rubber dam in 100 seconds english - quintessence · widespread use of the rubber dam. rubber dam in...

Johannes Müller, Norman TischerJohannes Müller, Norman Tischer 11

Rubber Dam in100 Seconds

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Rubber Dam in 100 Seconds


An Instructional ProgramAn Instructional Programbyby



Dr. Johannes Müller


Johannes Müller received his degree in Dental Medicine at the Ludwigs-Maximillians University in Munich in 1983 and, in thesame year, was awarded his Doctorate in Medical Dentistry.From 1984 to 1987, he undertook post-graduate specialty training in the field of Oral Surgery at the Clinic Rechts der Isar at theTechnical University of Munich. He then worked for a short while as an associate dentist in a practice in Graz, Austria, prior tosettling down in Wörth-on-the-Isar and establishing his own practice in 1989.He is a member of the American Academy of Operative Dentistry as well as the American Academy of Gold Foil Operators. He isalso the director of the R. V. Tucker Cast Gold Study Club of Lower Bavaria. From 1998 until 2006 he was president of the LowerBavarian Dental Association and a member of the Board of the Dental Association of Bavaria.


Norman Tischer


Norman Tischer received his degree in Dental Medicine at the Ludwigs-Maximillians University in Munich in 1993.From 1993 until 1996 he worked in several different dental offices before settling down in his own practice in Landshut on theIsar in 1997. He is a member of the American Academy of Gold Foil Operators, the German Society for Periodontology, theAssociation of Implant Dentists in Germany, as well as the R. V. Tucker Cast GoldStudy Club of Lower Bavaria.


Dedicated toOur Dear Parents



The following presentationis copyrighted



Rubber Dam in 100 SecondsForeword

TheThe routine use of the rubber dam routine use of the rubber dam isis the thecurrent international standard.current international standard.

It ought to be integrated into the treatmentIt ought to be integrated into the treatmentprotocol protocol forfor every dental practice. every dental practice.


There are a number of tricks There are a number of tricks that simplify thethat simplify theplacement placement of a rubber dam so of a rubber dam so muchmuch so so that thatthe procedure can be done elegantly the procedure can be done elegantly in ain amatter of matter of secondsseconds..AfterAfter integrating the integrating the rubber dam rubber dam into everyinto every--day day practice practice a a dentistdentist will will never wantnever want to do to dowithoutwithout oneone againagain..



The authors have collectedThe authors have collected a a multitude multitude of of tips tipsthat are most often not foundthat are most often not found in in textbooks textbooks..TheseThese tips have been expanded upon tips have been expanded upon and and put puttogether as one easytogether as one easy-to--to-understand conceptunderstand concept..Following this conceptFollowing this concept will will allow the clinician allow the cliniciantoto place the place the rubber dam rubber dam quickly quickly and and elegantly elegantlyoverover ten ten teeth teeth..



It is the authorsIt is the authors’’ desire desire to to promote the morepromote the morewidespread use widespread use of of the the Rubber Dam.Rubber Dam.



““Starting the daily use Starting the daily use of of the the rubber dam rubber dam is the beginningis the beginning of of wisdomwisdom..When the When the rubber dam rubber dam comes through the doorcomes through the door, , slipshod methods go slipshod methods go out ofout of

the windowthe window..It marks the beginning It marks the beginning of of better dentistrybetter dentistry..””

J. M. Prime (1937) J. M. Prime (1937)

Prime, J.M.:Prime, J.M.: Inconsistencies Inconsistencies in operative in operative dentistrydentistry.. J Amer J Amer Dent AssocDent Assoc 24 82 (1937) 24 82 (1937)




Rubber Dam:Rubber Dam:

Originating from the Originating from the English English term term ““cofferdamcofferdam””meaningmeaning::““…a …a watertight enclosurewatertight enclosure ... to ... to allow for constructionallow for constructionor repairsor repairs; ; safety precaution safety precaution in in tankerstankers … …””



HistoryHistory

PhotoPhoto taken from taken from::Preiswerk, G:Preiswerk, G:Lehrbuch und Atlas der Lehrbuch und Atlas der Konservierenden Zahnheilkunde.Konservierenden Zahnheilkunde.J.F.Lehmann`s Verlag München J.F.Lehmann`s Verlag München 19121912



