Rubber dam Application

Dr. M Arsalan Zubair MDS Trainee (2nd semester)

Operative DentistryDow Dental College

DUHS

Indications for rubber dam placement• moisture control• visibility• patient protection• patient treatment

Contraindications for rubber dam placement

• Claustrophobic patients• Asthamatic patient• Mouth breathers• Partially erupted or hyperplastic gingiva• Patients that need anesthesia to tolerate clamp• Severe crowding• Epileptic patient

Contents

• Armamentarium

• Methods of Application

•Errors during Placement and removal

Rubber Dam Sheet• Light and Dark

• It has shiny and dull surface, dull should face the occlusal side

• Thick Sheet- class V with butterfly clamps

• Thin Sheet- passing easily into tight contact

Patient Napkin

• Why important????

• Ivory- type Stokes-type clamp forceps• Ivory type- limit rotation of retainer• stokes type tip design- permits rotations

Rubber dam forceps

Lubricant• Lubrication Of Dam• Water soluble • Vaseline should not be used why????• Rather it can be applied as lubricant

for lips

Rubber Dam holders

• Strap holders• Woodbury frames• Frame holders• Young’s frame• Nygard-ostby frame• Materials : Metals and plastic

• Teeth themselves or stone cast can be used

• Rubber dam stamp• Templates

Hole positioning guides

• Retainers- retract gingival tissue.• Retainer should contact the

tooth on its four line angles• The prongs of some retainers are

gingivally directed (inverted)• Why????

Retainers

The jaws of the retainer should not extend beyond the mesial and distal line angles of the tooth because :

(1) interfere with matrix wedge placement,

(2) gingival trauma

(3) a complete seal around the anchor tooth is more difficult to achieve.

• Wing or wingless Retainer .What is the use???

• Bow Should be tied with floss .Why?????

Basic Kit of Retainer should a Student have with it self

Winged clamps:• Butterfly-type clamp for anterior teeth

• Universal premolar clamp • Mandibular molar clamp

• Maxillary molar clamp

S-G(Silker-Glickman) Clamp

Indication • Severe Broken Down tooth

• Placed on a tooth proximal to the one being treated.

Methods of tying floss

Rubber dam punch

The rubber dam punch have:a) rotating metal

table or anvils (disk) with holes of varying sizes

b) a tapered, sharp-pointed plunger

Ivory type

Hygienic type

Rotating Table or Anvils

• incisors and mesial surfaces of canines.

• canine

• posterior teeth

• premolars

• molars

• endodontic therapy

• first premolar to first premolar

• first molar to the opposite lateral incisor

• anteriorly to include the lateral incisor on the opposite side of the arch

• one to two teeth distally, and extend anteriorly to include the opposite lateral incisor

• as far distally, and extend anteriorly to include the opposite lateral incisor.

• only the tooth to be treated is isolated

Isolation according to Operation

Now Repeat it….

• For the maxillary central incisors. Holes are positioned approximately 1 inch (25 mm) from the superior border of the dam

• For the mandibular the posterior anchor tooth that is to receive the retainer

Methods of Placement

• Applying the dam and retainer simultaneously

• Applying the dam before the retainer

• Applying the Dam after the retainer

• Cervical retainer placement

• Substitution of a retainer with a matrix

• Split Dam Technique

APPLYING THE DAM AND RETAINER SIMULTANEOUSLY

• Bow being passed through the posterior anchor hole from the underside of the dam

• Gathering the dam to facilitate placement of the retainer

• Positioning the retainer on the anchor tooth

• Stretching the anchor hole borders over and under the jaws of the retainer.

Rubber dam, clamp, and frame Dam, clamp, and frame carried to mouth as one unit and placed

Clamp in place with four-point contactand rubber tucked under the wings

Split Dam TechniqueIndication

Insufficient coronal structure Single fix prosthesis

Abutment tooth for bridge Partially erupted tooth

Steps

•Two overlapping holes are punched in the dam

•Cotton roll is placed under the lip in the mucobuccal fold.

•Sheet is stretched over the three tooth, distal side each

•Clamp is placed on one side and other tied with ligature

Technique

Two overlapping holes are punched in the dam.

The rubber dam is stretched over the tooth to be treated and over one adjacent tooth on each side. The edge of the dam is carefully teased through the contacts on the distal sides of the two adjacent teeth.

APPLYING THE DAM BEFORE THE RETAINER

Applying the Dam after the retainer

After the clamp is placed, the dam is attached to the frame and gently stretched over the clamped tooth with the index finger ofeach hand.

The clamp is tested for a secure fit with gentle finger pressure (alternately) on the buccal and lingual aspects of the clamp apron.

SUBSTITUTION OF A RETAINER WITH A MATRIX

• Complete preparation of the terminal tooth with the retainer in place.

• Stretch the dam distally and gingivally as the clamp is being removed.

• The clamp is removed before placement of the matrix (Toffelmire)

• To maximize access and visibility the mouth mirror is used to reflect the dam distally and occlusally

Example Isolation: From Molar to opposite Lateral Incisor

Step 1: Testing and Lubricating the Proximal Contacts

Step 2: Punching Holes

Step 3: Lubricating the Dam Step 4: Selecting the Retainer

Step 5: Testing the Retainer’s Stability and Retention

Step 6: Positioning the Dam over the Retainer

Step 8: Positioning the Napkin

Step 7: Applying the Napkin

Step 9: Attaching the Frame

Step 10:Passing the Dam through thePosterior Contact

Step11:Applying the Anterior Anchor (If Needed)

Step 12:Passing the Septa through the Contactswithout Dental Tape

Step 13:Passing the Septa through the Contactswith Dental Tape

Step 14:Inverting the Dam Interproximally

Step 15:Inverting the Dam Faciolingually

Step 16:Confirming Proper Application ofthe Rubber Dam

Step 18:Inserting the WedgesStep 17: Checking for Access and Visibility

Removal of Rubber Dam

• Step 1: Cutting the Septa Step 2: Removing the Retainer

Step 3: Removing the Dam Step 4: Wiping the Lips

Step 5: Rinsing the Mouth and Massaging the Tissue

Step 6: Examining the Dam

In Children

• Isolation is from posterior tooth to the canine on the same side.

• Rubber dam sheet-Small, attach to frame

• Napkin should not be use

• Prongs engaged more gingivally

• Retainers:No. 27 and Ivory No. W14

Errors in Rubber dam application• An off-center dam- occlude the

patient’s nasal airway.

• punched arch form is too small,the holes are stretched open around the teeth, permitting leakage

• If the punched arch form is too large- the dam wrinkles around the teeth and may interfere with access

• Inappropriate retainer: may be too small

(1) Breakage (2) Unstable on the anchor tooth

(3) Impinge on soft tissue (4) Impede wedge placement

• Safe to tissues

• Be careful sheet should not tear

• Scissors can hurt tissue during removal of dam

THANK YOU