Dental Problems

Procedure for Rubber Dam Clamp Placement

ToothRubber dam is usually of latex rubber, it is one among the most effective means of isolating teeth. The procedure for the rubber dam clamp placement is discusses briefly in this article. Let us examine them.

Procedure for the rubber dam clamp placement

  1. The first step in the rubber damp clam placement is the selection and preparation of the rubber dam.
  2. Next the tooth which has to be clamped is decided.
  3. Then a clamp is selected.
  4. Later they introduce the required materials to the kid.
  5. A required length of floss is tied to the clamp.
  6. Then place the clamp, frame and the rubber dam.
  7. Slip a napkin near the rubber dam and spread it over the face.
  8. Place a protective covering of cocoa butter or varnish or petroleum over silicate or GIC restoration to prevent dehydration.
  9. Adapt and slip a saliva ejector tip between the rubber and the napkin in the non-operating side.

Selection and preparation of the rubber dam:

  • Heavy and extra heavy dams are used for restorative procedures while medium is considered ideal for endodontic purposes because of the following:
    • It retracts the tissues better than thin type and
    • It is easier to place than heavier type.
  • The dam is then punched.

A. In primary dentition rubber dam is routinely placed over c, d and e:

  • For the maxillary arch:

    • The first hole is punched for ‘c’in the midline of the rubber dam 1.25” (3.5 cms) from the upper border.
    • The second hole punched for ‘d’is one hole smaller in size, 4-5 centimeter away and at an angle of 40 degree vertical towards the dentist.
    • The third hole for ‘c’is punched a size smaller and again 4-5 centimeter form d forming an angle of 40 degree to the vertical.
  • From the mandibular arch:
    • Similar procedure is followed for the mandibular arch with the hole for ‘c’punched 1.75” (4.5 centimeter) away from the upper border in midline.
    • Second hole is punched one hole smaller in size, 4-5 centimeter away at an angle 40 degree to the vertical towards the dentist.

Advantages of this method:

  • The dam is centered on the quadrant being worked on.
  • Nasal obstruction is avoided.
  • Holes can be punched in absence of the template.

B. Readymade templates:

These can also be used for marking the areas of teeth that need to be punched.

Methods of placement:

  • The bow of the clamp is positioned through the hole in the dam and the rubber is placed over the wings of the clamp.
  • The clamp is stretched and placed on the tooth along with the dam which is teased under the wings of clamp. The dam is then attached to the frame.
  • Wingless clamp is placed on the tooth and the dam is stretched over the clamped tooth.
  • This allows the clinician to see the area of the tooth being clamped.
  • Variation to this method would be to place the rubber dam first followed by clamp and frame.
  • Split dam technique:

    This is used to isolate anterior teeth without the use of clamp. This is useful in cases of insufficient crown structures, for example horizontally fractured tooth.

Additional isolation aids:

Moisture control, retraction and access are the main aims of isolation. Apart from before mentioned techniques other alternatives to provide the isolation are mentioned below.

  • Retraction cord:

    It is usually used for cervical lesions when the use of rubber dam is impractical or inappropriate. They can be used with non-caustic styptics to control sulcular seepage or hemorrhage.

  • Mirror and evacuator tip:

    This help in retraction of oral soft tissues, especially in the absence of rubber dam.

  • Mouth prop:

    Mouth prop benefits both operator and the patient. They maintain mouth opening during various procedures and prevent muscle fatigue in patients.

  • Drugs:

    Antisialagogues can be used to decrease excessive salivation, example -Atroping.
    Local anesthesia is known to decrease pain. This in addition to the vasco-constrictor in it brings about a reduction in salivation.

The above article discusses briefly about the

procedure for rubber dam clamp placement


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