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Aislamiento Absoluto PDF
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Aislamiento Absoluto PDF
Aislamiento Absoluto PDF
Uploaded by
itza andradeCopyright:
Available Formats
%NDODONTICS
4OOTH )SOLATION THE 2UBBER $AM
!2.!,$/ #!34%,,5##) -$ $$3
4HE NEED TO WORK UNDER DRY CONDITIONS FREE OF SALI &URTHERMORE AN ENDODONTIC TREATMENT SHOULD NOT BE
VA HAS BEEN RECOGNIZED FOR CENTURIES AND THE IDEA OF UNDERTAKEN UNLESS THE TOOTH n PARTICULARLY IF DAMAGED
USING A SHEET OF RUBBER TO ISOLATE THE TOOTH DATES AL n HAS NOT BEEN RECONSTRUCTED TO ALLOW EASY POSITIONING
MOST YEARS 4HE INTRODUCTION OF THIS NOTION IS AT OF THE RUBBER DAM 4HERE SHOULD BE NO EXCUSE FOR NOT
TRIBUTED TO A YOUNG !MERICAN DENTIST FROM .EW 9ORK USING THE RUBBER DAM IN %NDODONTICS THE LAW SHOULD
3ANFORD #HRISTIE "ARNUM WHO IN DEMONSTRATED SEVERELY PUNISH THE DENTIST WHO CAUSES SERIOUS INJURY
FOR THE lRST TIME THE ADVANTAGES OF ISOLATING THE TOOTH INCLUDING DEATH TO A PATIENT BECAUSE HE DID NOT USE
WITH A RUBBER SHEET !T THAT TIME KEEPING THE RUBBER ONE 0ATICK 7AHL IN A RECENT ARTICLE SAYS THAT IN
IN PLACE AROUND THE TOOTH WAS PROBLEMATIC BUT THINGS THE 5NITED 3TATES ANY LAW SUIT IS LOST IF THE RUBBER DAM
SOON IMPROVED A FEW YEARS LATER WHEN IN 3 3 HAS NOT BEEN USED
7HITE INTRODUCED A RUBBER DAM PUNCH SIMILAR TO THAT 4HE ONLY TOOTH THAT MAY BE TREATED WITHOUT THE RUB
USED STILL NOW )N THE SAME YEAR $R $ELOUS 0ALMER IN BER DAM IS THE TOOTH THAT IS SO SEVERELY DAMAGED THAT
TRODUCED A SET OF METAL CLAMPS WHICH COULD BE USED THE ONLY INSTRUMENTS TO BE USED ARE THE EXTRACTING FOR
FOR DIFFERENT TEETH CEPS !S !IELLO STATES ONE MUST RECALL THAT THE RUBBER
4HIS SAID IT SEEMS INCREDIBLE THAT EVEN TODAY TWO CEN DAM CLAMP OCCUPIES THE FUTURE POSITION OF THE MAR
TURIES LATER AND LIVING NOW IN THE THIRD MILLENNIUM THE GINAL CLOSURE OF THE PROSTHETIC CROWN )T IS THEREFORE
RE ARE STILL DENTISTS WHO ARE NOT CONVINCED OF THE USE UNTHINKABLE TO ENDODONTICALLY TREAT A TOOTH ON WHICH
FULNESS OF THIS VERY SIMPLE RUBBER SHEET /N THE OTHER THE RUBBER DAM CANNOT BE ASSEMBLED SINCE IT IS NOT
HAND IT IS ALSO INCREDIBLE THAT THE 3CIENTIlC !SSOCIATIONS KNOWN WHETHER AND HOW THE TOOTH WILL BE RESTORED
WHO ARE IN CHARGE OF LAYING DOWN THE h'UIDELINESv DO ! CONTRAINDICATION TO THE USE OF THE RUBBER DAM IS A
NOT SAY THAT THE USE OF RUBBER DAM IS MANDATORY TO PATIENTS ALLERGY TO THE CHEMICAL CONSTITUENTS OF RUB
PERFORM ANY KIND OF NONSURGICAL ENDODONTIC TREATMENT BER )N THIS CIRCUMSTANCE ALBEIT RARE THE TEETH MAY
4HE 1UALITY !SSURANCE 'UIDELINES OF THE !MERICAN BE ISOLATED WITH POLYTHENE SHEETS WHICH IMPOSE LI
!SSOCIATIONS OF %NDODONTISTS SAYS THAT hCLEANING SHA MITATIONS RELATED TO THE LACK OF ELASTICITY OF THIS MATE
PING DISINFECTION AND OBTURATION OF ALL CANALS ARE AC RIAL AS COMPARED TO RUBBER 4ODAY hNO LATEXv DAM IS
COMPLISHED USING AN ASEPTIC TECHNIQUE WITH DENTAL AVAILABLE TO BE USED ON ALLERGIC PATIENTS &IG
DAM ISOLATION WHENEVER POSSIBLEv !CCORDING TO THE AU 4HERE ARE ODD RUMORS ABOUT THE USE OF THE RUBBER
THORS OPINION WHEN IT IS NOT POSSIBLE THE CLINICIAN HAS DAM FOR EXAMPLE IT IS CLAIMED THAT IT TAKES TOO MUCH
TWO OPTIONS ONE IS TO MAKE IT POSSIBLE AND THE OTHER IS TIME TO ASSEMBLE #RAGG CORRECTLY STATES THAT hTHAT
TO EXTRACT THE TOOTH 4HERE IS NO OTHER CHOICE WHICH TAKES MORE TIME WITH RESPECT TO THE RUBBER
4HE OPERATIVE PROCEDURES THAT ARE PERFORMED IN THE DAM IS TRYING TO CONVINCE THE DENTIST TO USE ITv
PATIENTS MOUTH MUST BE SEEN AS LARGER OR SMALLER SUR )T IS WORTH SPENDING A FEW SECONDS TO ASSEMBLE THE
GICAL PROCEDURES )N DENTISTRY AS IN GENERAL SURGERY RUBBER DAM FOR USE IN ENDODONTIC PROCEDURES AND
ISOLATION OF THE OPERATIVE lELD IS IMPERATIVE EVEN FOR THUS IMPROVE THE ENTIRE TREATMENT
