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INDEX
INTRODUCTION
ADVANTAGES
DISADVANTAGES
ARMAMENTARIUM
PREPARATIONOF THE CHILD PATIENT
ISOLATION OF SINGLE TOOTH
ISOLATION OF QUADRANT
ISOLATION OF ANTERIOR TEETH
ERRORS IN PLACEMENT AND REMOVAL
OF RUBBERDAM
CONCLUSION
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Introduction
To restore primary teeth
to a high standard the
operating area has to be well
isolated for two procedures :
a). Cavity preparation
b). Placement of restoration
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Means of isolation
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Rubber dam provides the best possible
isolation by far.
In 1964 S.C.Barnum a New York city
dentist introduced the rubber dam into
dentistry.
It is used to define the operating field by
isolating one or more teeth from oral
environment.
When excavating a deep carious lesions and
risking pulpal exposure, use of the rubber
dam is strongly recommended to prevent
pulpal contamination from oral fluids.
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Advantages
Provision of dry clean operating field.
Improvement of access & visibility by
eliminating tongue, lip, cheeks & saliva
from the operating field .
Retraction & protection of soft tissues.
Prevention of inhalation & ingestion of
foreign bodies.
Improved properties of dental materials
Aid to patient management.
Aid to cross-infection control by reducing
aerosol spread of micro-organisms.
Minimization of mouth breathing during
inhalation sedation procedures
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Disadvantages
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Armamentarium
1. Rubberdam sheets
2. Rubberdam clamps
3. Rubberdam holders(frame)
4. Rubberdam retainer forceps
5. Rubberdam punch
6. Rubberdam templates or stamps
7. Dental floss
8. Wedget
9.Wooden wedges, orthodontic
elastics & commercially available
latex cord.
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1.Rubberdam sheet
Available as rolls or sheets
size - 5״5* ״or 6״6* ״square.
Thickness - 0.006”to 0.01”
(thin, medium, heavy,
extraheavy)
colors - blue ,
green colors preferred to provide
good contrast with the surrounding
may be flavored for the children
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2. Rubberdam clamps
Used to secure the dam to
the teeth that are to
be isolated & to minimally
retract the gingival
tissue.
Parts - 4 prongs that
rest on the mesial &
distal line angle of the
tooth.
2 jaws connected
by a bow
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Types : 1). Winged retainers
DW BW
K
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K- winged clamp for larger,
fully erupted 1st lower
permanent molar.
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L- this is for small
1st primary
molars.
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3. Rubberdam holder (frame)
Used to maintain the
borders of the
rubberdam in position.
Types:
a).Young’s holder is a
U-shaped metal frame
with small metal
projections for
securing borders of
the rubberdam.
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b). Ash pattern - most
suitable for children.
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4. Rubberdam retainer
forceps
Used for placement and removal
of retainer from the tooth.
STOKES
BREWER
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ASH type
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Beaks of some patterns of forceps
Grooves on their outer surfaces to ensure
positive location of the clamp during expansion &
placement.
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5. Rubberdam punch
Used for making holes in the
dam
Parts a). Rotating metal disc
bearing 5 to 6 holes of
different sizes according to
size of teeth.
B). A sharp pointed plunger.
Ash pattern punch for
routine use. This has an
added advantage that jaws
can be removed and
replaced at minimal cost if
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they are damaged.
6. Rubberdam template
(stamp)
Both have positions of
the teeth marked on
them and are used to
transfer them to the
rubber dam sheet for
holes to be punched.
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7. Dental floss
tied around the retainer before carried to the oral cavity to
prevent accidental aspiration of clamp.
8. Wedget
an elastic used to secure the dam around the teeth farthest
away from the clamp.
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Preparation of the child patient
for rubber dam.
The dam can be presented as
a ‘raincoat’ that keeps the
tooth dry and held on by a
button (clamp) & kept
straight by a coat hanger
(frame). Sunglasses & a
suitable bib should be placed
to protect the eyes &
clothing.
Local analgesia should be
administered where a clamp
may impinge on the gingivae
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Single molar Isolation
1. Suitable clamp
selected. Floss is
secured around the
clamp to assist its
retrieval should it
come loose in mouth.
- looping around the
bow
- passing the floss
through forceps holes
2. The clamp is placed
on forceps expanded
and forceps locked.
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3. A sheet of medium
grade rubber dam is
selected and a double
overlapping hole in
punched in it .
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7.The rubber dam sheet
is carried to the
mouth, the index
fingers used to
stretch the hole and
position it over the
bow of the clamp.
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9. The frame is then
placed, first stretching
the lower dam onto the
bottom corners then
hooking it onto the
upper prong.
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11. If there is
excess dam at the
top edge, this can
be reflected and
tucked under the
top edge of the
frame.
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12.Optionally, a U-
shaped piece of
absorbent tissue can
be tucked under the
dam from below.
13.Once restorative
work is complete ,
the forceps are re-
engaged in the clamp
holes, and the clamp,
dam and frame are
removed in one
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14. Alternatively, the
forceps beaks may
be inserted into the
bow of the clamp
and expanded to
remove the clamp.
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Quadrant isolation: the trough
technique as an excellent method in
children
3. The trough is
stretched over the
clamp as before and
the frame placed.
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4. The dam is now
stretched forward and
hooked over the
primary canine. It
usually retains itself in
this position, isolating
the molars and canine
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Additional retention
1.An additional hole can
be punched about 5mm
beyond the anterior
end of the trough.
3. Commercially
available latex cord
can be stretched
and passed through
the contact area.
.
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4. Once released,
the strips expand
and lock the dam
into position
5. Orthodontic
elastic bands can
be used in a
similar fashion.
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Upper incisor teeth
Several methods of isolation
5. Retainer-pinched tissue.
6. Shredded or torn dam especially during
punching.
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7. Incorrect location of holes for class
V cavity lesion - circulation in the
interproximal tissue will be diminished
because of added pressure.
8. Sharp tips on NO22 retainer should
be sufficiently dulled to prevent
damaging the cementum.
9. Incorrect technique for cutting
septa during the removal of the dam.
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References
Theodore M. Roberson, Harald O. Heymann,
Edward J. Swift; Sturdevant’s Art & Science of
Operative Dentistry; fourth edition 2004;
published by Elsevier India Pvt. Limited.
MS Duggal, DEJ Curzon, SA Fayle, KJ Touma
Restoratve Technique in Paediatric dentistry;
second edition; Published by Martin Dunitz ltd.
the livery house London
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