11 - Field Isolation (Rubber Dam) Flashcards
advantages of clean and dry field
- better vision
- clean cavity walls (less chance of recurrent caries)
- more reliable detection of caries
- development of maximal properties of restorative materials
- intimate contact of prep walls with bases, liners, and restorative materials
advantages of rubber dam
- most effective isolation and longest duration
- access and vision
- protects soft tissue
- increases operator efficiency due to better access/vision
- less debris patient has to contend with
- protects dentist and assistant from aerosolized infectious material
- protects patient from swallowing debris, NaOCl, files, bits of amalgam
- controls sources of moisture such as pt breathe, crevicular fluid, blood, saliva
exceptions to using rubber dam
- partially erupted teeth unable to hold clamp
- some third molars
- some malposed teeth
- asthmatics/illness with nasal breathing difficulties
- lesion position (subgingival)
- psychological reasons - patient rejects the use of it
T/F: psychological reasons (patients rejecting use of rubber dam) is a primary reason to use the RD
FALSE!! NOT A PRIMARY REASON! most patients accept if process and benefits are clearly explained
function of clamps
provide anchorage for most distal aspect
components of RD clamp
- 4 prongs
- bow
- holes
- jaw
- wings
what hold dam out of way during placement but are often in the way otherwise. it is deisgned to be placed in the dam and then the entire apparatus is applied to the tooth
wings
what are the names of A, B, and C
a. winged rubber dam clamp
b. wingless rubber dam clamp
c. butterly rubber dam clamp
what is the universal clamp
W8A
what is W8A placed on
molars
Why is W8A preferred by professors
if can isolate molar, can isolate any other tooth in quadrant
what does W in clamp number mean
wingless
what does D in clamp number mean
distalization of the bow
what does the A in the clamp number mean
angles prongs and jaws of clamp. better grab on the tooth
“angled prongs aimed apically”
what are these used for
premolars/anteriors
what teeth used for
molars
what used for
anterior or gingival retraction
what used for
molars
use the ___ dimension of the anchor tooth as a guide in selecting the clamp
M-D dimension
Should the jaws extend past the M and D line angles?
NO
what should be taken into account when selecting clamps?
wedge placement, seal around tooth, and soft tissue trauma
what stretches the rubber dam to provide better access and vision
rubber dam frame
the curvature of rubber dam frame matches what
the curve of patient’s chin
1 hole punch used for what teeth
primary incisors
2 hole punch used for what teeth
smallest incisors
3 hole punch used for what teeth
max centrals, canines and premolars
4 hole punch used for what teeth
large premolars/small to normal molars
5 hole punch used for what teeth
large molars
6 hole punch used for what teeth
large molars and tooth to be clamped
what is used to clamp the clamp on the tooth
clamp forcep
what are the two choices for RD technique
- wingless clamp technique
- winged clamp technique
what is the wingless clamp technique
wingless clamp placed on the tooth (with floss ties around the bow) and the dam is stretched over top
what is the winged clamp technique
winged clamp affixed to the rubber dam by inserting it thru the appropriate punched hole (the most distal). attaches to RD with wings. frame, dam and clamp enter into mouth as one unit
technique preparation for RD
- exam
- select clamp
- safety: floss
- tryin
- prepare dam
- lubrication if desired
what is used to retrieve if clamp becomes dislodged when patient swallow
floss
when trying in clamp, what do you do?
open jaw, seat rotating form lingual to buccal, then check stability (pull up on bow)
floss goes around what part of clamp?
BOW! not the hole
does the floss come thru the dam from above or underneath?
underneath
what do you use to draw floss thru hole that will go over clamp
cotton forceps
what do you used to stretch the dam B-L over the clamp
index fingers
do you start maneuvering the dam over the most anterior tooth and work posterior toward the clamp
yes
how to apply winged RD
- place rubber dam on frame loosely
- place clamp with floss in hole for tooth to be clamped (held by wings)
- seat the clamp on the tooth
- remove RD from wings with a round ended instrument or with fingers by pulling out and pushing down at the same time
- floss down
- stabilize
- invert
how to floss the damn
- carry leading edge with floss or dental tape
- make a second pass to carry trailing edge
- pull the floss out toward the buccal
what is the process of ticking free edge under DM
inversion
what happens if you don’t invert rubber dam
positive pressure under the dam, created by tongue movement, swallowing, etc., will cause leakage of saliva into the operating field
what happens if you invert the rubber dam
positive pressure under the dam only causes the dam to seal more tightly against the tooth preventing leakage
how to remove the dam
cut the plastic part off, remove the clamp, and inspect the dam for missing bits
