Rubber Dam Prof. Paul V.

Abbott

Rubber Dam Rubber Dam

a) First reported use in ~ 1840
 Dr. S.C. Barnum – USA

University of Illinois - 1900

Rubber Dam
a) First reported use in ~ 1840
 Dr. S.C. Barnum – USA

b) Recommended by ALL teaching authorities

and professional societies since the 19th
Century for ALL endodontic procedures
 And for many other dental procedures!!

Reasons for Using RD Reasons for Using RD

a) Infection control
b) Patient safety
c) Patient comfort
d) Moisture control
e) Increased visibility
f) Increased access
g) Increased efficiency
h) “Dento-
Dento-legal”
legal” reasons
i) Improved treatment outcome

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Rubber Dam Prof. Paul V. Abbott

Infection Control Infection Control

Recovery of Micro-organisms With and Without
Rubber Dam during Cavity Preparation

Mean CFU
At the Dental Light
50
41

30
No RD used
21 RD used

10
0 1
Cochran et al
Anterior Posterior
JADA 1989
Teeth Teeth

Infection Control Patient Safety

Recovery of Micro-organisms With and Without
Rubber Dam during Cavity Preparation

Mean CFU
On the Patient’s Chest
400 381

300
211 No RD used
200
RD used
100 84
42

Cochran et al
Anterior Posterior
JADA 1989
Teeth Teeth

Patient Comfort Patient Comfort

 99% of patients accepted the use of RD  Favourable comments - 82% of patients:

 72% preferred RD
 20% had no preference
 8% preferred no RD
 When appointment was 45-
45-60 minutes:
 76% preferred RD
 24% had no preference
 0% preferred no RD
 Absence of things in the mouth
 Secure, comfortable, safe, relaxed, detached
 Tongue out of way, protected
 No dribbling, no bad tastes
 Can swallow any time & without fear of
swallowing bits of filling, etc
Gergely Gergely
BDJ 1989 BDJ 1989

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Rubber Dam Prof. Paul V. Abbott

Patient Comfort Moisture Control

 Unfavourable comments - 18% of patients:

 Disliked clamp placement
 Breathing difficulties
 Smell, colour
 Rubber irritated
 Apprehensive, claustrophobic

Gergely
BDJ 1989

Increased Access & Visibility Increased Access & Visibility

“You can do it better when you can see it better!”

better!”

Increased Efficiency “Dento-Legal” Reasons

 Saves significant operating time

 Quick to apply – mean: 1.9 minutes

 Gergely BDJ 1989
 BUT - they were general dentists
 Only used RD 5% of the time
 Regular users likely to be much faster
 Recommended by ALL teaching authorities
 NB: Local Anaesthesia needs and professional societies since the 19th
3-5 minutes to be effective Century for ALL endodontic procedures
 And for many other dental procedures!!

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Rubber Dam Prof. Paul V. Abbott

“Dento-
Dento-Legal”
Legal” Reasons “Dento-
Dento-Legal”
Legal” Reasons

 The Dental Practice Board of Victoria
 Policy Decision – Oct 1998; Revised Nov 2002
 “The use of rubber dam is mandatory for
routine endodontic therapy”
therapy”
 “Serious, deliberate or repeated departures
… could result in a dentist being charged
with professional misconduct”
misconduct”
 “One of the most obvious departures
from the accepted standard of care
(during endodontic treatment)
is the failure to use rubber dam”
dam”
 “There would be no argument regarding
liability and the only question would
be the amount of the settlement”
settlement”

Cohen & Schwartz

JoE 1987

Improved Treatment Outcome Improved Treatment Outcome

% of Cases with a No. of Studies

 A review of 50 studies of the outcome of Favourable Outcome
endodontic treatment
< 60 5 **
 Rubber dam was not used in 2 studies 60 – 69 0

 Jokinen et al 1978 - 53% favourable 70 – 79 8

 Barbakow et al 1981 - 59% favourable
80 – 89 22

90 – 100 15

Friedman - Essential Endodontology 1998 Friedman - Essential Endodontology 1998

Improved Treatment Outcome Reasons for Using RD

a) Infection control
 Leakage of composite resins placed clinically
b) Patient safety
 Rubber dam isolation: 30/30 teeth had no leakage c) Patient comfort
 Cotton roll isolation: only 16/30 had no leakage d) Moisture control
e) Increased visibility
f) Increased access
g) Increased efficiency
 Statistically significant difference
h) “Dento-
Dento-legal”
legal” reasons
i) Improved treatment outcome
Knight et al - Int J Prosthod 1993

