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 patientâ€™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.
Rubber dam Forcep
Different hole size
Anterior / Premolar
Stable, 4 point contact below the maximum bulbosity
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
â€˘ 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 patientâ€™s mouth!
Invert the rubber dam margins after you have isolated the tooth, otherwise saliva might still leak through the dam â€Ś.. 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.
â€˘ 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
â€˘ 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)
For badly broken down tooth