A SIMPLE lLLING )N %NDODONTICS USE OF THE RUBBER DAM CONFERS THE FOL
%VEN MORE SO THAN IN RESTORATIVE DENTISTRY THE RUBBER LOWING ADVANTAGES
DAM IS OBLIGATORY IN %NDODONTICS SO MUCH SO THAT 4HE PATIENT ARE PROTECTED FROM THE INGESTION
%NDODONTICS SHOULD NOT BE PERFORMED WITHOUT A DAM &IGS OR WORSE THE ASPIRATION OF SMALL
4OOTH )SOLATION THE 2UBBER $AM
&IG .O LATEX RUBBER DAM FOR ALLERGIC PATIENTS
&IG 4HIS RADIOGRAPH SHOWS THE PRESENCE OF AN
ENDODONTIC INSTRUMENT AMONG THE INTESTINAL LOOPS
&EW WEEKS LATER THE PATIENT DIED
4HE DENTISTS AND DENTAL ASSISTANTS ARE PROTECTED
AGAINST INFECTIONS WHICH CAN BE TRANSMITTED BY THE
PATIENTS SALIVA
4HE DENTISTS ARE MORE COMFORTABLE AS THEY MAY
WORK AT A MORE LEISURELY PACE AND MAY BE PERMIT
TED TO ANSWER AN IMPORTANT TELEPHONE CALL LEAVING
THE PATIENTS WELL PROTECTED WITH THE RUBBER DAM
&IG 4HIS PHOTOGRAPH TAKEN DURING GASTROSCOPY SHOWS A LARGE ROOT CANAL
REAMER AMONG THE FOLDS OF THE GASTRIC MUCOSA AND THE DENTAL ASSISTANT CLOSE TO THEM
"ETTER TACTILE SENSITIVITY DURING THE CLEANING AND SHA
PING PROCEDURE 7ITHOUT THE RUBBER DAM THE DEN
INSTRUMENTS DENTAL FRAGMENTS IRRIGATING SOLUTIONS TISTS AWARE OF THE RISK OF CAUSING THE PATIENTS TO IN
OR IRRITANT SUBSTANCES GEST OR ASPIRATE AN INSTRUMENT HOLDS THE lLES IN SUCH
4HE OPPORTUNITY TO OPERATE IN A CLEAN SURGICAL AS WAY THAT THEY WILL NOT SLIP FROM THEIR lNGERS 4HE
lELD PRESSURE THEY APPLIE TO THE HANDLE OF THESE INSTRU
2ETRACTION VERY IMPORTANT FOR WORKING IN THE PO MENTS REDUCES THE SENSITIVITY OF THEIR lNGERS AND
STERIOR AREAS AND PROTECTION OF THE SOFT TISSUES PRECLUDES THE USE OF THE INSTRUMENTS TO PERFORM DE
GUMS TONGUE LIPS AND CHEEKS WHICH ARE SHEL LICATE PROCEDURES 7ITH THE RUBBER DAM IN PLACE ON
TERED FROM THE CUTTING ACTION OF THE BUR THE OTHER HAND THEY MAY HOLD THE INSTRUMENTS DELI
"ETTER VISIBILITY IN THE WORKING AREA 4HE ADVERTISE CATELY WITHOUT FEARING THAT THEY MAY SLIP FROM THEIR
MENT OF A FAMOUS MANUFACTURER OF INSTRUMENTS FOR HAND
THE ASSEMBLY OF THE RUBBER DAM CORRECTLY READS 4HE PATIENTS ARE MORE COMFORTABLE AS THEY DO
h$O BETTER WHAT YOU SEE AND SEE BETTER WHAT YOU NOT FEEL THAT THEIR MOUTH IS INVADED BY HANDS
DOv INSTRUMENTS AND LIQUIDS
2EDUCTION OF DELAYS THE PATIENTS WITH FORTUNATELY 0ATIENTS INCREASINGLY APPRECIATE THE USE OF THE RUBBER
RARE EXCEPTIONS CANNOT CONVERSE EXCEPT WITH GREAT DAM /N OCCASION THEY MAY ASK WHETHER IT IS A NEW
DIFlCULTY BESIDES THEY WILL NOT HAVE TO RINSE THEIR INVENTION AND ONCE THEY HAVE TRIED IT THEY DO NOT
MOUTH EVERY lVE MINUTES WANT TO DO WITHOUT IT IN THE FUTURE
%NDODONTICS
).3425-%.43 CHING A HOLE IN THE DAM IT IS STRETCHED IN DIFFERENT DI
RECTIONS TO CONlRM THAT IT DOES NOT TEAR
4O FACILITATE THE ASSEMBLY OF THE RUBBER DAM IT IS ADVI
SABLE TO HAVE THE APPROPRIATE INSTRUMENTS WITHIN ARMS
REACH 4HIS IS SIMPLER THAN IT MIGHT APPEAR &IG 2UBBER DAM PUNCHES
)T IS USED TO MAKE ROUND HOLES OF DIFFERENT DIAME
2UBBER DAM TERS n MM DEPENDING ON THE TOOTH TO BE ISOLA
TED 3EVERAL BRANDS ARE AVAILABLE .ONETHELESS IT IS NE
4HE DAM COMES IN DIFFERENT SIZES v X v INCHES AND CESSARY TO CHECK WHETHER THE DAM OPENING IS EXACTLY
v X v INCHES AS WELL AS ROLLS COLORS LIGHT BLUE ROUND WITHOUT IRREGULARITIES 4O DETERMINE THIS IT SUF
GRAY AND GREEN AND THICKNESSES SPECIAL HEAVY lCES TO PUNCH A HOLE IN A DAM SHEET AND THEN ENLARGE
EXTRA HEAVY HEAVY MEDIUM AND THIN THIS OPENING BY STRETCHING THE SHEET IN DIFFERENT DIREC
4HE v X v FORMAT IS USEFUL IN RESTORATIVE DENTISTRY TIONS 4HE DAM SHOULD NOT TEAR
WHERE IT IS NECESSARY TO ISOLATE SEVERAL TEETH AT THE
SAME TIME )N %NDODONTICS WHERE ONE TOOTH IS ISO
LATED AT A TIME THE v X v FORMAT IS MORE THAN SUF
2UBBER DAM CLAMPS
lCIENT EVEN FOR WORKING IN THE POSTERIOR SECTORS OF
THE MOUTH 4HE lT OF THE RUBBER DAM ESSENTIALLY DEPENDS ON THE