HistoryHistory1836 1836 RichRich usedused a a gold gold band band that that was was put around put around the tooth for isolation the tooth for isolation.. This technique This technique is described as is described as ““cofferdamcofferdam””..1839 Goodyear 1839 Goodyear discovered the chemical discovered the chemical vulcanization process vulcanization process to turn to turn the sap from the sap from the the Indian rubber Indian rubber tree into tree into Rubber. Rubber.1864 On1864 On the the 15 15thth of of March March,, while treating while treating aa lower molar lower molar, , Barnum cameBarnum came up up with with the idea the idea of of punching punching a hole in a a hole in a sheet sheet of rubber andof rubber and pulling it over the tooth pulling it over the tooth. . In May of In May of the same year the same year, , the solutionthe solution to to the problem the problem of of maintaining maintaining a a dry working dry working field field was was announced during announced during a a meeting meeting of of the the Cooper Institute. Cooper Institute. The method The method was was immediately taken immediately taken up up by other dentists by other dentists..1867 After1867 After this short this short time, time, the use the use of of BarnumBarnum’’s s rubber damrubber dam technique is described as technique is described as ““widespreadwidespread””..1882 S.S. White 1882 S.S. White develops thedevelops the rubber dam hole rubber dam hole punch which is punch which is still in still in use today use today..

1882 1882 Delos Delos Palmer Palmer introducedintroduced a a set set of 32 of 32 clamps clamps,, each each designed for designed for a a specific tooth specific tooth..1920 1920 With the introductionWith the introduction of of silver amalgam silver amalgam, to, to the the rise rise of of the the so- so-calledcalled ““conceptconcept of of focal infection focal infection”” and and the the development development of of improved suction techniques improved suction techniques,, the the enthusiasm for the enthusiasm for the rubber dam rubber dam waned waned..

Quoted fromQuoted from: Winkler, R.: : Winkler, R.: Kofferdam Kofferdam in Theorie in Theorie und Praxis, p. 15-17. Quintessenz-Verl.-GmbH, 1991und Praxis, p. 15-17. Quintessenz-Verl.-GmbH, 1991

1994 At1994 At the annual meeting the annual meeting of of The American AcademyThe American Academy of of Operative Operative Dentistry Dentistry, H., H. Brinker Brinker presentedpresented his his technique for the use technique for the use of rubber dam of rubber dam as as an an aid aid to to Professional Professional Teeth CleaningTeeth Cleaning.. The technique utilized The technique utilized special retraction clamps which were special retraction clamps which were also also developed developed by Brinker by Brinker. .

Modern Modern techniques for enamel techniques for enamel and and dentin bonding dentin bonding,, as as wellwell as for endodontic procedures as for endodontic procedures,, have awakened have awakened aa renewed interest for the use renewed interest for the use of of the the rubber dam. rubber dam.



I.I. Objectives Objectives


Objective

1. Demonstration of 1. Demonstration of howhow to to place place a rubber dam a rubber dam in a matter of in a matter of seconds for seconds for::

a) a) Conservative Conservative ( (RestorativeRestorative) ) ProceduresProcedures b)b) Endodontic Procedures Endodontic Procedures c) Hygiene c) Hygiene ProceduresProcedures d) d) Crown PreparationsCrown Preparations

suited for every general suited for every general dentaldental practice practice


2. 2. Description Description of of solutions for problems encounteredsolutions for problems encounteredwhen placing when placing a Rubber Dama Rubber Dam

3. Demonstration of 3. Demonstration of applications for specialapplications for specialcircumstancescircumstances

Objective


Target GroupsTarget Groups::1. Dentist 1. Dentist with assistancewith assistance2. Dental 2. Dental assistant with assistanceassistant with assistance - - placementplacement of of thethe rubber dam rubber dam prior prior to to the the dentist beginning treatment dentist beginning treatment - - placementplacement of of thethe rubber dam in rubber dam in preparation preparation for prophylaxis procedures for prophylaxis procedures

Objective


Objective

It is importantIt is important to to apply the apply the rubber dam rubber dam from the from themolar areamolar area to to the bicuspid area the bicuspid area on on the the contralateral contralateralsideside

- also - also when workingwhen working onlyonly on front on front teethteeth- also- also for endodontic for endodontic procedures procedures in in molarsmolars and and premolarspremolars


Objective

RationaleRationale- - increased accessincreased access to to the working area the working area- - less irritationless irritation to to the gingiva because clamps the gingiva because clamps fit fit betterbetter on on molars than molars than on on premolarspremolars- - economicaleconomical, , since the specified standard clampssince the specified standard clamps almost always almost always fit fit


Objective

Rubber Dam from16 (#3) to 24 (#12) forrestorations in theanterior teeth


Objective

Rubber Dam from16 (#3) to 24 (#12) for anendodontic procedure ina posterior quadrant

The multiple-hole technique for use in endodontics is a personal preference of the authors. Without adoubt, optimal endodontic results are also possible with single-hole isolation.


