Rubber Dam - 07 - Handout

Prof. Paul V. AbbottRubber Dam

UWA - 3rd Yr Endodontics 2007

Rubber DamRubber Dam Rubber DamRubber Dam

a)a) First reported use in ~ 1840First reported use in ~ 1840

Dr. S.C. BarnumDr. S.C. Barnum –– USAUSA

University of IllinoisUniversity of Illinois -- 19001900Rubber DamRubber Dam

a)a) First reported use in ~ 1840First reported use in ~ 1840

Dr. S.C. BarnumDr. S.C. Barnum –– USAUSA

b)b) Recommended byRecommended by ALLALL teaching authoritiesteaching authoritiesand professional societies since the 19and professional societies since the 19thth

Century forCentury for ALLALL endodontic proceduresendodontic procedures

And for many other dental procedures!!And for many other dental procedures!!

Reasons for Using RDReasons for Using RD Reasons for Using RDReasons for Using RD

a)a) Infection controlInfection control

b)b) Patient safetyPatient safety

c)c) Patient comfortPatient comfort

d)d) Moisture controlMoisture control

e)e) Increased visibilityIncreased visibility

f)f) Increased accessIncreased access

g)g) Increased efficiencyIncreased efficiency

h)h) ““DentoDento--legallegal”” reasonsreasons

i)i) Improved treatment outcomeImproved treatment outcome



Infection Control

Cochran et alJADA 1989

Recovery of Micro-organisms With and Without

Rubber Dam during Cavity Preparation

At the Dental LightMean CFU

50

30

10

41

0

21

1

Anterior PosteriorTeeth Teeth

No RD usedNo RD used

RD usedRD used

Infection Control

Infection Control

Cochran et alJADA 1989

Recovery of Micro-organisms With and Without

Rubber Dam during Cavity Preparation

On the Patient’s ChestMean CFU

400

300

200

100

381

84

211

42

Anterior PosteriorTeeth Teeth

No RD usedNo RD used

RD usedRD used

Patient Safety

Patient ComfortPatient Comfort

99% of patients accepted the use of RD99% of patients accepted the use of RD

72%72% preferred RDpreferred RD

20%20% had no preferencehad no preference

8%8% preferred no RDpreferred no RD

When appointment was 45When appointment was 45--60 minutes:60 minutes:

76%76% preferred RDpreferred RD

24%24% had no preferencehad no preference

0%0% preferred no RDpreferred no RD GergelyGergelyBDJBDJ 19891989


Favourable commentsFavourable comments -- 82% of patients:82% of patients:

Absence of things in the mouthAbsence of things in the mouth

Secure, comfortable, safe, relaxed, detachedSecure, comfortable, safe, relaxed, detached

Tongue out of way, protectedTongue out of way, protected

No dribbling, no bad tastesNo dribbling, no bad tastes

Can swallow any time & without fear ofCan swallow any time & without fear ofswallowing bits of filling, etcswallowing bits of filling, etc

GergelyGergelyBDJBDJ 19891989




Unfavourable commentsUnfavourable comments -- 18% of patients:18% of patients:

Disliked clamp placementDisliked clamp placement

Breathing difficultiesBreathing difficulties

Smell, colourSmell, colour

Rubber irritatedRubber irritated

Apprehensive, claustrophobicApprehensive, claustrophobic

GergelyGergelyBDJBDJ 19891989

Moisture ControlMoisture Control

Increased Access & VisibilityIncreased Access & Visibility Increased Access & VisibilityIncreased Access & Visibility

““You can do it better when you can see it better!You can do it better when you can see it better!””

Increased EfficiencyIncreased Efficiency

Saves significant operating timeSaves significant operating time

Quick to applyQuick to apply –– mean: 1.9 minutesmean: 1.9 minutes

GergelyGergely BDJBDJ 19891989

BUTBUT -- they were general dentiststhey were general dentists

Only used RD 5% of the timeOnly used RD 5% of the time

Regular users likely to be much fasterRegular users likely to be much faster

NB: Local Anaesthesia needsNB: Local Anaesthesia needs33--5 minutes to be effective5 minutes to be effective

“Dento-Legal” Reasons

Recommended by ALL teaching authoritiesand professional societies since the 19thCentury for ALL endodontic procedures

And for many other dental procedures!!



““DentoDento--LegalLegal”” ReasonsReasons

The Dental Practice Board of VictoriaThe Dental Practice Board of Victoria

Policy DecisionPolicy Decision –– Oct 1998; Revised Nov 2002Oct 1998; Revised Nov 2002

““The use of rubber dam is mandatory forThe use of rubber dam is mandatory forroutine endodontic therapyroutine endodontic therapy””

““Serious, deliberate or repeated departuresSerious, deliberate or repeated departures…… could result in a dentist being chargedcould result in a dentist being chargedwith professional misconductwith professional misconduct””

““DentoDento--LegalLegal”” ReasonsReasons

““One of the most obvious departuresOne of the most obvious departures

from the accepted standard of carefrom the accepted standard of care(during endodontic treatment)(during endodontic treatment)

is the failure to use rubber damis the failure to use rubber dam””