3OME PREFER THE DARK COLORS SINCE THE TOOTH STANDS OUT CHOICE OF THE APPROPRIATE CLAMP AND ITS CORRECT POSI
BETTER BUT IT IS REALLY A QUESTION OF HABIT 4HE LIGHT
CO
TIONING
LORED DAM IS SLIGHTLY TRANSPARENT UNLIKE THE OTHER CO
4HE CLAMPS ARE CLASSIlED AS WINGED OR WINGLESS 4HE
LORS WHICH MAY BE HELPFUL IN POSITIONING THE INTRA
DENTIST MAY CHOOSE THOSE WITH WHICH HE FEELS MORE
OPERATIVE RADIOGRAPH COMFORTABLE &IGS
4HE POSITIONING TECHNIQUES
4HE QUALITY OF THE DAM SHEETS DETERIORATES WITH TIME VARY SLIGHTLY BUT THE lNAL RESULT IS THE SAME 3OMETIMES
IN PARTICULAR THEY LOSE ELASTICITY /NE SHOULD THEREFORE WINGLESS CLAMPS ARE PREFERABLE INASMUCH AS THEY ARE LESS
STOCK THEM IN MODERATE QUANTITIES KEEP THEM REFRIGE
BULKY AND MAY BE USED EASILY IN THE POSTERIOR SECTORS IN
RATED OBSERVE THE EXPIRATION DATE ON THE BACK OF THE PATIENTS WITH PARTICULARLY THICK CHEEKS
BOX AND OBTAIN ONES SUPPLIES FROM A DISTRIBUTOR THAT 4HE MOST COMMONLY USED ARE
SELLS THEM AT HIGH VOLUME SO AS TO AVOID BUYING SUP
PLIES THAT HAVE ALREADY BEEN IN THE WAREHOUSE FOR A &2/.4 4%%4(
LONG PERIOD OF TIME AND HAVE THUS ALREADY EXPIRED )6/29
4O TEST THEM ONE CAN PERFORM THE SAME TEST AS THAT TO )6/29
CHECK THE ADEQUACY OF THE DAM PUNCH JUST AFTER PUN
)6/29 .
)6/29 3
)6/29
02%-/,!23
)6/29
)6/29
)6/29 !
-/,!23 4(!4 !2% #/-0,%4%,9 %2504%$ 7(/,%
/2 #/6%2%$ "9 &5,, #2/7.3
)6/29
-/,!23 4(!4 !2% ).#/-0,%4%,9 %2504%$ /2
!,2%!$9 02%0!2%$ &/2 ! &5,, #2/7.
)6/29
&IG -INIMUM SET OF INSTRUMENTS NECESSARY FOR THE ASSEMBLY OF THE RUB )6/29 !
BER DAM IN THE DIFFERENT SECTORS OF THE MOUTH )6/29 !
4OOTH )SOLATION THE 2UBBER $AM
&IG #LAMPS FOR THE FRONT TEETH &IG #LAMPS FOR THE PREMOLARS
! "
&IG #LAMPS FOR THE MOLARS ! 7INGED " 7INGLESS
!39--%42)#!, -/,!23 ). 0!24)#5,!2 4(% THE RUBBER DAM n IS ACHIEVED
3%#/.$ !.$ 4()2$ 4HE ONLY DANGER IS FRACTURE OF THE RUBBER DAM CLAMP
)6/29 ONCE IT HAS BEEN POSITIONED IN THE MOUTH )F THIS OC
)6/29 CURS THE ELASTICITY OF THE DAM WILL CAUSE THE FRAGMENTS
)6/29 ! TO BE EJECTED FROM THE PATIENTS MOUTH )T IS THEREFORE
)6/29 ! PRUDENT TO SECURE THE CLAMP WITH DENTAL mOSS AND AN
CHOR IT TO THE DAM FRAME
7).',%33 4/ "% 53%$ 7(%. 4(% 7).'3 /"3425#4
4(% 7/2+).' &)%,$
)6/29 7! 2UBBER DAM CLAMP FORCEPS
)6/29 .
4HIS INSTRUMENT IS NECESSARY TO OPEN THE CLAMP AND
4HE CLAMPS MAY ALSO BE MODIlED TO IMPROVE THEIR POSITION IT AROUND THE TOOTH 4HE )VORY FORCEPS ARE
GRIP AND ALLOW A MORE PRECISE lT -OREOVER THERE IS PREFERABLE BECAUSE THEY ALLOW THE DENTIST TO APPLY DI
NO REASON NOT TO USE A PREMOLAR CLAMP ON A SMALL MO RECT PRESSURE TOWARD THE GUM WHICH IS FREQUENTLY NE
LAR OR FRONTAL TOOTH OR A CLAMP ON A HEMISECTED CESSARY TO POSITION THE CLAMP SECURELY BELOW THE BUL
ROOT OF A LOWER MOLAR ANY SUCH ADAPTATION IS PERMIT GE OF THE TOOTH CROWN
TED AS LONG AS THE lNAL RESULT n CORRECT PLACEMENT OF
%NDODONTICS
2UBBER DAM FRAME NAPE OF THE NECK ARE OUT DATED AND HAVE NO USE IN
MODERN %NDODONTICS
4HIS IS NECESSARY TO MAINTAIN TENSION IN THE DAM SO &URTHERMORE THEY HAVE NUMEROUS DISADVANTAGES THEY
THAT THE LIPS AND CHEEKS MAY BE RETRACTED WELL 3OME REQUIRE MORE TIME FOR POSITIONING THEY COMPLETELY
FRAMES INCLUDING THE 9OUNG FRAME ARE MADE OF VE COVER THE PATIENTS NOSE AND MOUTH GIVING HIM THE
RY THIN METAL OTHERS INCLUDING THE .YGAARD /STBY OR UNPLEASANT SENSATION OF SUFFOCATION AND THEY DO NOT
3TARLITE FRAME ARE PLASTIC )N COMPARISON TO THE 9OUNG CAUSE THE LEAST BIT OF RETRACTION OF THE LIPS OR CHEEKS
FRAME THE LATTER HAVE THE ADVANTAGE OF BEING TRANSPA LIKE THE OTHERS
RENT ON THE OTHER HAND THEY ARE BULKIER .EW RUBBER DAMS RECENTLY INTRODUCED IN THE MARKET
$AM TENSORS SUCH AS THOSE OF 7OODBURG #OGSWELL ARE THE (ANDIDAM !SEPTICO 7OODINVILLE 7! AND
-ITCHELL AND &ERNALD &IG WHICH ARE BASED ON THE )NSTI $AM :IRC #OMPANY "UFFALO -. TWO RUB
