[Enter the rubber dam technic: endodontic rubber dam technic].
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Dentistry, Operative↗
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Effect of various irrigant and autoclaving regimes on the fracture resistance of rubber dam clamps.
Rubber dam clamps are known to break during clinical use in endodontics. This in-vitro study examined some of the variables which may contribute to the fracture. Stainless steel rubber dam clamps were subjected to various cleaning and autoclaving regimes and exposure to various solutions of sodium hypochlorite (NaOCl). Each clamp was examined after four cycles of cleaning and exposure to NaOCl. During environmental exposure to NaOCl, the clamp was stressed over a perspex rod to simulate placement onto the crown of a tooth. Clamps were examined after each test cycle visually and microscopically, or immediately after breakage. Results suggested that the fractures were because of a stress corrosion cracking phenomenon. There was evidence of intergranular and transgranular cracking of the metal. Corrosion spots were seen on the surface of the clamps and fracture occurred mainly through these spots. A number of recommendations to reduce breakage of clamps have been suggested.
Corrosion↗
Hardness and stress-corrosion of rubber dam clamps.
Rubber dam clamps fracture infrequently during use. There are no American National Standards Institute or International Standards Organization standards for their manufacture. The purpose of this study was to measure the hardness of the clamps and test their resistance to a stress-corrosion test. Upper molar, lower molar, and premolar clamps were obtained from two manufacturers (A, B). The Rockwell C hardness at four sites on the bow of each clamp was then determined. Fresh clamps were placed on blocks corresponding to the average buccal-lingual dimension of the tooth on which they would be used. These blocks were then submerged in room temperature 5.25% sodium hypochlorite for 20 min and then allowed to air dry for 30 min. This was repeated 10 times. Rockwell C hardness values ranged from C30 to 38, with the clamps of manufacturer B being significantly harder. None of the clamps from manufacturer B cracked or corroded. When a third batch received from manufacturer A was tested in the same manner, none of the clamps fractured or corroded either.
Analysis of Variance↗
An innovative method of cushioning metal clamp jaws during rubber dam isolation.
Competent rubber dam use increases both operating speed and treatment quality. In many instances, however, the application of rubber dam clamps may cause immediate and/or postoperative discomfort, and some dentists continue to use this as a "justifiable" excuse for not employing rubber dam. This paper reviews the iatrogenic potential of metal rubber dam clamps, and introduces a new cushioning technique that makes use of light-cured provisional material.
Acrylic Resins↗
Endodontic procedures must never be performed without the rubber dam.
The rubber dam is an absolute essential in all endodontic procedures. In documentation of that fact, we have presented the case of a 50-year-old man who swallowed an endodontic broach during endodontic treatment; the instrument passed through the gastrointestinal tract without difficulty.
Dental Instruments↗
An investigation of possible iatrogenic damage caused by metal rubber dam clamps.
Rubber dam may be held in place over a tooth by metal clamps. It has been shown that a mismatch of contact between the clamp gripping edge and the tooth surface may be reduced to a point contact, thereby concentrating the gripping force generated by the bow of the clamp. Experiments were conducted to measure the force. Clinically realistic loading of the tooth surface by sections of the gripping edge of clamps was carried out using special apparatus. Examination by scanning electron microscopy showed that iatrogenic damage to the tooth could occur. Therefore a plea is made for clamps to be redesigned to reduce any harm.
Dental Instruments↗
Rubber dam--the easy way.
Rubber dam use can only enhance a dental procedure by allowing better access, visibility, and dry field isolation. The reasons offered by many dentists for not using the dam can be overcome by additional training and clinical use. Suggestions are given that have made rubber dam use routine for the author and have facilitated much improved dentistry.
Dental Restoration, Permanent↗
Polydam--polythene sheet, a practical alternative to rubber dam for patients allergic to rubber compounds.
An alternative to rubber dam is required to ensure nasopharyngeal protection during endodontic procedures on patients who are allergic to rubber compounds. The use of polythene sheeting as a practical alternative is described, illustrated and discussed.
