recruited a convenience sample of 548 general dental practitioners attending continuing professional development courses during 2017-2023; 539 were analyzed after exclusion of nine incomplete questionnaires.An anonymous, study-specific questionnaire, pilot-tested with 20 practitioners but not formally validated, recorded professional experience, self-reported RD use during endodontic and adhesive restorative procedures, and barriers to non-routine use.Responses were pooled across the recruitment period.Analyses used Pearson's chi-square tests and one-way analysis of variance (ANOVA) with Tukey post-hoc comparisons of professional experience across endodontic RD-use categories.No multivariable adjustment was performed.Results: Reported routine RD use ("I use it") was 47.5% for endodontic procedures and 24.9% for adhesive restorative procedures.Routine RD use was less frequent in the Middle East/Africa than in Europe for both endodontic procedures (33.4% vs. 67.6%;χ²₁=60.99;p<0.001) and adhesive restorative procedures (18.3% vs. 34.2%;χ²₁=17.75;p<0.001).Years of professional experience differed across reported endodontic RD-use categories (one-way ANOVA; p<0.001).Among respondents included in the barrier analysis, patient-related barriers were reported more frequently in the Middle East/Africa than in Europe (21.6% vs. 5.7%; χ²₁=15.00;p<0.001).Conclusions: Self-reported routine RD use, defined as the "I use it" response category, was limited, particularly for adhesive restorative procedures, despite professional recommendations supporting RD isolation.Routine use was less frequent in the Middle East/Africa than in Europe, and routine endodontic users had fewer mean years of professional experience than non-users.These findings describe unadjusted associations in the surveyed sample during 2017-2023 and do not establish independent effects or current practice patterns.Targeted continuing education addressing technical skills and patient communication warrants formal evaluation as a potential strategy to improve routine RD use.