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Rubber Dam - Dentistry

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Rubber Dam - Dentistry

  1. 1. RUBBER DAM Presented by : Cheng Yung Yew P11132
  2. 2. Goals of Isolation • Moisture Control • Retraction and Access • Harm Prevention • Local Anesthesia
  3. 3. Definition - Rubber Dam • A small latex or non-latex sheet • used to isolate a tooth or teeth from the oral environment and to prevent migration of fluids or foreign objects into or out of the operative field • providing a dry, visible and clean operative field.
  4. 4. Rubber Dam Isolation • 1864, New York City – S.C. Barnum, introduced rubber dam • Ensures appropriate dryness of the teeth • Isolating one or more teeth from oral environment • Prevent pulpal contamination from oral fluids
  5. 5. Advantages of Rubber Dam 1. A dry, clean operating field 2. Improved access and visibility 3. Improved properties of dental materials 4. Protection of patient and operator 5. Operating efficiency
  6. 6. Disadvantages of Rubber Dam 1. Low usage among private practitioners 2. Time consuming 3. Patient objection 4. Conditions precluding use of rubber dam  Teeth that have not erupted sufficiently  Some third molars  Extremely malpositioned teeth  Patients with asthma (breathing difficult thru nose)
  7. 7. Materials and Instrument I. Rubber Dam Material II. Rubber Dam Holder (frame) III. Rubber Dam Retainer (clamp) IV. Rubber Dam Punch V. Rubber Dam Retainer Forceps VI. Rubber Dam Napkin VII. Lubricant VIII.Modeling Compound IX. Anchors
  8. 8. I. Rubber Dam Material Dam material available in 5x5 inch or 6x6 inch sheets Thicknesses or weights othin (0.15mm), medium (0.2mm), heavy (0.3mm), super heavy (0.35mm) Has a shiny and a dull side oDull side  less light reflective  placed facing the occlusal side of the isolated teeth
  9. 9. II. Rubber Dam Holder ( Young’s frame) Maintains the borders of rubber dam in position U-shaped metal frame Small metal projections An optional Neck Strap may be placed behind the patient’s neck  attached to 2 hooks
  10. 10. III. Rubber Dam Retainer (clamp) Consists of 4 prongs and 2 jaws, connected by a bow Used to anchor the dam to most posterior tooth to be isolated Used to retract gingival tissue Available in different sizes and shapes Wings  provide extra retraction of rubber dam Disadvantage : interfere with placement of matrix bands, wedges
  11. 11. IV. Rubber Dam Punch A precision instrument having a rotating metal table (disk) with 6 holes of varying sizes, and a tapered, sharp-pointed plunger Plunger should be centered in the cutting hole  avoid chipping of holes by plunger tip
  12. 12. V. Rubber Dam Retainer Forceps Used for placement and removal of retainer from tooth
  13. 13. VI. Rubber Dam Napkin Placed between rubber dam and patient’s skin Advantages : Prevents skin contact with rubber to reduce possible allergic reactions Absorbs any saliva seeping at corners of mouth Acts as cushion Convenient method wiping patient’s lip on removal of the dam
  14. 14. VII.Lubricant Applied in area of punched holes to facilitate the passing of dam through proximal contacts Cocoa butter, petroleum jelly  applied to corners of mouth to prevent irritation VIII. Modeling Compound Sometimes used to secure retainer to tooth Prevent retainer movement during operative procedure
  15. 15. IX. Anchors (Other than Retainers)  Proximal contact may be sufficient to anchor the dam on the tooth farthest from the posterior retainer  To secure the anchor further, a waxed dental tape (or floss), or a small piece of rubber dam material, can be passed through the proximal contact.
  16. 16. Hole Size and Position • Holes must be punched by following arch form • 5-6 holes in cutting table of rubber dam punch • Smaller holes  incisors, canines & premolars • Larger holes  molars, posterior anchor tooth
  17. 17. • Guidelines in Positioning the Holes : - 1. Punch an identification hole in upper left corner of rubber dam (optional) 2. When operating on the incisors and mesial surfaces of canines, isolate from first premolar to first premolar.
  18. 18. 3. When operating on posterior teeth, isolate anteriorly to include the lateral incisor on the opposite side of arch from the operating site. 4. Isolation of minimum of 3 teeth is recommended except when endodontic therapy is indicated. 5. The distance between holes is equal to the distance from the center of one tooth to the center of adjacent tooth, measured at level of gingival tissue  prevents wrinkles of the dam between teeth.
  19. 19. 6. When a cervical retainer is used for isolation of a Class V lesion, a heavier rubber dam usually recommended for better tissue retraction.  Hole for the tooth should be punched slightly facial to arch form  The farther gingivally the lesion extends, the farther the hole must be positioned from arch form.  Hole should be slightly larger
  20. 20. 7. When a thinner rubber dam is used, smaller holes must be punched, because thin dam has greater elasticity to seal around the teeth. 8. For inexperienced operator, a rubber stamp that imprints permanent and primary arch forms on rubber dam is available. 9. A plastic template can be also used to mark hole position.
  21. 21. Placement of Rubber Dam • Before placing the rubber dam  dental chair adjusted for optimal patient comfort • Usually, administering anesthetic precedes application of rubber dam • Rubber dam and retainer can be placed sequentially  provides maximal visibility when placing retainer, reduces risk of impinging on gingival tissue
  22. 22. • Alternative placement : -  Applying Dam and Retainer Simultaneously 1. reduce risk of retainer being swallowed 2. this approach ease the passing of the dam over a previously placed retainer  Applying Dam Before Retainer 1. There is no need of manipulate dam over retainer 2. Reduction in visibility of underlying gingival tissue, which may impinged on by retainer
  23. 23. Application of Rubber Dam Isolation• STEP 1 : Testing and Lubricating the Proximal Contacts • STEP 2 : Punching the 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 7 : Applying the Napkin • STEP 8 : Positioning the Napkin
  24. 24. • STEP 9 : Attaching the Frame • STEP 10 : Attaching the Neck Strap *(Optional) • STEP 11 : Passing the Dam Through Posterior Contact • STEP 12 : Applying Compound *(Optional) • STEP 13 : Applying the Anterior Anchor (If needed) • STEP 14 : Passing the Septa Through the Contacts without Tape • STEP 15 : Passing the Septa Through the Contacts with Tape
  25. 25. • STEP 16 : Technique for Using Tape *(Optional) • STEP 17 : Inverting the Dam Interproximally • STEP 18 : Inverting the Dam Faciolingually • STEP 19 : Using a Saliva Ejector *(Optional) • STEP 20 : Confirming a Properly Applied Rubber Dam • STEP 21 : Checking the Access and Visibility • STEP 22 : Inserting the Wedges
  26. 26. Removal of Rubber Dam Isolation • 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
  27. 27. Factors affecting Rubber Dam Placement• Variation with Age • Errors in Application and Removal 1. Off-Center Arch Form 2. Inappropriate Distance between the Holes 3. Incorrect Arch Form of Holes 4. Inappropriate Retainer 5. Retainer-Pinched Tissue 6. Shredded or Torn Dam 7. Incorrect Location of Hole for Class V Lesion 8. Sharp Tips on No.212 Retainer 9. Incorrect Technique for Cutting Septa
  28. 28. Reference • Sturdevant’s Art and Science of Operative Dentistry, Fifth Edition; Theodore Robertson, Herald Heymaan, Ed Swift; Chapter 10 Rubber Dam Isolation; 10:463-86 • http://www.youtube.com/watch?v=5e979h67 YVc
  29. 29. You don't have to brush your teeth - just the ones you want to keep.