THE PRINCIPLE OF MAINTAINING TENSION IN THE DAM BY THE BER DAM SYSTEMS WITH BUILT IN FOLDABLE RADIOLUCENT
USE OF CLIPS AND ELASTIC BANDS PASSING DIRECTLY OVER THE PLASTIC FRAME &IG
! " #
$ %
&IG ! 7OODBURGS RUBBER DAM TENSORS WHICH ARE NO LONGER USED COURTESY OF $ENTAL 4REY &ORLÖ " $R #OGSWELLS DAM HOLDER # $R #OGSWELLS DAM IN PLACE
$ $R &ERNALDS DAM HOLDERS % $R "RASSEURS DAM HOLDER FROM % !NDREU 4RAITÏ DE DENTISTERIE OPERATOIRE 0ARIS
4OOTH )SOLATION THE 2UBBER $AM
0/3)4)/.).' /& 4(% $!-
!FTER USING DENTAL mOSS TO CHECK THE NATURE OF THE CON
TACTS &IG AND DETERMINE WHETHER THERE IS WEL
DING BETWEEN PROSTHETIC CROWNS OR WHETHER THERE ARE
IRREGULARITIES OF OLD RESTORATIONS THAT NEED TO BE ELIMI
NATED ONE SELECTS THE CLAMP THAT ONE THINKS MIGHT BE
APPROPRIATE FOR THE CASE AND TRIES IT IN THE MOUTH &IG
)T IS ADVISABLE TO SECURE THE CLAMP WITH DEN
&IG 4HE )NSTI $AM LEFT AND THE (ANDIDAM RIGHT
,UBRICANT
"EFORE POSITIONING THE DAM IT IS AN ADVISABLE TO LU
BRICATE THE INNER SURFACES WELL WITH 6ASELINE OR MO
RE SIMPLY SOAP SO THAT THE SHEET WILL SLIDE BETTER OVER
&IG 4HE USE OF DENTAL mOSS PROVIDES INFORMATION ABOUT THE
THE CONTOURS OF THE TEETH MORE EASILY OVERCOME THE CONTACT AREAS
CONTACT AREAS AND CLOSE TIGHTLY AROUND THE CERVIX OF
THE TOOTH
2UBBER DAM NAPKINS
4HESE PREVENT DIRECT CONTACT BETWEEN THE RUBBER
SHEET AND THE PATIENTS CHEEK "Y ABSORBING THE SALI
VA THAT ACCUMULATES BENEATH THE DAM BY CAPILLARY AC
TION THEY FACILITATE TREATMENT 4HEIR USE IS NOT MANDA
TORY HOWEVER THEY ARE PARTICULARLY INDICATED IN CASES
OF ALLERGY TO THE RUBBER OF THE DAM !
$ENTAL mOSS
!PART FROM PREVENTING THE INGESTION OR ASPIRATION OF
THE CLAMP DENTAL mOSS IS PARTICULARLY USEFUL FOR AS
SESSING THE CONDITION OF THE MESIAL AND DISTAL CONTACT
AREAS AND THUS FOR FACILITATING THE PASSAGE OF THE RUB
BER SHEET BENEATH THEM
"
!SSISTANT
&IG ! 4HE CLAMP IS POSITIONED AROUND THE TOOTH IN SUCH A WAY THAT IT
IS STABLE AND DOES NOT DAMAGE THE PERIODONTAL TISSUES $ENTAL mOSS HAS BEEN
4HE DENTIST MAY POSITION THE RUBBER DAM ON ANY TOOTH TIED TO THIS CLAMP FOR SECURITY REASONS )F IT SLIPPED OFF DURING THE TRIAL PLACE
MENT IT COULD BE SWALLOWED OR ASPIRATED )F IT BROKE WHILE BEING OPENED WITH
USING ONLY HIS HANDS BUT IT IS OBVIOUS THAT THIS PROCE
THE RUBBER DAM CLAMP FORCEPS THE LINGUAL PART COULD EASILY DISAPPEAR INTO THE
DURE IS FACILITATED BY THE HELP OF AN ASSISTANT PATIENTS THROAT " 3AME PRECAUTION FOR A FRONT TOOTH
%NDODONTICS
TAL mOSS TO PROTECT THE PATIENT FROM THE INGESTION OR IN THE OPENING OF THE RUBBER SHEET &IG WHICH
THE ASPIRATION OF THE CLAMP )F IT COMES OFF EASILY IT SHOULD ALREADY HAVE BEEN PREPARED
SHOULD BE CHANGED )F IT APPEARS STABLE ONE INSERTS IT )NITIALLY IT MAY BE DIFlCULT TO POSITION THE OPENING
! "
# $
% &
' (
&IG ! 4HE RUBBER SHEET IS PUNCHED WITH THE RUBBER DAM PUNCH " # 4HE RUBBER DAM IS STRETCHED OVER THE WINGS OF THE SELECTED CLAMP $ 7ITH THE HELP OF
AN ASSISTANT THE DAM AND CLAMP ARE PLACED IN POSITION IN THE PATIENTS MOUTH % 4HE RUBBER DAM CLAMP FORCEPS POSITIONS THE CLAMP AROUND THE TOOTH TO BE TREATED
& ' 9OUNGS FRAME IS POSITIONED TO PRODUCE TENSION IN THE DAM ( 5SING AN INSTRUMENT THE DAM IS SLIPPED BENEATH THE CLAMP WINGS ON THE BUCCAL SIDE CONTINUED
4OOTH )SOLATION THE 2UBBER $AM
&IG )N DECIDING WHERE TO PUNCH THE OPENING IN THE RUBBER SHEET ONE
CAN MENTALLY TRACE THREE VERTICAL AND THREE HORIZONTAL LINES 4HE ELLIPSE INSCRI
BED WITHIN THE CENTRAL RECTANGLE CORRESPONDS TO THE TWO DENTAL ARCHES
&IG CONTINUED ) 4HE SAME IS DONE ON THE LINGUAL SIDE * + $ENTAL mOSS
IS USED TO FORCE THE DAM THROUGH THE INTERPROXIMAL CONTACTS
"
CORRECTLY SO THAT THE DAM DISTURBS NEITHER THE DENTIST
NOR THE PATIENT 4HE POSTERIOR TEETH MAY PRESENT GREA
TER PROBLEMS )N THESE CASES IT IS ADVISABLE TO PUNCH
THE OPENING MORE CENTRALLY THAN SUGGESTED BY THE