Dentistry, Operative↗
Rubber dam isolation in a difficult situation.
Rubber dam retainers can be modified easily in the dental office to enable the dentist to isolate teeth with difficult restorative problems with the rubber dam. Isolation with the rubber dam enhances visibility and access and gives the dentist the opportunity to render safe, restorative care of high quality to the patient.
Dental Caries↗
Using rubber dams to boost quality, quantity of restorative services.
Rubber dam use for restorative dentistry is far too low. If practitioners realized rubber dam's advantages and increased treatment quality, its use would be irresistible. Few other dental procedures offer both an increase in operating speed and treatment quality. To save the most time, competent auxiliary staff should be taught to place rubber dams before the clinical procedure begins. (Additional information on rubber dam placement by auxiliary staff is available from Dr. Christensen.)
Dental Restoration, Permanent↗
Secondary retention of rubber dam: effective moisture control access considerations.
Primary rubber dam retention affects attachment of the latex sheet to the anchor teeth bordering the isolated working field. Secondary rubber dam retention is the provision of an effective seal at the dam-tooth junction, which is essential to the maintenance of adequate access and moisture control within the working field. Practical hints are offered to optimize access and moisture control through well-planned and properly executed secondary retention of classic rubber dam applications. In addition, innovative solutions to the limitations of general field isolation, which pertain mostly to secondary retention of the unrestrained buccal and lingual curtains of the slit dam, are introduced.
Dentistry, Operative↗
Improvement of the rubber dam frame.
An improvement of the rubber dam frame for obtaining the endodontic operative field is proposed. The device consists of an articulated frame that maintains the currently used standard rubber dam sheet in position. A hinge allows the frame to be folded, resulting in easier accessibility to the working area. This accessibility facilitates taking of radiographs, administration of additional doses of anesthetics, and evacuation of therapeutic liquids, which may have accidentally entered the buccal cavity. In addition, a reservoir at the bottom of the frame allows the placement of gauze compresses and an aspiration cannula to avoid leakage of fluids such as sodium hypochloride onto the patient's clothing.
Biocompatible Materials↗
"Supra-dammed impressions": successful impressions with rubber dam in place.
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Dental Impression Technique↗
The efficacy of the rubber dam as a barrier to the spread of microorganisms during dental treatment.
This study evaluated the rubber dam as an infection control barrier during standard restorative procedures. Microbial collection was performed during preparation and placement of amalgam and composite resin restorations with and without the rubber dam, and during handpiece and air-water syringe spraying with and without the rubber dam. The results showed a significant reduction in microorganisms with the use of the rubber dam--70% to 88% and 95% to 99%, respectively; and 90% to 98% when all data were combined. These results indicate that using the rubber dam is a method of reducing microbial contamination at the primary source. Used with gloves, mask, and protective eyewear, the rubber dam provides an excellent barrier to the potential spread of infectious disease in the dental office.
Bacteria↗
Mercury levels in plasma and urine after removal of all amalgam restorations: the effect of using rubber dams.
