Placement of Rubber Dam in Pedodontics

 

Welcome to the University of Michigan dentistry podcast series, promoting or health care worldwide for restorative procedures and Peter tonics we will routinely employ the use of a rubber Dam. This program is designed to show you visually two methods for placing the rubber dam in Peter Onix, which are different from a method which you’ve been taught already in Peter tonics. We’Ll use the five inch by five inch, medium gauge rubber dam in our clinic in your cubicles you’ll have either the SS white or the ivory rubber damn punch. The stage of the punch is the both regardless is the same, regardless of which punch you use. Now.

I’M going to punch the holes in the rubber dam, the lighter the gauge of the rubber dam, the larger the hole you should punch in this situation. We are going to isolate teeth, 19k, l and m, and so I’ll begin punching for tooth number, 19 and then k and then L and then a slightly smaller hole for the primary cuspid tooth M. There are three elements in the completed rubberdam procedure. One element, of course, is the punched rubber Dam. The second is the clamp which holds the rubber dam on the clamp tooth, and the third is the rubber dam frame.

These can be placed independently, first, placing the clamp then the rubber dam, then the frame, however impeded Onix is often more convenient to place. The entire assembly, together, in other words, assembling the rubber dam on the frame, placing the clamp on the rubber dam and then carrying the symbol, the assembled unit to the mouth in peated onyx. We use the young rubber dam frame. It is similar to a rubber dam frame that you are already using, except there is no extension on the bottom portion of the rubber dam frame. There are seven prongs for attaching the rubber dam to the frame now to place the rubber dam as a single unit.

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I’M going to attach the punched rubber dam onto the four corners of the frame. I’M doing this tight enough to to attach the rubber dam firmly and yet I’m not attaching it at the base. Part of the rubber dam for when I carried the rubber dam distally in the mouth, I would like to have a considerable amount of flexibility in the rubber dam. Typically, we will use either a number fourteen or a number fourteen, a rubber dam clamp on your left. I’M holding a number fourteen, a rubber dam clamp compare this with the clamp on your right, which is a number fourteen rubber dam clamp.

You will see that the beaks of the number fourteen, a rubber dam clamp, are angled cervical E much greater than the number fourteen rubber dam clamp to clamp tooth number. Nineteen. In this situation, I am going to use the number fourteen. A rubber dam clamp in a young permanent tooth where the eruption of the tooth is not complete. It is convenient to use a clamp that will displace a general tissue considerably.

The number fourteen, a clamp will do this for a partially erupted. First permanent molar. Remember in this situation, we are dealing with a sulcus depth, which may be as great as six to eight millimeters compared to an adult sulcus depth of about one to two millimeters, and so our goal in placing this clamp is to displace tissue, but not to impinge On the tissue, so I’m going to test the rubber dam clamp by placing it on this first permanent molar and seating it below the height of contour. You can see that I am just placing tissue cervical II, but I am not impinging on the tissue now. Having tested the clamp, I’m ready to place the rubber dam clamp on the rubber dam that I have punched in place on the rubber dam frame.

In order for you to view it more easily, I have turned the rubber dam upside down and corresponding the frame upside down. My purpose now is going to be to engage the wings of the rubber dam clamp into the most distal hole which I have in order to do this. I will stretch the hole and engage the clamp, the wings of the clamp onto the rubber dam. Now the assembled rubber dam is ready to be placed in the mouth. The clamp is in place.

The way I want it, a piece of floss has been attached. The distal of the rubber dam clamp to prevent aspiration in case of accidental dislodgement of the clamp the rubber dam is attached at four corners of the rubber dam frame. The bottom portion of the rubber dam is loose and I am ready to carry this assembly and clamp it on tooth number. 19. There are two rubber dam clamped forceps that we will have a bit available for your use.

The one on your left is the Watling type, rubber dam, clamp for Sep, and the one on your right is the ivory rubber dam clamp for Sep. This is the one that I will use now. I am ready to carry the assembled rubber dam, clamp and rubber dam with the frame attached onto tooth number 19 at this point is important to use your index finger to make sure that the cheek and buccal mucosa and lip do not accidentally become impinge upon by The rubber dam clamp during the insertion of the rubber dam I’m going to carry the clamp back to clamp tooth number 19 and release the clamp at this point. The rubber damage Fe viewers should be very stable on the clamp tooth. We can either use our finger or an instrument to dislodge the rubber dam material from the wings of the rubber dam clamp to test the stability of the clamp I’m going to seat it farther civically with light finger pressure and the clamp is quite stable.

Remember we had not attached the anterior portion of the rubber dam to the rubber dam frame. Look at the position now compared with to when we began when we when we began there was an excess of rubber dam material below the rubber dam frame. Now the material is about even with the rope with the rubber dam frame, and I will attach it to tighten it and now we’ll begin the process of attaching the rubber dam over the other teeth to be isolated. The first thing that we will do is to carry the rubber dam forward over to the most anterior tooth to be isolated here, the primary cuspid. At this point, we want to check to make sure that that there is rubber Dam in between the interproximal areas of each of the teeth to be isolated by the rubber dam, and we see this to be true in this situation.