COMMERCIALLY AVAILABLE STAMPS OR AT THE POINT CORRE
SPONDING TO THE IMAGINARY ELLIPSE THAT REPRESENTS THE
DISTRIBUTION OF THE TEETH IN THE PATIENTS TWO ARCHES
&IG )N TREATING A POSTERIOR TOOTH IT IS PREFE
RABLE TO PLACE THE TOOTH IN THE CENTER OF THE DAM PLA
CING THE DAM ASYMMETRICALLY WITH RESPECT TO THE PA
#
TIENTS FACE &IG RATHER THAN THE OPPOSITE &IG
4HE MORE DISTAL THE POSITION OF THE TOOTH THE &IG ! 4HE OPENING HAS BEEN MADE MORE OR LESS WITHIN THE CENTER OF THE
DAM WHICH IS ASYMMETRICAL WITH RESPECT TO THE PATIENTS FACE " )N THIS WAY
CLOSER THE OPENING MUST BE TO THE CENTER OF THE RUBBER THE METALLIC FRAME DOES NOT INTERFERE WITH THE 8
RAY MACHINE # 4HE PATIENT
SHEET )T IS BETTER THAT THE TOOTH UNDER TREATMENT BE IN CAN ALSO BREATHE THROUGH THE MOUTH
%NDODONTICS
! "
# $
&IG ! 4HE OPENING HAS BEEN MADE AT THE POINT INDICATED BY THE ELLIPSE RULE 4HE DAM IS THEREFORE ASYMMETRIC WITH RESPECT
TO THE PATIENTS FACE WHILE THE TOOTH EMERGES AT A POINT CLOSE TO THE METALLIC FRAME " # 4HE METALLIC FRAME INTERFERES WITH THE 8
RAY MACHINE CAUSING IT TO PROJECT THE FRAMES SHADOW ONTO THE RADIOGRAPH $ 4HE DAM ADHERES TO THE ENTIRE CIRCUMFERENCE OF THE
MOUTH PRECLUDING ORAL RESPIRATION
THE CENTER OF THE OPERATIVE lELD THAN THAT THE RUBBER THE DAM ESPECIALLY IN VERY YOUNG PATIENTS FOR EXAM
BE IN THE CENTER OF THE MOUTH PLE WE CAN PLACE A lNGERTIP IN THE DAM OPENING &IG
#ENTRAL POSITIONING OF THE OPENING HAS SEVERAL ADVAN 4HE PATIENTS MUST ALSO BE TOLD THAT WITH THE
TAGES IN TREATING THE MOLARS DAM IN PLACE THEY MAY SAFELY SWALLOW COUGH OR
n /NCE POSITIONED THE DAM WILL BE QUITE ASYMMETRI YAWN AND THAT THEY MAY DO SO WITHOUT PLACING THEIR
CAL WITH RESPECT TO THE PATIENTS MOUTH AND THEREFO HAND IN FRONT OF THEIR MOUTH 4HE ONLY THINGS THEY
RE FURTHER DISPLACED FROM THE SIDE BEING WORKED ON MUST NOT DO ARE TALK AND RINSE
4HIS INSURES GREATER RETRACTION OF THE LIPS AND IPSILA 0ATIENTS WITH AN EASILY PROVOKED GAG REmEX SHOULD RE
TERAL CHEEK LAX SINCE THE RUBBER DAM WILL NOT TOUCH THE AREAS THAT
n 3INCE THE DAM IS ASYMMETRICAL THERE IS ENOUGH SPACE MAY PROVOKE THEIR REmEX STILL THE DAM IS DElNITELY
FROM THE CONTROLATERAL PART TO PERMIT ORAL RESPIRATION BETTER TOLERATED AND SAFER THAN COTTON ROLLS
ON THE PART OF THE PATIENT WHICH IS ESSENTIAL IN PATIEN 4HERE ARE MANY METHODS OF PLACING THE DAM 4HEY ARE
TS WHO HAVE DIFlCULTY WITH NASAL RESPIRATION 4HE DEN MORE OR LESS SIMPLE AND THE DENTIST CAN CHOOSE THE
TIST CAN ALSO EASILY INTRODUCE ANY RADIOGRAPHS INTO THE PREFERRED ONE 4HE ASSISTANT CAN PLACE THE DAM AROUND
PATIENTS MOUTH THAT NEED TO BE TAKEN INTRAOPERATIVELY THE TOOTH &IG AS THE DENTIST POSITIONS THE CLAMP
WITHOUT HAVING TO DISMOUNT THE FRAME OF THE DAM &IG AND THEN THE FRAME &IG 4HIS PRO
n 4HE SAME SPACE CAN BE USEFUL IN THE PATIENT WITH CEDURE IS OFTEN DIFlCULT IF NOT IMPOSSIBLE ESPECIALLY IN
ABUNDANT SALIVATION TO KEEP AN ASPIRATOR IN THE THE POSTERIOR AREAS OR PARTICULARLY SMALL MOUTHS
MOUTH !NOTHER METHOD REQUIRES PLACING THE CLAMP WITHIN THE
n "ECAUSE THE DAM IS DISPLACED FROM THE SIDE IN WHICH OPENING OF THE DAM "OTH THE CLAMP AND DAM ARE PO
ONE IS WORKING THE RISK OF OBTAINING INTRAOPERATIVE SITIONED AROUND THE TOOTH EVEN WITHOUT AN ASSISTANT
RADIOGRAPHS OBSTRUCTED BY THE METAL FRAME IS REDUCED 4HE POSITIONING OF THE FRAME FOLLOWS /BVIOUSLY IN
"EFORE POSITIONING THE RUBBER DAM IT IS A GOOD IDEA THIS CASE THE TECHNIQUE VARIES SLIGHTLY DEPENDING ON
TO ILLUSTRATE TO THE PATIENTS THE UTILITY AND FUNCTION OF WHETHER ONE USES WINGED &IG OR WINGLESS
4OOTH )SOLATION THE 2UBBER $AM
&IG 4HE lNGERTIP IS INTRODUCED IN THE DAM OPENING TO BETTER ILLUSTRATE TO &IG 4HE ASSISTANTS HANDS POSITION THE DAM DIRECTLY AROUND THE TOOTH
THE PATIENT THE FUNCTIONS OF THIS RUBBER SHEET TO BE TREATED