Contents

PrefacePreface:..................................................................................................:.................................................................................................. 99I.I. Objectives Objectives, , Target GroupsTarget Groups.................................................................................................................................. 1717

II. Set up of Materials and Instruments.................………………...….II. Set up of Materials and Instruments.................………………...…. 2525 a) a) PrePre--stampedstamped and and prepre--punchedpunched rubber dam rubber dam sheetssheets........................... ........................... 2727 b) b) LubricantLubricant ( (shavingshaving cream ) in cream ) in dappendappen dishdish..................................... ..................................... 3939 c) c) Clamp selection Clamp selection and and preparationpreparation..................................................... ..................................................... 4343 d) d) ClampClamp forcepsforceps................................................................................. ................................................................................. 4747 e) e) NapkinNapkin............................................................................................. ............................................................................................. 4949 f) Rubber dam f) Rubber dam frameframe........................................................................... ........................................................................... 5151

Clicking a particular topic will take you to thecorresponding part of the presentation


Contents

III. Application of the Rubber Dam in the Upper Arch.…..........…….. 53 a) Preparation immediately prior to the application of the rubber dam in the upper arch........................................................... 54 b) Sitting position................................................................................ 59 c) Placement of the clamp................................................................... 61 d) Rubber dam pulled over the clamp................................................. 65 e) Placement of the rubber dam for -light interdental contacts................................................................. 71 -moderately tight interdental contacts.............................................. 77 -tight interdental contacts................................................................. 83 f) guiding the rubber dam septa through the interdental contacts using finger pressure........................................................... 89


Contents

g) g) Guiding theGuiding the rubber dam rubber dam septa through the septa through the interdental interdental

contacts using contacts using floss - floss -Loop techniqueLoop technique............................................... ............................................... 93 93 h) h) ThreeThree-hand -hand TechniqueTechnique.......................................................................................................................................... 100100 i) i) Securing theSecuring the dam on dam on the the contralateral contralateral sideside.......................................................................... 107107 j) j) ApplicationApplication of of the the rubber dam in rubber dam in the upper arch the upper arch on on patientspatients.................... 113113 k) k) Inverting the cervical portionInverting the cervical portion of of the the dam........................................ dam........................................ 114114 l) Proper l) Proper technique for holding thetechnique for holding the dental floss................................. dental floss................................. 123123 m) Removal of m) Removal of the the rubber dam............................................................ rubber dam............................................................ 128128


Contents

IV. IV. PlacementPlacement of of the the Rubber Dam in Rubber Dam in the Lower the Lower Arch..........................Arch.......................... 133133 a) a) Sitting positionSitting position.................................................................................................................................................................. 134134 b) Dam b) Dam over the clamp over the clamp................................................................................................................................................ 135135 c) c) Application Application of of thethe rubber dam......................................................... rubber dam......................................................... 136136 d) d) ApplicationApplication of of thethe rubber dam on rubber dam on patientspatients............................................................................ 139139


Contents

V. V. TipsTips and and AdviceAdvice.............................................................................................................................................................. 141141 1.) Rain 1.) Rain channelchannel//Splash guardSplash guard............................................................. ............................................................. 142142 2.) 2.) Saliva controlSaliva control.................................................................................. .................................................................................. 144144 3.) 3.) Evacuation Evacuation of spray of spray waterwater.............................................................. .............................................................. 146146 4.) 4.) Using indirect vision with Using indirect vision with aa mirror under water mirror under water spray................... spray................... 148148 5.) Problem: Rubber dam rips on 5.) Problem: Rubber dam rips on the clamp the clamp – Double-Hole – Double-Hole TechniqueTechnique 152152 6.) Problem: 6.) Problem: Unnegotiable proximal contactsUnnegotiable proximal contacts:.....................................:..................................... 156156 Separation Separation withwith a Heidemann- a Heidemann-spatulaspatula........................................................ 157157 7.) Problem: 7.) Problem: Worn anterior Worn anterior teethteeth:: Separation Separation with with a metal a metal matrixmatrix band.............................. band.............................. 160160 8.) 8.) LubricatedLubricated wedgeswedges.................................................................................................................................................... 162162


