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Tooth Isolation in Operative Dentistry Dr Eason Soo Dr Shalini Kanagasingam Dept of Operative Dentistry Faculty of Dentistry UKM


By the end of the lecture the students should

be able to:

Identify the instruments used for rubber dam placement.

List the purpose of field isolation in operative dentistry.

List the methods of field isolation.

Discuss the advantages/benefits of using rubber dam.

List the criteria for acceptable and non-acceptable rubber dam isolation.

Place rubber dam effectively in the phantom head.

Evaluate the rubber dam placement, identify faults and rectify them if present.


•

The rubber dam is a sheet of latex placed in the mouth to form a barrier between patient’s mouth and teeth, in effect isolating them.

•

This means that the patient can swallow and breathe normally, and prevents from ingesting mercury from old fillings or swallowing small dental instruments.


Armamentarium


Rubber dam Forcep

Hole Puncher

Frame

Clamps


Different hole size


Metal Plastic


Molar

Anterior / Premolar

Anterior

Premolar


Stable, 4 point contact below the maximum bulbosity


Techniques


Clamp (winged) and dam together, then frame later a. The hole in the rubber dam is stretched across the wings of the clamp b. The clamp is held in the forceps and fitted over the tooth c. A flat plastic instrument is used to push the rubber off the wings d. The frame is applied Note: Wingless clamped can be used too


Dam over clamp (Wingless/winged), then frame

The correct clamp is selected and placed over the tooth The dam is stretched into place over the clamp The frame is applied


• Clamp (Wingless) over dam, then frame

The rubber dam is placed first over the tooth to be isolated The assistant holds the dam in place The clamp is placed over the rubber dam and the tooth by the operator Problem: Too many fingers The frame is applied in the patient’s mouth!


Invert the rubber dam margins after you have isolated the tooth, otherwise saliva might still leak through the dam ‌.. and contaminate the working area.


ADVANTAGES OF RUBBER DAM PLACEMENT


Very high patient acceptance because it allows them to relax. 95% of patients react positively to its use. Even if we have effective local anaesthetic our patients still have to contend with things falling down the back of their throats, which is enough to make any one anxious. Rubber dam allows patients to truly relax and many fall asleep in your chair.

Protection of the patient's airway from debris associated with removing old restorations so they don’t swallow or inhale amalgam/mercury etc.


• Protection of patient's soft

tissue, keeping tongue, lips and cheeks out of the way Infection control - placing a high speed drill/handpiece in someone's mouth creates an aerosol spray with the patient's saliva increasing the risk to dentist and assistant alike

• Isolation of the operating

field - the essential requirement for the successful use of a bonding system and placement is a clean dry field.


• Huge time saver

because patient doesn't need to sit up and rinse. One doesn't have to waste time with cotton rolls, saliva ejectors, keeping tongue and cheeks protected and out of the way. Also not the constant need for suction

• Improved access

and visibility – much easier for dentist and assistant to see the area they are working on


Maintains a clean and visible field for the dentist

The operative field can be dried, and mirror fogging caused by breathing is prevented

Protects the patients – prevent the accidental aspiration or swallowing of instruments, irrigants, fragments of tooth and restorative materials

To reduce and control the aerosol of microbes and saliva produced when using a turbine handpiece. In addition, the patient does not have a mouth full of water

To prevent contamination of the access cavity and root canal system with saliva

Retracts and protects the soft tissues of the mouth

Increase efficacy by minimizing patient conversation and need for frequent rinsing

Rubber dam produces a watertight seal that allows the safe use of sodium hypochlorite and other disinfectants as irrigants

Improved properties of restorative materials. If the restorative materials come in contact with the saliva, the properties of the material deteriorates

Psychological benefit to the patient

Treatment is quicker and more pleasant for both the patient and the clinician


• When it may be contraindicated: •

If a tooth is too short to hold a clamp or a non-restorable tooth

Tooth not fully erupted

Mouth breather / asthmatic patients

Patient's inability to handle their own oral secretions, e.g., a person with Parkinson's disease may have a diminished ability to swallow and therefore be unable to handle saliva accumulation under the rub

Allergic to latex rubber dam, alternative: use latex-free rubber dam


Criteria of Clinically Acceptable RD Placement


Minimum of 5 teeth must be isolated Do not place the clamp on the tooth to be treated The treated tooth should be in the middle of the rubber dam


Single tooth isolation Pre-endo restoration/build-up for badly broken down tooth to achieve optimal seal Adjunctive materials like OraSeal and rubber dam stabilization cord (Wedjets)


Problems solving


Wedjets

For badly broken down tooth


OraSeal


Thank you


Rubber dam isolation oct2013:2014 soo