&IG 4HE DENTIST POSITIONS THE CLAMP &IG 7ITH ASSISTANCE THE DENTIST POSITIONS 9OUNGS FRAME
! "
&IG 0OSITIONING OF THE DAM CAN BE PERFORMED WITHOUT THE HELP OF AN ASSISTANT ! 4HE PERFORATED DAM HAS BEEN STRETCHED OVER THE WINGS OF THE CLAMP
" 7HILE THE DENTISTS LEFT HAND SUPPORTS THE UPPER MARGIN OF THE DAM HIS RIGHT HAND POSITIONS THE CLAMP AROUND THE TOOTH
%NDODONTICS
CLAMPS &IG /NE CAN ALSO PUT THE CLAMP ON A TH &IG &INALLY ONE CAN PLACE THE CLAMP ON
DAM THAT HAS ALREADY BEEN PLACED ONTO A FRAME AND THE TOOTH AND THEN SLIP THE FRAMED DAM AROUND IT
POSITION THE ENTIRE ASSEMBLY IN THE PATIENTS MOU &IG
! "
# $
% &
'
&IG 0OSITIONING OF THE RUBBER DAM WITH A WINGLESS CLAMP ! 4HE CLAMPS ARCH IS PASSED THROUGH THE DAMS OPENING " 4HE RUBBER DAM CLAMP FORCEPS ARE INTRO
DUCED INTO THE CLAMPS OPENINGS # 4HE DAM IS FOLDED WITH THE CLAMP AT THE TIP WHILE THE CLAMP IS MOVED TOWARD THE TOOTH $ 4HE CLAMP HAS BEEN POSITIONED % 4HE
DAM IS STRETCHED WITH 9OUNGS FRAME & ' 4HE DENTIST IS SLIDING THE DAM COMPLETELY BELOW THE CLAMP WITH THE lNGERS
4OOTH )SOLATION THE 2UBBER $AM
4HE TECHNIQUE MOST COMMONLY USED IS THAT DESCRI
BED IN &IG
2EMOVAL OF THE DAM IS EASY AS ALL ONE NEEDS TO DO IS
TO TAKE AWAY THE CLAMP )F SEVERAL TEETH LIE BENEATH THE
DAM AND ONE OF THEM HAS A TEMPORARY OR RECENT RESTO
RATION IT IS PREFERABLE TO CUT IT AND EXTRACT IT FROM BE
LOW RATHER THAN PASSING THE RUBBER SHEET THROUGH THIS
DELICATE CONTACT AREA &IG /NCE IT HAS BEEN RE
MOVED THE DAM MUST ALWAYS BE CHECKED SO THAT NO
SMALL FRAGMENTS ARE LEFT BELOW THE CONTACT AREAS
)N THE CASE OF INCOMPLETELY ERUPTED TEETH THAT ARE VE
&IG ! DAM WITH A WINGED CLAMP HAS BEEN STRETCHED OVER
RY CONICAL OR WHERE THE BULGE IS APICAL TO THE GINGI
9OUNGS FRAME 4HE CLAMP DAM AND FRAME ARE POSITIONED IN THE VAL CREST THERE ARE NO UNDERCUTS TO PREVENT THE CLAMP
MOUTH AS A SINGLE UNIT FROM SLIDING CORONALLY
)N SUCH CASES ONE CAN RESORT TO AN EXPEDIENT THAT
TAKES A FEW MINUTES BUT ALLOWS ONE TO WORK AS ONE
SHOULD /NE CAN ACID ETCH THE ENAMEL BUCCALLY AND
PALATALLY OR LINGUALLY TO ALLOW THE ADHESION OF TWO
SMALL RIBBONS OF COMPOSITE RESIN WHICH SERVE AS AREAS
WHICH THE CLAMP MAY GRIP
4HESE COMPOSITE RIBBONS MUST NOT INTERFERE WITH THE
PERIODONTIUM BUT MUST BE POSITIONED OR MM FROM
THE GINGIVAL MARGIN TO ALLOW POSITIONING OF THE CLAMP
4HE LINGUAL OR PALATINE SPOTS SHOULD NOT INTERFERE WITH
THE FUTURE ACCESS CAVITY OR THE OCCLUSION 4HEY WILL RE
! QUIRE SMOOTHING SO AS NOT TO DAMAGE THE LIPS ESPE
CIALLY IF AS IN THE CASE OF &IG THEY MUST BE LEFT
IN PLACE FOR SEVERAL MONTHS AND MULTIPLE APPOINTMENT
PROCEDURES
)N THE CASE OF VERY DAMAGED TEETH WHICH REQUIRE IM
MEDIATE ATTENTION SUCH AS FOR ESTHETIC REASONS IT MAY
BE USEFUL TO ANCHOR THE DAM TO THE ADJACENT TEETH &IG
"
&IG ! ! WINGLESS CLAMP HAS BEEN POSITIONED AROUND THE &IG 4O FACILITATE ITS REMOVAL THE DAM IS CUT RATHER THAN PASSED THROUGH
TOOTH " # 4HE RUBBER SHEET HAS BEEN SLID BELOW THE CLAMP THE INTERPROXIMAL CONTACT
WHICH IS ALREADY IN PLACE
%NDODONTICS
4HE DAMS STABILITY CAN ALSO BE MAINTAINED WITH THE TEETH SUCH FRAGMENTS MAY EVEN SUBSTITUTE FOR THE
HELP OF SMALL RUBBER FRAGMENTS OF THE RUBBER DAM IT
DAM CLAMPS &IG 3PECIAL ELASTIC WIRES ARE ALSO
SELF WHICH ARE PASSED BELOW THE CONTACT AREAS OF THE AVAILABLE IN DIFFERENT THICKNESS &IG TO STABILIZE
ADJACENT TEETH &IG )N PARTICULARLY CROWDED THE DAM IN THE SAME WAY
! "
&IG ! 4HE FRACTURED TOOTH REQUIRING ENDODONTIC TREATMENT STILL HAS NOT COMPLETELY ERUPTED AND ITS HEIGHT OF CONTOUR IS STILL
APICAL TO THE GINGIVAL MARGIN 4O POSITION THE RUBBER DAM CLAMP IT WAS NECESSARY TO POLYMERIZE TWO SPOTS OF COMPOSITE RESIN ON
THE BUCCAL AND PALATAL ENAMEL " !CCESS CAVITY CREATED ON THE FRACTURE RIM .OTE THE TWO COMPOSITE SPOTS THAT HOLD THE CLAMP IN
POSITION
&IG 4HE DAM HAS BEEN PLACED ON THE CANINE AND CENTRAL
