Rubber dam application

Upgraded

1. Rubber dam Application Dr. M Arsalan Zubair MDS Trainee (2nd semester) Operative Dentistry Dow Dental College DUHS

2. Indications for rubber dam placement moisture control visibility patient protection patient treatment Contraindications for rubber dam placement Claustrophobic patients Asthamatic patient Mouth breathers Partially erupted or hyperplastic gingiva Patients that need anesthesia to tolerate clamp Severe crowding Epileptic patient

3. Contents Armamentarium Methods of Application Errors during Placement and removal

4. Rubber Dam Sheet Light and Dark It has shiny and dull surface, dull should face the occlusal side Thick Sheet- class V with butterfly clamps Thin Sheet- passing easily into tight contact Patient Napkin Why important????

5. Ivory- type Stokes-type clamp forceps Ivory type- limit rotation of retainer stokes type tip design- permits rotations Rubber dam forceps

6. Lubricant Lubrication Of Dam Water soluble Vaseline should not be used why???? Rather it can be applied as lubricant for lips Rubber Dam holders Strap holders Woodbury frames Frame holders Young’s frame Nygard-ostby frame Materials : Metals and plastic

7. Teeth themselves or stone cast can be used Rubber dam stamp Templates Hole positioning guides Retainers- retract gingival tissue . Retainer should contact the tooth on its four line angles The prongs of some retainers are gingivally directed (inverted) Why???? Retainers

8. The jaws of the retainer should not extend beyond the mesial and distal line angles of the tooth because : (1) interfere with matrix wedge placement, (2) gingival trauma (3) a complete seal around the anchor tooth is more difficult to achieve. Wing or wingless Retainer . What is the use??? Bow Should be tied with floss . Why?????

9. Basic Kit of Retainer should a Student have with it self Winged clamps: B utterfly-type clamp for anterior teeth U niversal premolar clamp M andibular molar clamp M axillary molar clamp

10. S-G( Silker -Glickman ) C lamp Indication S evere Broken Down tooth P laced on a tooth proximal to the one being treated.

11. Methods of tying floss

12. Rubber dam punch The rubber dam punch have: rotating metal table or anvils (disk) with holes of varying sizes a tapered , sharp-pointed plunger Ivory type Hygienic type

13. Rotating Table or Anvils

14. incisors and mesial surfaces of canines. canine posterior teeth premolars molars endodontic therapy first premolar to first premolar first molar to the opposite lateral incisor anteriorly to include the lateral incisor on the opposite side of the arch one to two teeth distally, and extend anteriorly to include the opposite lateral incisor as far distally, and extend anteriorly to include the opposite lateral incisor. only the tooth to be treated is isolated Isolation according to Operation

15. Now Repeat it…. For the maxillary central incisors. Holes are positioned approximately 1 inch (25 mm) from the superior border of the dam For the mandibular the posterior anchor tooth that is to receive the retainer

16. Methods of Placement Applying the dam and retainer simultaneously Applying the dam before the retainer Applying the Dam after the retainer Cervical retainer placement Substitution of a retainer with a matrix Split Dam Technique

17. APPLYING THE DAM AND RETAINER SIMULTANEOUSLY

18. Bow being passed through the posterior anchor hole from the underside of the dam Gathering the dam to facilitate placement of the retainer Positioning the retainer on the anchor tooth Stretching the anchor hole borders over and under the jaws of the retainer.

19. Rubber dam, clamp, and frame Dam, clamp, and frame carried to mouth as one unit and placed Clamp in place with four-point contact and rubber tucked under the wings

20. Split Dam Technique Indication Insufficient coronal structure Single fix prosthesis Abutment tooth for bridge Partially erupted tooth Steps Two overlapping holes are punched in the dam Cotton roll is placed under the lip in the mucobuccal fold. Sheet is stretched over the three tooth, distal side each Clamp is placed on one side and other tied with ligature

21. Technique Two overlapping holes are punched in the dam. The rubber dam is stretched over the tooth to be treated and over one adjacent tooth on each side. The edge of the dam is carefully teased through the contacts on the distal sides of the two adjacent teeth.

22. APPLYING THE DAM BEFORE THE RETAINER

23. Applying the Dam after the retainer After the clamp is placed, the dam is attached to the frame and gently stretched over the clamped tooth with the index finger of each hand. The clamp is tested for a secure fit with gentle finger pressure (alternately) on the buccal and lingual aspects of the clamp apron.

24. SUBSTITUTION OF A RETAINER WITH A MATRIX

25. Complete preparation of the terminal tooth with the retainer in place . Stretch the dam distally and gingivally as the clamp is being removed . The clamp is removed before placement of the matrix ( Toffelmire ) To maximize access and visibility the mouth mirror is used to reflect the dam distally and occlusally

26. Example Isolation: From Molar to opposite Lateral Incisor

27. Step 1: Testing and Lubricating the Proximal Contacts Step 2: Punching Holes

28. Step 3: Lubricating the Dam Step 4: Selecting the Retainer

29. Step 5: Testing the Retainer’s Stability and Retention St ep 6: Positioning the Dam over the Retainer

30. Step 8: Positioning the Napkin Step 7: Applying the Napkin Step 9: Attaching the Frame Step 10:Passing the Dam through the Posterior Contact

31. Step11: Applying the Anterior Anchor (If Needed) Step 12:Passing the Septa through the Contacts without Dental Tape

32. Step 13:Passing the Septa through the Contacts with Dental Tape Step 14: Inverting the Dam Interproximally

33. Step 15:Inverting the Dam Faciolingually Step 16:Confirming Proper Application of the Rubber Dam

34. Step 18:Inserting the Wedges Step 17: Checking for Access and Visibility

35. Removal of Rubber Dam Step 1: Cutting the Septa Step 2: Removing the Retainer

36. Step 3: Removing the Dam Step 4: Wiping the Lips Step 5: Rinsing the Mouth and Massaging the Tissue Step 6: Examining the Dam

37. In Children Isolation is from posterior tooth to the canine on the same side. Rubber dam sheet-Small, attach to frame Napkin should not be use Prongs engaged more gingivally Retainers:No . 27 and Ivory No. W14

38. Errors in Rubber dam application An off-center dam- occlude the patient’s nasal airway. punched arch form is too small,the holes are stretched open around the teeth, permitting leakage If the punched arch form is too large- the dam wrinkles around the teeth and may interfere with access

39. Inappropriate retainer: may be too small (1) Breakage (2) Unstable on the anchor tooth (3) Impinge on soft tissue (4) Impede wedge placement Safe to tissues Be careful sheet should not tear Scissors can hurt tissue during removal of dam

40. THANK YOU