Contents

9.) 9.) Lubricant stored Lubricant stored in a 20cc in a 20cc syringesyringe................................................................................................ 163163 10.) Special 10.) Special useuse: : Woodbury frameWoodbury frame.............................................................................................................. 164164 11.) Problem 11.) Problem:: StretchedStretched and and improperly sealed improperly sealed dam dam adjacent adjacent to a to a gapgap 169169 12.) Problem: Lack of 12.) Problem: Lack of seal around the seal around the neck of a neck of a toothtooth................................................ 172172 13.) 13.) Class Class V V fillings with subgingival cavity marginsfillings with subgingival cavity margins.................................................. 177177 14.) 14.) Clamp individualizationClamp individualization................................................................................................................................ 186186 15.) Problem: 15.) Problem: Bow Bow of of the clamp the clamp in in contact with the ascending ramus contact with the ascending ramus.. 192192 16.) Problem: 16.) Problem: Buccal portionBuccal portion of of thethe clampclamp in in contactcontact withwith thethe coronoidcoronoid process process...................................................................................................................................................................................... 200200 17.) 17.) DifficultyDifficulty in in clamp retention with the clamp retention with the #12A/13A- #12A/13A-ClampClamp.......................... 202202 18.) 18.) PitPit and and fissure sealants using fissure sealants using rubber dam..................................... rubber dam..................................... 209209 19.) Rubber dam Roll-in 19.) Rubber dam Roll-in TechniqueTechnique in in difficult casesdifficult cases.................................................... 212212 20.) Rubber dam and 20.) Rubber dam and retractionretraction cordcord........................................................................................................ 220220


Contents

21.) Problem: Matrix21.) Problem: Matrix bands bands on on terminal teeth terminal teeth ( (clamped teethclamped teeth)...........)........... 225225 22.) 22.) Unusual archUnusual arch form........................................................................ form........................................................................ 228228 23.) 23.) RepairRepair of a hole of a hole punchpunch.................................................................................................................................... 231231 24.) Problem: 24.) Problem: Splinted crowns or bridges Splinted crowns or bridges...................................................................................... 235235 25.) 25.) Crown preparation underCrown preparation under rubber dam........................................... rubber dam........................................... 243243 26.) Computer- 26.) Computer-aidedaided restorationsrestorations................................................................................................................ 245245 27.) Floss 27.) Floss ligatures ligatures.............................................................................................................................................................. 251251 28.) 28.) EndodonticEndodontic applicationsapplications.............................................................................................................................. 253253 29.) 29.) Securing theSecuring the rubber dam rubber dam clamp with clamp with dental floss........................ dental floss........................ 256256 30.) Gag- 30.) Gag-reflexreflex – – acupunctureacupuncture.......................................................................................................................... 257257 31.) 31.) ClaustrophobiaClaustrophobia – – creatingcreating a a breathingbreathing hole.................................. hole.................................. 260260 32.) TMJ 32.) TMJ painpain duringduring longlong proceduresprocedures.................................................................................................. 262262


Contents

VI. VI. ReviewReview................................................................................................................................................................................ 263263VII. VII. Clinical examples Clinical examples in operative in operative dentistrydentistry.......................................................................... 264264VIII. Rubber dam VIII. Rubber dam for procedures for procedures on on primary teethprimary teeth................................................................ 299299IX. IX. Teeth cleaningTeeth cleaning and and prophylaxisprophylaxis proceduresprocedures underunder rubber dam.. rubber dam.. 313313X. X. The mostThe most importantimportant advantagesadvantages forfor dentistsdentists regardingregarding thethe useuse of of thethe rubber dam....................................................................... rubber dam....................................................................... 324324