““There would be no argument regardingThere would be no argument regarding

liability and the only question wouldliability and the only question wouldbe the amount of the settlementbe the amount of the settlement””

Cohen & SchwartzCohen & SchwartzJoEJoE 19871987

Improved Treatment OutcomeImproved Treatment Outcome

A review of 50 studies of the outcome ofA review of 50 studies of the outcome ofendodontic treatmentendodontic treatment

Rubber dam was not used in 2 studiesRubber dam was not used in 2 studies

JokinenJokinen et alet al 19781978 -- 53% favourable53% favourable

BarbakowBarbakow et alet al 19811981 -- 59% favourable59% favourable

FriedmanFriedman -- Essential EndodontologyEssential Endodontology 19981998


FriedmanFriedman -- Essential EndodontologyEssential Endodontology 19981998

15159090 –– 100100

22228080 –– 8989

887070 –– 7979

006060 –– 6969

55 **< 60< 60

No. of StudiesNo. of Studies% of Cases with a% of Cases with aFavourable OutcomeFavourable Outcome


KnightKnight et alet al -- Int JInt J ProsthodProsthod 19931993

Leakage of composite resins placed clinicallyLeakage of composite resins placed clinically

Rubber dam isolation: 30/30 teeth had no leakageRubber dam isolation: 30/30 teeth had no leakage

Cotton roll isolation: only 16/30 had no leakageCotton roll isolation: only 16/30 had no leakage

Statistically significant differenceStatistically significant difference

a)a) Infection controlInfection control









Reasons for Using RDReasons for Using RD



Rubber DamRubber Dam

Medium bodyMedium body

GreenGreen

Rubber Dam EquipmentRubber Dam Equipment

PunchPunch


Holes are too largeHoles are too large Difficult to position RDDifficult to position RD

PunchPunch


Use the largestUse the largesthole ONLYhole ONLY

-- one size fits all !!!one size fits all !!!

Clamp ForcepsClamp Forceps


ClampsClamps


Keep it Simple !!!


ClampsClamps Winged clamps preferredWinged clamps preferred



ClampsClamps Anterior teethAnterior teeth


ClampsClamps Premolar teethPremolar teeth


ClampsClamps Molar teethMolar teeth


ClampsClamps Keep the choices simple!!Keep the choices simple!!


FramesFrames


FramesFrames YoungYoung’’s frame (metal)s frame (metal)




FramesFrames StarStar ““VisiVisi”” frameframe


FramesFrames NygaardNygaard--ÖÖstby framestby frame









Extra ItemsExtra Items OraSealOraSeal




Extra ItemsExtra Items WedjetsWedjets


Extra ItemsExtra Items WedjetsWedjets


Extra ItemsExtra Items WedjetsWedjets ++ OraSealOraSeal

Applying Rubber DamApplying Rubber Dam

Preferred methodPreferred method RD on a winged clampRD on a winged clamp


Preferred methodPreferred method RD on a winged clampRD on a winged clamp

Place on tooth togetherPlace on tooth together


AVOIDAVOID Placing clamp in mouth without RDPlacing clamp in mouth without RD




AVOIDAVOID Placing clamp in mouth without RDPlacing clamp in mouth without RD

If usedIf used Remove floss once RD placedRemove floss once RD placed

a)a) Single Tooth IsolationSingle Tooth Isolation

b)b) Cuff TechniqueCuff Technique

RD Techniques for EndodonticsRD Techniques for Endodontics

a)a) Single Tooth IsolationSingle Tooth Isolation

RD Techniques for EndodonticsRD Techniques for EndodonticsHole Positions - Single Tooth

Technique

x x

Anterior Teeth Posterior Teeth

Lab

ial

Me

sia

l

¼ ⅓








RD Techniques for EndodonticsRD Techniques for Endodontics Hole Positions - Cuff Technique

x x

Anterior Teeth Posterior Teeth

Lab

ial

Me

sia

l

¼ ⅓

Rubber DamRubber Dam

Some AdditionalSome Additional

Tricks & HintsTricks & Hints

““NonNon--latexlatex”” Rubber DamRubber Dam


OrashieldOrashield -- Rubber Dam NapkinsRubber Dam Napkins

Rubber Dam EquipmentRubber Dam Equipment Rubber Dam EquipmentRubber Dam Equipment

OrashieldOrashield -- Rubber Dam NapkinsRubber Dam Napkins



Some Other Hints

Missing teethMissing teeth

Some Other Hints

Orthodontic brackets / arch wiresOrthodontic brackets / arch wires

Some Other Hints

RD not well adapted to the toothRD not well adapted to the tooth

Record Keeping

ClampsClamps

Rubber Dam EquipmentRubber Dam Equipment Some Other Hints

Be sure to isolate the correct tooth!!Be sure to isolate the correct tooth!!



Some Other Hints

Be sure to isolate the correct tooth!!Be sure to isolate the correct tooth!!a)a) Infection controlInfection control









Reasons for Using RDReasons for Using RD

ItIt’’ss ““DamDam”” Easy !!Easy !!

Rubber Dam - 07 - Handout

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