INCISOR TO ALLOW ENDODONTIC THERAPY OF THE ROOT OF THE LATERAL IN
CISOR
&IG 4HE DAM IS KEPT IN PLACE BY A CLAMP POSITIONED ON THE &IG 3INCE THE FRONT TEETH OF THIS PATIENT WERE SO CROWDED
MESIAL TOOTH AND BY A FRAGMENT OF THE DAM WHICH HAS BEEN PAS
THERE WAS NO SPACE FOR THE CLAMPS 4HE DAM IS KEPT IN PLACE BY
SED BENEATH THE DISTAL CONTACT AREA OF THE DISTAL TOOTH TWO FRAGMENTS OF THE DAM WHICH HAVE BEEN PASSED UNDER THE DI
STAL CONTACT AREAS OF THE LATERAL INCISORS
4OOTH )SOLATION THE 2UBBER $AM
" #
&IG ! %LASTIC WIRES OF DIFFERENT THICKNESS TO KEEP THE RUBBER DAM IN PLACE " # 4HE CLAMP WAS INTERFERING WITH THE MIRROR USED IN THIS PARTICULAR CASE
FOR DOCUMENTATION PURPOSES THEREFORE THE ELASTIC WIRES WERE USED
7HEN TREATING ENDODONTICALLY A BRIDGE ABUTMENT OR
A TOOTH WITH AN INTRACORONAL SPLINTING OR ORTHODONTIC
WIRE ONE CAN USE VARIOUS TECHNIQUES TO ENSURE THAT
THE DAM ISOLATES THE lELD FROM SALIVA WELL
n 3UTURING OF THE DAM BELOW THE CONNECTIONS OF THE
PROSTHESIS OR SPLINTING
n 5SE OF CAVITY VARNISHES FOR SMALL DEFECTS CAVIT
/RABASE ORAL ADHESIVES PERIODONTAL DRESSING
2UBBER BASE ADHESIVE MIXTURE OF DENTURE ADHESI
VE AND ZINC OXIDE POWDER 0': OR /RASEAL &IG
4HE LAST MENTIONED IS THE MATERIAL OF
CHOICE BECAUSE IT IS VERY EASY TO USE
)N THE CASE IN WHICH THE TOOTH UNDER TREATMENT IS CON
NECTED TO THE ADJACENT TEETH BY ORTHODONTIC WIRE ONE
CAN TRY TO POSITION THE CLAMP ABOVE THE ORTHODONTIC AT &IG /RALSEAL IS THE MATERIAL OF CHOICE TO IMPROVE THE SEALING OF LEAKING
RUBBER DAMS
TACHMENT AND WIRE &IG
%NDODONTICS
)F THE TOOTH REQUIRING ENDODONTIC TREATMENT IS PARTICU THE DENTIN &IG !NOTHER SUGGESTION COULD BE
LARLY DAMAGED SO THAT THE CLAMP CANNOT BE POSITIO POSITIONING THE CLAMP ON A DISTAL TOOTH SO THAT THE ELA
NED STABLY IT MUST BE PRE TREATED SEE #HAPTER SO STICITY OF THE DAM DOESNT INTERFERE WITH THE TOOTH TO BE
AS TO ALLOW ADEQUATE POSITIONING OF THE RUBBER DAM TREATED WHERE A SECOND CLAMP CAN BE GENTLY POSITIO
!N EASY AND FAST WAY TO PRE TREAT THE DAMAGED TOOTH IS NED &IG
CURING A hCOLLARv OF DENTIN BONDING AFTER ACID ETCHING
! "
&IG ! 4HE ORTHODONTIC WIRE PRECLUDES TIGHT SEALING OF THE RUBBER SHEET " ! TIGHT SEAL HAS BEEN
ACHIEVED WITH /RASEAL
! "
&IG ! 4HE PRESENCE OF THE WELDING HAMPERS THE DAM FROM PASSING BELOW THE CONTACT AREA " /RASEAL HELPS TO OBTAIN AN EQUALLY GOOD SEAL
4OOTH )SOLATION THE 2UBBER $AM
! "
# $
% &
&IG 4HE LOWER LEFT SECOND PREMOLAR REQUIRES ENDODONTIC THERAPY ! /CCLUSAL VIEW " "UCCAL VIEW # $ 0OSITIONING THE CLAMP BELOW THE ORTHODONTIC
ATTACHMENT THE DAM STRADDLES THE WIRE AND THEREFORE DOES NOT SEAL % & 4HE CLAMP HAS BEEN POSITIONED ABOVE THE ORTHODONTIC ATTACHMENT AND WIRE THUS
THE DAM SEALS PERFECTLY
%NDODONTICS
! "
&IG ! 4HE UPPER LEFT CUSPID HAS NO CROWN 4HE PATIENT HAD
ESTHETIC PROBLEMS WHICH PRECLUDED A CROWN LENGHTENING PROCE
DURE TO BE DONE BEFORE THE ENDODONTIC RETREATMENT " # 4HE
CLAMP HAS BEEN POSITIONED ON THE ADJACENT PREMOLAR AND AL
SO THE TWO CENTRAL INCISORS HAVE BEEN ISOLATED ! SMALL hCOLLARv OF
COMPOSITE HAS BEEN CURED ON THE BUCCAL ASPECT OF THE ROOT OF THE
CUSPID $ % 4HE SAME KIND OF PRETREATMENT WAS DONE TO THE lRST
MOLAR TO HAVE A MORE STABLE RUBBER DAM CLAMP
&IG 4HE UPPER RIGHT SECOND PREMOLAR HAS A ² CROWN FRACTURE AND THE
. CLAMP KEEPS SLIDING UNDER THE TENSION OF THE RUBBER SHEET /NE CLAMP
HAS BEEN POSITIONED ON THE SECOND MOLAR AND ANOTHER ONE . ON THE SE
COND PREMOLAR TO BE TREATED .OW THE ELASTICITY OF THE DAM IS PULLING ON THE
MOLAR AND NOT AT ALL ON THE PREMOLAR
4OOTH )SOLATION THE 2UBBER $AM
")",)/'2!0(9
!)%,,/ ' #OME METTERE LA DIGA SUI DENTI DIFlCILI )L $ENTISTA )32!%, (! ,%"!. 3' !SPIRATION OF AN ENDODONTIC IN
-ODERNO STRUMENT * %NDOD
!-%2)#!. !33/#)!4)/. /& %.$/$/.4)343 +./7,%3 +) )"!22/,! * ,5$,/7 -/ !.$%23/.