Contents

XI. XI. ArmamentariumArmamentarium and and Reference SourcesReference Sources.................................................................................... 329329 a) Rubber dam a) Rubber dam sheetssheets.................................................................................................................................................... 331331 b) b) Recommended clampsRecommended clamps........................................................................................................................................ 336336 c) c) Recommended clamp forcepsRecommended clamp forceps.................................................................................................................. 338338 d) d) RecommendedRecommended rubber dam rubber dam framesframes.................................................................................................... 341341 e) e) RecommendedRecommended hole hole punchpunch............................................................................................................................ 342342 f) f) Recommended stampRecommended stamp.............................................................................................................................................. 343343 g) Rubber dam g) Rubber dam caulkingcaulking productsproducts forfor sealingsealing gapsgaps.......................................................... 344344 h) h) Reference sourcesReference sources...................................................................................................................................................... 346346 i) Rubber dam i) Rubber dam setssets accordingaccording to to DrsDrs. Müller & Tischer...................... Müller & Tischer..................... 347347


Contents

XII. XII. OtherOther HelpfulHelpful TipsTips.................................................................................................................................................... 350350 a) a) Warming the Warming the mouthmouth mirrormirror............................................................................................................................ 351351 b) b) Relaxed Relaxed and and erecterect working positionworking position................................................................................................ 354354 c) c) ErgonomicErgonomic instrumentinstrument hand-off...................................................... hand-off...................................................... 356356 d) d) Caries removal in areas of undermined enamel……….Caries removal in areas of undermined enamel………................................... 358358 e) e) And when absolutely nothing seems to workAnd when absolutely nothing seems to work.................................................................... 360360

XIII. XIII. Advice for Teaching PersonnelAdvice for Teaching Personnel and and Students Students............................... ............................... 362362

AcknowledgementsAcknowledgements............................................................................................................................................................ 367367

ContentsContents................................................................................................................................................................................................ 370370

MastheadMasthead............................................................................................... ............................................................................................... 381381


All of All of the products namedthe products named in in this compendium this compendium are are worthworthmentioning becausementioning because, in, in the hands the hands of of the authors the authors and in and in their theirindividualindividual practicespractices,, these products seem these products seem to to be the be the best best suited suitedfor their stated usefor their stated use.. AA complete product review complete product review was was beyond beyondthe scopethe scope of of this compendium this compendium and and it it was was expressly expressly notnot the theintentionintention of of the authors the authors to to have presented have presented a a complete product complete productoverviewoverview. . NorNor was was it it to to deny the possibility that other equallydeny the possibility that other equallyworthy products may be available worthy products may be available onon the market the market.. The authors The authorsdodo not have any commercial interest not have any commercial interest in in any any of of the products the productsmentionedmentioned,, nor have they received any monetary or nor have they received any monetary or non- non-monetary compensation for the mention monetary compensation for the mention ofof any product or any product orproductsproducts..

DisclaimerDisclaimer


Dr. Johannes MüllerDr. Johannes MüllerLandshuter Str. 32Landshuter Str. 32D-84109 Wörth a. d. IsarD-84109 Wörth a. d. Isare-e-mailmail::kofferdamkofferdam@@muellerjohannesmuellerjohannes.de.de

ZA Norman TischerZA Norman TischerBischof-Sailer-Platz 421Bischof-Sailer-Platz 421D-84028 LandshutD-84028 Landshute-e-mailmail::kofferdamkofferdam@@normantischernormantischer.de.de

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The authors hold practicalcourses on this techniquein German, English,French, Italian andSpanish. Please inquirewith the authors toarrange a course.


AuthorsAuthorsJohannes MJohannes Müüller, Wller, Wöörth/Isar Landshutrth/Isar LandshutNorman Tischer, LandshutNorman Tischer, Landshut ProgrammingProgramming / / Production ProductionJoachimJoachim Gr Gröötzingertzinger VideoVideo Production ProductionNorbert NetzerNorbert Netzer MusicMusicCamille Saint-Camille Saint-SaensSaens „„The SwanThe Swan““ fromfrom „„The CarnivalThe Carnival of of the Animals the Animals““Version:Version: AntonAnton Schr Schrööpferpfer ProductProduct Management ManagementMartin Martin HecklingerHecklinger

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Quintessenz Verlags GmbHQuintessenz Verlags GmbHIfenpfadIfenpfad 2-4 2-4D-12107 BerlinD-12107 Berlininfoinfo@@quintessenzquintessenz.de.dewww.www.quintessenzquintessenz.de.de Order NumberOrder Number: 5851: 5851 ©© 2006 Quintessenz Verlags GmbH, Berlin 2006 Quintessenz Verlags GmbH, Berlin

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rubber dam in 100 seconds english - quintessence · widespread use of the rubber dam. rubber dam in...

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