rubber dam lecture
TRANSCRIPT
Rubber Dams in dentistry
Dr. Arpana. A. DeviBDS (Fj) Post grad dip Endo (Aust)
a piece of thin, stretchable latex or nonlatex material that becomes a barrier to selected teeth when applied. The isolation technique helps protect the teeth for all types of dental procedures
What is a Rubber Dam?
University of Illinois - 1900
University of Illinois - 1900
Rubber Dams
First reported use in ~ 1840Dr. S.C. Barnum – USA
Recommended by ALL teaching authorities and professional societies since the 19th Century for ALLendodontic procedures
And for many other dental procedures!!
Reasons for Using RD
Reasons for Using RD
• Infection control• Patient safety• Patient comfort• Moisture control• Increased visibility
• Increased access• Increased efficiency• “Dento-legal”
reasons• Improved treatment
outcome
1. Infection Control
2. Patient Safety
Increased visibility and access
“You can do it better when you can see it better!”
Don’t have to deal with tongue, saliva and patient
7. Increased Efficiency
Saves significant operating time
Quick to apply – mean: 1.9 minutesGergely BDJ 1989
7. Increased Efficiency
Saves significant operating time
Quick to apply – mean: 1.9 minutesGergely BDJ 1989
BUT - they were general dentistsOnly used RD 5% of the time
Regular users likely to be much faster
7. Increased Efficiency
Saves significant operating time
Quick to apply – mean: 1.9 minutesGergely BDJ 1989
BUT - they were general dentistsOnly used RD 5% of the time
Regular users likely to be much faster
NB: Local Anaesthesia needs 3-5 minutes to be effective
Dento-legal reasons
8. Dento- legal reasons
“One of the most obvious departures from the accepted standard of care(during endodontic treatment)
is the failure to use rubber dam”
Cohen & SchwartzCohen & SchwartzJoEJoE 19871987
MATERIALS
Rubber Dam
Sizeavailable: precut squares of 6 in × 6 in and 5 in × 5 in. The 6 in × 6 in is usedfor posterior applications. The5 in × 5 in squares are for anteriorapplication and primary detention.ThicknessThe dental dam’s thicknessgauge can vary from thin, medium,and heavy. Colorwide variety of colors. scented or unscented, flavored or unflavored. prefered the darker shades for contrast.
Punch
Rubber Dam Equipment
Holes are too largeHoles are too largeDifficult to position RDDifficult to position RD
Dam Punch
used to create holes , needed to expose the teeth that are to be isolated. The punch’s working end is used to puncture the dam for the correct hole sizes:Size 5 is the largest size used for anterior tooth.Size 4 the next size smaller used for molars.Size 3 is for bicuspids and canines.Size 2 is for maxillary anteriors and incisiors.Size 1 is the smallest size used for mandibularanterior incisors.
Punch
Rubber Dam Equipment
Use the largest Use the largest hole ONLYhole ONLY
-- one size fits all !!!one size fits all !!!
Clamp Forceps
Rubber Dam Equipment
Dental forceps
used to place and remove the dental dam clamp. The beaks of the forceps fit into the holes on the clamp’s jaws.The handles have a spring action that allows the forceps, when squeezed, to open up and fit over the tooth. When the handles are released, so is the clamp.
ClampsRubber Dam Equipment
Keep it Simple !!!
clamp is used to stabilize the dental dam. The dam clamp holds the dental dam secure on the end nearest the tooth thatis being treated. Clamps can be ligatedfor security and safety of the patient from swallowing if the clamp becomes dislodged during treatment.
Types
Non winged winged
Clamps Anterior teeth
Clamps Premolar teeth
Clamps Molar teeth
Keep the choices simple!!
necessary to stabilize and stretch the dam tightly over the teeth. Frames come in plastic and metal. Both can be cold or heat sterilized.
Dam Frames
Young’s frame (metal)
Star “visi” frame
Nygaard-Östby frame
OraSeal
Extra Items
Wedjets
Anterior teeth isolated with wedjets
RD placement techniquesSeveral methods: Single tooth isolation and multiple teeth
1. RD and clamp already set-up and placed on tooth together as a unitUsually requires assistance. Stretch the dam material from side to side to secure the corners of the dam on the four projections at the corner of the frame. The rubber dam material should appear baggy on the frame rather than tight to allow easier placement in the oral cavity. Pass the dam and attached frame to the dentist for placement in the oral cavity. As the dentist stretches the rubber dam material over each tooth to be isolated, the assistant uses floss to slip the septum (rubber dam material between the holes)between the teeth without tearing the material. Always place the floss on the tooth, never directly on the rubber dam itself. Placement of the floss upon the tooth assists in bringing a single thickness of the dam through the interdental area
Applying Rubber DamPreferred method RD on a winged clamp
Applying Rubber DamPreferred method RD on a winged clamp
Place on tooth together
Applying Rubber Dam
Applying Rubber Dam
Applying Rubber Dam
Applying Rubber Dam
Can set it up in a frame then place Or
put clamp and dam then put frame
2.places the rubber dam clamp on the tooth first. Then slip the rubber dam material over the clamp.
Applying Rubber Dam
Applying Rubber DamAVOID Placing clamp in mouth without RD
If used Remove floss once RD placed
a) Single Tooth Isolation
RD Techniques for Endodontics
Hole Positions - Single Tooth Technique
x
Anterior Teeth
Labi
al ¼¼¼
Labi
al
Hole Positions - Single Tooth Technique
x x
Anterior Teeth Posterior Teeth
Labi
al
Mes
ial
¼¼¼ ⅓⅓⅓
Mesial
Cuff Technique: multiple teeth isolation
RD Techniques
Hole Positions - Cuff Technique
x
Anterior Teeth
Labi
al ¼¼¼
Labi
al
Hole Positions - Cuff Technique
x x
Anterior Teeth Posterior Teeth
Mes
ial
¼¼¼ ⅓⅓⅓Labi
al
Hole Positions - Cuff Technique
x
Posterior Teeth
Mes
ial
⅓⅓⅓Mesial
Cuff technique using extra Items Wedjets + OraSeal
WHATS NEW
“Non-latex” Rubber Dam
Orashield - Rubber Dam Napkins
Orashield - Rubber Dam Napkins
Some Other HintsMissing teeth
Some Other HintsOrthodontic brackets / arch wires
Some Other HintsRD not well adapted to the tooth
Record Keeping
Some Other HintsBe sure to isolate the correct tooth!!
Some Other HintsBe sure to isolate the correct tooth!!
Plastic Clamps
Some Other Hints“Opti Dam” - the “3D rubber dam”
Some Other Hints“Opti Dam”
Some Other Hints“Optra Dam”
Some Other Hints
Some Other Hints“Improvisation” - in Vietnam 2000
Rubber Glove !!Rubber Glove !!
1) Infection control2) Patient safety3) Patient comfort4) Moisture control5) Increased visibility6) Increased access7) Increased efficiency8) “Dento-legal” reasons9) Improved treatment
outcome
Reasons for Using RD
It’s “Dam” Easy !!