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anyone have any good rubber dam tips? placement if a crown is too short, or not enough tooth to clamp on to? thanks
rubber dam
- Thread starter sules
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Here are some points that I think are impotant:
1) Make sure you are using the correct retainer (some are specific to molars and so forth)
2) Lubricate the rubber dam as most instructions state, but what I've tried that works is also lubricating the teeth a bit. Clinically you dont lubricate the teeth and the salive is good enough.
3) What I do that is a deviation from the instructions we have provided is that young's frame is placed on the rubber before I place the rubber on the retainer.
4) Also, when you floss the dam, dont take the floss out by pulling it out coronally, just pulled it out from the embrasure area.
Hope that helps,
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Be careful! Somebody on SDN will accuse you for providing substandard dental care 😀😀😀😀
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For a short crown(especially a molar), what I'll do if I absolutely have to have rubber dam isolation would be 1 of 2 things
1) If feasible, using cotton roll isolation, quickly build up the clinical crown height using composite, then with the newly increased crown height, apply the rubber dam as usual (this works nicely for endo access situations)
2) Use rubber dam retainers with POINTED tips (i.e. a #14) for a molar. Sharpen those tips first, make sure that you have PROFOUND anesthesia of the adjacent attached mucosa, and then place the retainer, sharpened tips an all) directly into the attached mucosa. When done, tell the patient that they'll be sore when brushing for the next few days😀
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Enh.
My attitude about this will probably change as I spend time in practice, but at least for now I don't place class II composites if I can't get a rubber dam in there. It's too easy to get just a little moisture contamination at the gingival margin of the box without realizing, and send the patient home with a beautiful restoration that's going to fail in a couple years at best.
There are plenty of dentists out there who place posterior composites all day who haven't looked at a rubber dam since dental school, and I'm sure many of them do a fine job, but I'm not yet confident enough to do it that way myself.
C
clickytop
If its a posterior and at the gingival margin, just use amalgam. No rubber dam required and it'll last longer too.
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Thats a poor opinion. The rubber dam is very important and considered standard of care in many procedures. If the crown is too short, or subging, clamp that puppy to the attached gingivae/alveolar bone. Sure the patient will be sore for a couple days, but that beats having a restoration fail, or a patient swallowing an endo file. I like to prep alot of inlays/onlays. Moisture control during cementation is HUGE. I'll even place a dam to insert these restorations if I have 2 or three in a quadrant. Once you get the hang of placing these things, they really make operative dentistry much easier (no tongue, no cheeks , good contrast, less fogging of mirrors--etc). Sure its a pain when you first start placing them, but now it take me less then a minute to have that sucker on and ready to go.
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That's up to the patient to decide...and amalgam will be extinct in 5 years.
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Speaking of off-topic things, I think orange is the new green.
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You dont make any sense.
C
clickytop
Yeah, in 5 years there'll be a Democrat in the White House and national healthcare will be telling us that amalgam isn't cost effective...we just wait till the teeth fall out and then flippers for everyone! Hurray!
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I agree with the points you make, however, there are a lot of patients out there that hate palatal injections...
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I have been using the isolite device more and more in situations especially where I'm doing quadrants of composites more and more lately instead of a traditional ruber dam ( http://www.isolitesystems.com/ ) Works well for *most* patients (heavy tongue thrusters, gaggers, and people with what I call HTS - hyperactive tongue syndrome) can overwhelm the isolite from tiem to time though. And suprisingly enough they're actually pretty comfortable.
I will admit to being a bit skeptical about this product when it was first introduced, but what convince me to try it was actually when my wife was placing some ortho brackets on me and her office has basically a full mouth version of the isolite(without the light source) that they use for retraction/dry field maintenance during bracketing and it kept me bone dry for the 20 or so minutes it took for my brackets to be cemented. It got me thinking about the product and the isolite. I'll also say that the isolite really does illuminate the field.
I will admit to being a bit skeptical about this product when it was first introduced, but what convince me to try it was actually when my wife was placing some ortho brackets on me and her office has basically a full mouth version of the isolite(without the light source) that they use for retraction/dry field maintenance during bracketing and it kept me bone dry for the 20 or so minutes it took for my brackets to be cemented. It got me thinking about the product and the isolite. I'll also say that the isolite really does illuminate the field.
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We have an Isolite on our mobile sealant clinic. I was a little skeptical about it at first, but it worked great. I'd definitely consider having one in the office.
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In my book it's one of the greatest recent dental inventions (granted my professional experience is minimal) 😀
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The CEO/inventor of Isolite (Tom Hirsch) was a gentleman as well. Myself and a couple friends had the opportunity to sit chairside with him at the Chicago Midwinter Meeting as he demonstrated it on some of the company reps. They had some crazy deals going on it too at CMW. 👍
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While rubber dams are a pain, I think they are great. I use them on virtually all operative procedures for two reasons:
1. It keeps the patient from talking non-stop and slowing down treatment
2. Most importantly, it keeps the site clean and it keeps the patient from getting in your way with his tongue and such.
It does suck to get it on sometime, but it's well worth the extra couple of minutes. In our clinic, the assistants are always willing to help you get it on too.
1. It keeps the patient from talking non-stop and slowing down treatment
2. Most importantly, it keeps the site clean and it keeps the patient from getting in your way with his tongue and such.
It does suck to get it on sometime, but it's well worth the extra couple of minutes. In our clinic, the assistants are always willing to help you get it on too.
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Personally I hate dams, but here at UFCD we have no choice in the matter. In pre-clinic they are required on all procedures (thus far) and as far as I know they are required in clinic (as far as I know).
That being said, here is what I have found to be helpful in pre-clinic (some of which is the same as others have said.
1. Loosen the teeth in your dentaform (I turn the screws 180 degrees)
2. Use lots of lube, I just lube the teeth (but it won't hurt to do both)
3. Place the clamp though the dam BEFORE placing it in the mouth
4. After placing the clamp (say on #31) start with the opposite (most anterior side first) (eg #25) and then work backwards to the most posterior tooth
5. When flossing double up the floss and pull it out buccally
6. GET HELP FROM SOMEONE ELSE! Placing a dam alone SUCKS! If you get a classmate to help you it should not take more than 1 minute to place a dam
Hope this helps.
-C
That being said, here is what I have found to be helpful in pre-clinic (some of which is the same as others have said.
1. Loosen the teeth in your dentaform (I turn the screws 180 degrees)
2. Use lots of lube, I just lube the teeth (but it won't hurt to do both)
3. Place the clamp though the dam BEFORE placing it in the mouth
4. After placing the clamp (say on #31) start with the opposite (most anterior side first) (eg #25) and then work backwards to the most posterior tooth
5. When flossing double up the floss and pull it out buccally
6. GET HELP FROM SOMEONE ELSE! Placing a dam alone SUCKS! If you get a classmate to help you it should not take more than 1 minute to place a dam
Hope this helps.
-C
