Rubber dam
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rubber dam isolation technique
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Rubber dam
- 1. RUBBER DAM Dr.Nilesh Rathi
- 2. Introduction Dr Sanford Christie Barnum in 1864. Rubber dam method application by Dr Hodson in 1870.
- 3. Advantages Isolation of the tooth from saliva, blood, gingival exudates. Aids isolation from bacteria of saliva. Protects patients from swallowing or inhaling the instruments. Prevents infection of patient to the dentist Creates a psychological barrier between patient and dentist.
- 4. Additional uses After periodontal surgery along with periodontal pack Root planning Thermal test Electric pulp testing
- 5. Disadvantages Patient cannot speak Claustrophobia Time consuming Sensitivity to teeth for some time after removal.
- 6. Contraindication Contact allergy Metal crowns Ceramic crowns Mouth breathing Respiratory problems
- 7. Classification Winged and Non winged Metal and Polycarbonate (Endo-technic) Bland and Retentive
- 8. Armamentarium Rubber dam sheet Rubber dam frame Rubber dam clamp Rubber dam clamp holder Ainsworth rubber dam punch Floss or wedges or wood stick Rubber dam template Rubber dam lubricant Napkin
- 10. Clamp forcep Punch forcep Rubber dam frame Rubber dam clamp Armamentarium
- 11. Armamentarium
- 12. Rubber dam Sheet Rubber dam template Lubricant Armamentarium
- 13. Steps of Rubber Dam Application Cleaning of teeth Selection of clamp Punching of hole in rubber dam Flossing the clamp Application of the rubber dam Application of lubricant & flossing through contact with lubricant Application of napkin and holder
- 14. Pre Operative Assessment 1. Patient`s mouth – calculus or any sharp edges of instrument 2. Contact points 3. Rinse and dry mouth 4. Local anesthesia before application
- 15. Selection of clamp Four point contact below the maximum coronal diameter. Try bland type first followed by retentive Measure M-D crown length at gingival margin and select clamp just smaller to it. For sub gingival restoration use- Ferrier 212 clamp Thick rubber dam
- 16. Clamp selection S No Clamp Teeth 1 #8 A, #14 A For irregularly shaped, structurally compromised or partially erupted molars 2 #9, #212 Anteriors 3 #00, #1, #2 Maxillary Premolars, Primary incisors and Canine Large Bicuspids, Primary first molar 4 #3, #4, #8, #7, #W56 Molars 5 #12A #13A Lower right, Upper right molars Lower left & upper left molars
- 17. Rubber Dam Sheet Sr No Type Thickness (mm) Thickness (inches) 1 Thin 0.15 0.006 2 Medium 0.20 0.008 3 Heavy 0.25 0.010 4 Extra heavy 0.30 0.012 5 Super heavy 0.35 0.014
- 18. Colour of sheet Sr No Colour Special Uses 1 Blue/ Green Photography 2 Black For contrast with enamel for fillings 3 Grey Alternative for black colour 4 Transparent Endodontics
- 19. Punch holes S No Hole Teeth 1 A Mandibular 1 molar, Large maxillary molar 2 B Maxillary molar small, Second primary molar 3 C Canine , Premolars, First primary molar 4 D Upper incisors 5 E Lower incisors
- 20. Floss Method
- 21. Rubber dam fixation Single tooth isolation Multiple teeth isolation 1. Fissure sealants 2. Class I and Class V cavity restoration 3. Endodontics 1. Bleaching 2. Class II restoration 3. Multiple restorations Preferably winged clamp for retaining Preferably wingless clamp for retaining Posterior most tooth or operating tooth Premolar to premolar , premolar to contra lateral lateral incisor
- 22. Method of Application Sr No Methods Utility 1 Clamp before rubber dam Posterior teeth in children and adults 2 Clamp along with rubber dam Third molars 3 Clamp after rubber dam placement Anteriors and Premolars
- 23. Guidelines Sr No Teeth Operating Teeth applied with rubber dam 1 Incisors Canine to canine (Clamp not compulsory) 2 Canines 1st premolar to 1st premolar 3 Posteriors Two teeth distal to lateral incisors of contralateral side 4 Any other At least one tooth distal and one tooth mesial
- 24. Sterilization Autoclave Hot Air Oven Clamps, frame, forceps Punches
- 26. References: Sturdevent. Textbook of Operative Dentistry. Raymond Braham. Rubber Dam in Clinical Practice.
Editor's Notes
- S C Barnum connecticut valley dental society in 1864
- Always keep the rubber dam inverted in the sulcus for complete isolation. The clamp should be fixed below the height of contour of the teeth.
- Punches made up of carbon steel.