!PPROPRIATENESS OF CARE AND QUALITY ASSURANCE GUIDELINES RD *2 .%7#/-" "% 2UBBER LATEX ALLERGY AND THE ENDODON
ED P TIC PATIENT %NDOD
!.$2)%5 % 4RAITÏ DE $ENTISTERIE /PERATORIE /CTAVE $OIN ,!-"2)!.)$)3 4 "%,4%3 0 !CCIDENTAL SWALLOWING OF EN
%DITEUR 0ARIS DODONTIC INSTRUMENTS %NDO $ENT 4RAUMATOL
!.42)- $$ 2UBBER DAM ISOLATION OF lXED PROSTHESES * ,!6!'./,) ' ,A CAVITÌ DACCESSO $ENTAL #ADMOS
%NDOD
"%!5$29 2* 0REVENTION OF RUBBER DAM HYPERSENSITIVITY *
,)%$%."%2' 7( -ANIPULATION OF RUBBER DAM SEPTA
%NDOD
AN AID TO THE METICULOUS ISOLATION OF SPLINTED PROSTHESES *
"%.#% 2 (ANDBOOK OF CLINICAL ENDODONTICS ND ED 3T %NDOD
,OUIS 4HE #6 -OSBY #OMPANY PAG
-%*)! *, $/.!$/ *% 0/3!$! ! !CCIDENTAL SWAL
"2!-7%,, *$ ()#3 -, 3OLVING ISOLATION PROBLEMS WITH LOWING OF A DENTAL CLAMP * %NDOD
RUBBER BASE ADHESIVE * %NDOD
0!44%23/. #*7 0OLYDAM
POLYTHENE SHEET A PRACTICAL AL
#!-%2/. 3- 7()4,/#+ 7, 4!"/2 -3 &OREIGN TERNATIVE TO RUBBER DAM FOR PATIENTS ALLERGIC TO RUBBER COM
BODY ASPIRATION IN DENTISTRY A REVIEW * !M $ENT !SSOC POUNDS )NT %NDOD *
0%##()/.) ! %NDODONZIA -ANUALE DI TECNICA OPERATIVA )6
#/#(2!. -! -),,%2 #( 3(%,$2!+% -! 4HE EFl
ED )#! P
CACY OF THE RUBBER DAM AS A BARRIER TO THE SPREAD OF MICROOR
GANISMS DURING DENTAL TREATMENT * !M $ENT !SSOC 2%54%2 *& 4HE ISOLATION OF TEETH AND THE PROTECTION OF THE
PATIENT DURING ENDODONTIC TREATMENT )NT %NDOD *
#2!'' 4+ 4HE USE OF RUBBER DAM IN ENDODONTICS * #AN
$ENT !SSOC 3#(7!24: 3& 0REPARATION FOR THERAPY )N #OHEN 3 AND
$)!3 $% !.$2!$% % 2!.!,) * 6/,0!4/ -# -/44! "URNS 2# EDS 0ATHWAYS OF THE PULP RD ED 3T ,OUIS 4HE
-!)! $% /,)6%)2! - !LLERGIC REACTION AFTER RUBBER DAM #6 -OSBY #OMPANY P
PLACEMENT * %NDOD
4!).4/2 *& ")%34%2&%,$ 2# ! SWALLOWED ENDODONTIC
&2%3! 2 )L CONSENSO INFORMATO IN /DONTOIATRIA ' %DIZ lLE CASE REPORT * %NDOD
-EDICO 3CIENTIlCHE 4ORINO P
7!(, 0 )SOLAMENTO DEL CAMPO E RADIOLOGIA ,)NFORMATORE
'!,,/ '' ,A DIGA 6)) #ONGRESSO )NTERNAZIONALE DEL
%NDODONTICO
LA 3OCIETÌ )TALIANA DI %NDODONZIA 4AVOLA CLINICA #HIAVARI
.OVEMBRE 7!+!"!9!3() ( /#() + 4!#()"!.! ( -!435
-/4/ + ! CLINICAL TECHNIQUE FOR RETENTION OF A RUBBER DAM
'2%%.% 22 3)+/2! &! (/53% *2 2UBBER DAM APPLI
CLAMP * %NDOD
CATION TO CROWNLESS AND CONE
SHAPED TEETH * %NDOD
7%).% &3 %NDODONTIC THERAPY RD ED 3T ,OUIS 4HE #6
-OSBY #OMPANY P
(%,).' " (%,).' ) %NDODONTIC PROCEDURES MUST NE
VER BE PERFORMED WITHOUT THE RUBBER DAM /RAL 3URG 7%)3-!. -) 2EMEDY FOR DENTAL DAM LEAKAGE PROBLEMS *
%NDOD
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