Rubber Dam: Components, Application Techniques - PDF

Rubber Dam By Dr. Hamed Ibrahim Mohammad Head of conservative dentistry department  What is the rubber dam Indications & Other Retainers Contraindications Floss ligatures /...

Rubber Dam By Dr. Hamed Ibrahim Mohammad Head of conservative dentistry department  What is the rubber dam Indications & Other Retainers Contraindications Floss ligatures / Components of ties importance rubber dam system Inversion of the Types & indications of rubber dam sheet clamps Application techniques Specifically for gingival of Rubber Dam retraction A thin sheet (latex or nitrile) used to isolate the operative site (one or more teeth) from the rest of the mouth Moisture control Optimum accessibility & visibility Soft tissue retraction (tongue & cheek) Ideal application of adhesive system Decrease risk of injury Decrease risk of injury Decrease fogging Time saving of operation procedures  Disadvantage Time 2. patient’s consuming e objection, beginners 3. Asthmatic or (uncomfortable psychological pt. to some not tolerate patients). rubber dam. Components  1- Rubber dam sheet Thickness ▪ Thin, medium, heavy & extra heavy Thicker dam retract tissue & less tear recommended for isolating Class V. Thinner dam easier passing tight contacts  Materials 1. Latex 2.Non-Latex colors Light & dark are available Darker colors preferred for contrast.  2-Frame Has small projections for securing borders of rubber dam. 3- Rubber dam punch  The rubber dam punch have 1) Tapered, sharp-pointed plunger 2) Rotating metal disk with holes of varying sizes Hole-Positioning Guides 1) Template :  4- Rubber dam clamp forceps Used for placement and removal of clamps from the tooth Types  have stabilizers that prevent clamp rotation Ivory-type clamp on the beaks forceps Its use limited to teeth that are within range of normal angulation  2) Stokes-type clamp forceps : have notches near the tips of their beaks allow a range of rotation for the clamp Used for on teeth that are mesial or distally angled  5- Clamps (retainers) rest on the mesial & distal line angle of the tooth Consists of 1. Two jaws connected by a bow 2. Two holes Function 1. Anchor dam to tooth to be isolated. 2. Retract gingival tissue.  Sizes of clamps Various sizes depending on the tooth small clamps are designed to be used on small single-rooted teeth larger clamps are for use with molar teeth. Types of clamps  METAL OR NON-METAL  WINGED OR WINGLESS If it away from retainer or in Cl-I cavity; Any clamp may be used to retain the sheet When work distal to the abutment tooth you need wingless clamp to put band NORMAL OR ACTIVE Anterior Premolars multiple teeth isolation Molars If in the same tooth (not fully erupted, small molar or wisdom ) use w8A (provide deep grip & increase retention If in the same tooth (proximally, bucc. or ling cavity) use w8A  Specifically for gingival retraction Cervical retracting clamp the jaws with their blades are movable (even after attaching the clamp to the tooth). By moving the blade apically, the gingiva can be retracted apically Disadvantages As the jaws of these clamps are fine, they are not particularly stable and may require support as compound stick They have limited life Gingival Tissue Retraction Dental Clamp  In multiple teeth isolation (MTI) B4 may be used in subgingival cavity as retractor  Lubricant A water-soluble lubricant applied to both sides of the dam around the punched holes aids in passing the dam through the contacts Application of Rubber Dam  Three techniques : A) Clamp first B) Dam first C) Dam & clamp together A) Clamp first Clamp positioned on the tooth Positioning the dam over the retainer With the fore finger , stretch the anchor hole of the dam over the retainer and then under the jaws. The rubber dam is slipped over the wings of the rubber dam clamp.  Indications Posterior teeth in children & adults except 3rd molars Advantages Tooth and gingival margins are clearly visible, this will enable to place the clamp precisely with minimal risk of gingival trauma. Disadvantages Difficult procedure Chances of dislodgement and aspiration of clamp while placing rubber dam B) Dam first It should be carried out with assistance Restricted mostly to anterior teeth & possibly pre-molar because of limited access Assistant’s hands position the dam directly around the tooth to be treated position the clamp  C) Clamp & dam together Indications Posterior most teeth, 3rd molars Advantages Not a difficult procedure to perform Very less chances of dislodgement of the clamp Most commonly used technique Disadvantage Limited vision Rubber dam is stretched over the wings of selected clamp Dam & clamp placed in position in patient’s mouth, with the help of an assistant  Inversion of the rubber dam sheet For secure seal around teeth In multiple teeth isolation. with a flat instrument & dental floss Saliva, blood and GCF (Gingival Crevicular Fluid) away.  Use waxed dental floss to pass the dam through the contacts Inversion of the rubber dam sheet Floss ligatures / ties Retract/displace the rubber dam sheet more apically (greater retraction of the soft tissue and visibility) in Deep Class II, Class V, Anterior teeth isolated for veneers Inversion of the rubber dam  Other Retainers 1.Dental floss or dental tape placed doubly through a contact and then cut to a short length so that it does not impede access 2. A short strip of rubber dam material is cut from the edge of the rubber dam, stretched and carried through the contact, and then allowed to relax to retain the dam Recent Advances in Rubber Dam  Optidam: Optradam: ✓It is a Rubber dam with a 3- It differ from optidam by having dimensional shape embedded frame and printed ✓It is designed to reduce tension: dots resulting in easier rubber dam application and low risk of clamps coming off.  Pre-Framed Dental Dams 1. Built-in flexible frame which eliminates the use of separate frame. 2. Pre-punched hole helps eliminate tearing. 3. Radiographs may be taken by bending the frame without removing the dam. 1. Single-use and hence eliminates the need for sterilization  Opti Dam 3-dimensional shape and nipple design Opti Dam is available in two versions: anterior and posterior. Advantage easier rubber dam application and low risk of clamp displacement less working time than for conventional rubber dams. (no marking of the tooth position) It offers maximum patient comfort and allows them to breath with no pressure around the nasal area.  Optra dam 1. combining the benefits of a lip and cheek retractor, with the total isolation of a rubber dam 2. Place without the need for clamps. 3. there is no need for a separate rubber dam frame 4. more comfort to patient 5. easily to place 6. create large isolated field and complete isolation of both arches can be achieved at the same time  How to use Stretch the Hold outer and inner ring together Punsh holes material Put the rubber dam wings in the The inner ring rest in vestibule of upper and buccal corners lower lips Thank you