OBJECTIVE: The aim of the present study was to determine whether removal of all amalgam restorations might significantly affect mercury levels in plasma and urine and whether the use of rubber dams might reduce patient exposure to mercury during amalgam removal. METHODS: All amalgam restorations were removed from 18 subjects during a single treatment session in which a rubber dam was used and from 10 subjects when a rubber dam was not used. All amalgam restorations were removed by the same dentist using high-speed cutting, water coolant, and high-volume evacuation. The levels of mercury in plasma and urine were analyzed both before and during the subsequent twelve months after amalgam removal. In order to determine whether removal of all amalgam restorations might cause an exposure large enough to significantly increase the mercury levels in two indicator media for mercury exposure, i.e., plasma and urine, and to determine if the removal might cause a significant decrease in the mercury levels found over time, the one-tailed, paired Students' t-test was used. For each individual, the pre-removal levels were compared with both the levels found in plasma on d 1 and in urine on d 10, and also with the levels found 1 y after removal. Furthermore, in order to examine whether the use of rubber dams had any effect on the mercury levels found after removal, the changes in the mercury levels found were compared between the groups using the Wilcoxon-Mann-Whitney rank sum test. RESULTS: After removal of all amalgam restorations, only the non-rubber dam group showed significant increases in the mercury levels found in plasma (p = 0.012) and urine (p = 0.037). However, one year later, the mercury levels in plasma and urine had sunk significantly below the pre-removal levels for both groups. When the changes in the mercury levels found were compared between the groups, the non-rubber dam group showed a significantly higher increase of mercury in plasma than the rubber dam group the day after removal (p = 0.0010). Compared to the pre-removal mercury levels in plasma and urine, the levels found 1 y after removal of all amalgam restorations were on average 52 +/- 23% (range 4-89%) lower in plasma and 76 +/- 21% (range 20-94%) lower in urine. SIGNIFICANCE: The study showed that dental amalgam had a statistically significant impact on the mercury levels found in plasma and urine in the patients tested, and that the use of a rubber dam during removal of all amalgam restorations significantly reduced the peak of mercury in plasma following removal.
Adult↗
The protein content of dental rubber dams.
OBJECTIVES: The purpose of this study was to analyse the protein content of 17 commonly used rubber dams and to determine if they contained known allergenic proteins. METHODS: Proteins were eluted with buffer from 17 brands of commercially available rubber dams. The quantity of eluted protein was measured and expressed in micrograms in every gram of rubber. The molecular weights of the individual proteins eluted were then measured after resolution on sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and compared with those of known allergens. RESULTS: The rubber dams were shown to contain significant amounts of protein (950-5850 micrograms). The subsequent analysis of these proteins using SDS-PAGE confirmed that some of these proteins were of the same molecular weight as known allergens. CONCLUSIONS: The results of this study confirm that all the rubber dams tested contained significant amounts of protein. The molecular weights of these proteins correspond with those of known allergens, and they could, therefore, be a cause of hypersensitivity reactions to dental rubber dams.
Allergens↗
Extending the use of rubber dam isolation: alternative procedures. Part I.
Most dentists are well aware of the value of the rubber dam in allowing technical excellence; however, few recognize the potential for protecting the dentist and staff against the ever-growing number of carriers of the hepatitis and human immunodeficiency viruses. The effectiveness of the rubber dam as an isolation barrier is dependent on the consistency of its application. Sporadic rubber dam application is therefore a weak link in an infection control program. This paper describes additional modified utilizations of rubber dam, uses that are generally not attempted with restrictive orthodox application methods. In addition, practical hints on other means of retention are offered, with the emphasis on nuisance-free and easy application.
Dental Implants↗
Effect of rubber dam on mercury exposure during amalgam removal.
It was the aim of this investigation to treat 20 volunteers with maximally 5 amalgam fillings by the same comprehensive protocol in which all removals with (n = 8) and without (n = 12) rubber dam had been performed within a few months. Nine amalgam-related parameters indicated a close matching of both groups before removal. In the group without rubber dam, mercury (Hg) levels in plasma increased significantly above preremoval values at days 1 and 3 after removal; they decreased significantly below preremoval values at day 30 in the rubber-dam group and at day 100 in both groups. Excretion rates did not increase significantly in either group, but decreased significantly at day 100 in the protected group. Peak plasma-Hg was 0.6 ng/mL on average at day one and decreased with halftimes of 3 and 43 d in subjects protected by rubber dam. The results indicated that concentrations of total mercury in plasma responded rapidly to changes in the amalgam status and reflected the actual absorption most reliably. Notably, plasma-Hg levels were sensitive enough to detect a transient attenuation of the additional exposure by using rubber dam during the removal of only a few fillings. However, being small in magnitude and lasting 100 d at best, the rubber-dam effect had minor toxicological relevance.
Absorption↗