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Rubber Dam Prof. Paul V. Abbott

Rubber Dam Equipment Rubber Dam Equipment

 Rubber Dam  Punch

 Medium body
 Green

  Holes are too large

 Difficult to position RD

Rubber Dam Equipment Rubber Dam Equipment

 Punch  Clamp Forceps

 Use the largest

hole ONLY
- one size fits all !!!

Rubber Dam Equipment Rubber Dam Equipment

 Clamps  Clamps  Winged clamps preferred

Keep it Simple !!!

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Rubber Dam Prof. Paul V. Abbott

Rubber Dam Equipment Rubber Dam Equipment

 Clamps  Anterior teeth  Clamps  Premolar teeth

Rubber Dam Equipment Rubber Dam Equipment

 Clamps  Molar teeth  Clamps  Keep the choices simple!!

Rubber Dam Equipment Rubber Dam Equipment

 Frames  Frames  Young’

Young’s frame (metal)

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Rubber Dam Prof. Paul V. Abbott

Rubber Dam Equipment Rubber Dam Equipment

 Frames  Star “Visi”

Visi” frame  Frames  Nygaard-
Nygaard-Östby frame

Rubber Dam Equipment Rubber Dam Equipment

 Frames  Nygaard-
Nygaard-Östby frame  Frames  Nygaard-
Nygaard-Östby frame

Rubber Dam Equipment Rubber Dam Equipment

 Frames  Nygaard-
Nygaard-Östby frame  Extra Items  OraSeal

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Rubber Dam Prof. Paul V. Abbott

Rubber Dam Equipment Rubber Dam Equipment

 Extra Items  Wedjets  Extra Items  Wedjets

Rubber Dam Equipment Applying Rubber Dam

 Extra Items  Wedjets + OraSeal  Preferred method  RD on a winged clamp

Applying Rubber Dam Applying Rubber Dam

 Preferred method  RD on a winged clamp  AVOID  Placing clamp in mouth without RD

 Place on tooth together

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Rubber Dam Prof. Paul V. Abbott

Applying Rubber Dam RD Techniques for Endodontics

 AVOID  Placing clamp in mouth without RD a) Single Tooth Isolation

 If used  Remove floss once RD placed b) Cuff Technique

Hole Positions - Single Tooth

RD Techniques for Endodontics
Technique
a) Single Tooth Isolation

Mesial
⅓
Labial

x x

Anterior Teeth Posterior Teeth

RD Techniques for Endodontics RD Techniques for Endodontics

b) Cuff Technique b) Cuff Technique

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Rubber Dam Prof. Paul V. Abbott

RD Techniques for Endodontics Hole Positions - Cuff Technique

b) Cuff Technique

Mesial
Labial
¼

x x

Anterior Teeth Posterior Teeth

Rubber Dam Rubber Dam Equipment

 “Non-
Non-latex”
latex” Rubber Dam

Some Additional
Tricks & Hints

Rubber Dam Equipment Rubber Dam Equipment

 Orashield - Rubber Dam Napkins  Orashield - Rubber Dam Napkins

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Rubber Dam Prof. Paul V. Abbott

Some Other Hints Some Other Hints

 Missing teeth  Orthodontic brackets / arch wires

Some Other Hints Record Keeping

 RD not well adapted to the tooth

Rubber Dam Equipment Some Other Hints

 Be sure to isolate the correct tooth!!
 Clamps

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Rubber Dam Prof. Paul V. Abbott

Some Other Hints Reasons for Using RD

 Be sure to isolate the correct tooth!!
a) Infection control
b) Patient safety
c) Patient comfort
d) Moisture control
e) Increased visibility
f) Increased access
g) Increased efficiency
h) “Dento-
Dento-legal”
legal” reasons
i) Improved treatment outcome

It’s “Dam” Easy !!

UWA - 3rd Yr Endodontics 2007 Page 12