I am going to ligate all the teeth that I am isolating with the rubber dam. When Peter Onix, we will use wax dental floss to ligate each of the teeth to be isolated. Here I will not lie get tooth number 19 because it carries the rubber dam. Clamp, but I will log eight tooth M: I’m going to show you how I tie one of the ligatures first we’ll insert the flaws in approximately beginning on the distal and carrying it below the contact, cervical E and correspondingly. We will carry it through the contact on the mesial and then pull the rubber dam.

The floss tight against the lingual surface, I’m going to tie a knot which is basically self tying. The first loop is is made and then a second loop is made and the loop is now brought up tightly against the buccal surface of the tooth. Now we want to carry the floss ligature below the height of contour of the tooth. To do this. There is one of two ways to do it.

Some suggest the use of a large spoon excavator, even a large spoon, excavator has a very small working surface and an accidental slip can make this instrument act much like a curette in oral surgery. Alternatively, we can use a large Carver, for example, a 7c Wesco Carver, where there is a larger working surface and a different angulation, so that a careful gingival displacement would result in a slip which might last ray the gingiva a very small amount on the lingual. I will use this Carver to carry the floss below the height of contour, while I am pulling on the knot on the buccal and then having done this, the first loop is tightened and a second loop is made in a reverse direction and the knot tightened. The ligatures have been tied and all of the teeth isolated, except the clamp, we’re now essentially ready to begin operative procedures, which, of course, will emit for this videotape. Some individuals like to leave the dental floss ligatures long.

We feel that by leaving them long, we can gain some additional mechanical retraction by being able to retract slightly as we prepare a deep cervical, for example. Others feel that this is too much extra material to be in the way and they would prefer to clip the ligatures. Now we’re ready to take the rubber dam off. We essentially have two tasks: one to move the ligature and, secondly, to remove the clamp and the rubber dam frame and the river dam in a single assembly to undo the ligature. We can either cut the ligature with a pair of fine, pointed scissors, and we will insert the scissor under the floss and cut through and pull the remainder of the floss through either with our finger or with a pair of thumb.

Forceps. Another method we can use is to use a spoon excavator or an explorer and untie the ligature and lift it off the tooth to remove the ligature from tooth Kay. I will use an explorer and, as I try to untie it begin to lift it off the tooth, and here it removes in one piece now using the sharp pointed scissors, I will pull the rubber Dam so that I can see in between the interproximal areas and Then, using the scissor lifting up the interproximal cutting each interproximal up to the clamp teeth now the music over damn clamp, forcep, engage the clamp and remove the entire assembly. When we finish, we will want to check and make sure there are no residual pieces of dental floss and also we will take the removed rubber Dam and approximate the edges to make sure that the rubber dam came out intact, as it has in this situation. There is a second method of placing a rubber dam which is equally as effective, and that is by placing the tooth the clamp on the tooth to be clamped initially and then carrying the rubber dam and the rubber dam frame over the clamp in a single unit.

Plus, for example, use a number 14 clamp on tooth Cay. I will seat the clamp first to test it. However, I will leave the clamp in place and now we will use a rubber dam, which has been punched as before with one modification. The most distal hole has been punched larger because we are going to stretch this medium gage rubber dam over the rubber dam, clamp as before. I will place the rubber dam on the frame attaching it at the four corners only and leaving the bottom portion loose.

To give some flexibility, as I stretch the rubber dam over the clamp tooth now in a single motion outside of the rubber dam, we will stretch the rubber dam over the clamp beginning at the distal and carry it forward over the wings completely of the tooth to Be clamped very commonly clinically, we will see what I have shown here, where the dissolution of the rubber Dam has become hung up. If you will, on the mesial of the first permanent molar here, a spoon excavator will lightly lift the rubber dam back where it should be. Now as before. We will carry the rubber dam to attach it to the bottom portion of the frame and then attach the rubber dam over all of the teeth to be isolated. In this procedure, which I have chosen to show tooth k, tooth l and 2m as before, we will log 8 all of the teeth, except the clamp tooth.

So, since toothpaste carries the rubber dam clamp, we will like to L and tooth m, as we did before, leaving the ligatures either long or cutting them off. As we showed earlier at the completion of the procedure, the rubber dam is removed as before, where the ligatures are cut and the rubber dam cut and the rubber dam clamp force up, engage on the clamp to remove the entire assembly, been listening to a presentation from The University of Michigan’s School of Dentistry, which is dedicated to supporting open learning and open educational resources. This recording is licensed under the Creative Commons. It may be reused and redistributed for nonprofit use. Please attribute materials to the University of Michigan’s School of Dentistry and redistribute under this same license for more information on how this and other university of michigan school of dentistry recordings may be used.

 

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