Note the different in- crement in size between the old and new standardizations continued. Continued E, F. Regarding the material of which the instruments are The characteristics of stainless steel instruments Fig. This The characteristics of carbon steel instruments Fig. The clinical use of stainless steel instruments there-

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Autori: Arnaldo Castellucci Shares The need to work under dry conditions, free of saliva, has been recognized for centuries, and the idea of using a sheet of rubber to isolate the tooth dates exactly years! The introduction of this notion is attributed to a young American dentist from New York, Sanford Christie Barnum, who in demonstrated for the first time the advantages of isolating the tooth with a rubber sheet.

Christie S. It was the result of much persecution from the inroads of saliva. I had spent many an hour, weary and distracted, battling against its incursions. Many a sleepless night had I over sad failures… with the one absorbing question ever before me unanswered. In a sort of half desperate way, and partly to try the new idea, I cut a hole in my napking protector and over the tooth it went. White introduced a rubber dam punch similar to that used still now.

Rubber dam punch introduced by S. White in In the same year Dr. Delous Palmer, and later Dr. Stokes and Dr. Elliot, introduced a set of metal clamps which could be used for different teeth. Delous Palmer in Metal clamps designed by Dr. Stokes Metal clamps designed by Dr. From: Andrieu E. This said, it seems incredible that even today, two centuries later and living now in the third millennium, there are still dentists who are not convinced of the usefulness of this very simple rubber sheet.

One of the primary objectives of endodontic treatment is disinfection of the root canal system. Only dental dam isolation minimizes the risk of contamination of the root canal system by indigenous oral bacteria.

The dental dam also offers other benefits, such as aiding in visualization by providing a clean operating field and preventing ingestion or aspiration of dental materials, irrigants and instruments. There is no other choice. In dentistry, as in general surgery, isolation of the operative field is imperative, even for a simple filling.

Even more so than in restorative dentistry, the rubber dam is obligatory in Endodontics,5 so much so that Endodontics should not be performed without a dam. Furthermore, an endodontic treatment should not be undertaken unless the tooth — particularly if damaged — has not been reconstructed to allow easy positioning of the rubber dam. As Aiello 25 states, one must recall that the rubber dam clamp occupies the future position of the marginal closure of the prosthetic crown.

It is therefore unthinkable to endodontically treat a tooth on which the rubber dam cannot be assembled, since it is not known whether and how the tooth will be restored. This new dam has the same elasticity and it is even more resistant to corrosion when in contact with endodontic solutions like sodium hypochlorite or endodontic solvents like chloroform. No-latex rubber dam, for allergic patients. There are odd rumors about the use of the rubber dam; for example, it is claimed that it takes too much time to assemble.

In Endodontics, use of the rubber dam confers the following advantages: The patients are protected from the ingestion 10 Fig.

The opportunity to operate in a clean surgical field. Retraction very important for working in the posterior areas and protection of the soft tissues gums, tongue, lips, and cheeks Fig. Better visibility in the working area. Better tactile sensitivity during the cleaning and shaping procedure. The pressure applied to the handle of these instruments reduces the sensitivity of the fingers and precludes the use of the instruments to perform delicate procedures.

This radiograph shows the presence of an endodontic instrument among the intestinal loops. Few weeks later, the patient died! This radiograph shows the presence of an endodontic instrument lodged in the upper respiratory tract. This patient died! To improve protection of soft tissues, some of the old clamps designed by Palmer were made with tongue-guards. From: Harris C. Patients increasingly appreciate the use of the rubber dam.

On occasion, they may ask whether it is a new invention,32 and once they have tried it, they do not want to do without it in the future. This is simpler than it might appear. Minimum set of instruments necessary for the assembly of the rubber dam in the different sectors of the mouth. Some prefer the dark colors, since the tooth stands out better, but it is really a question of habit.

The light-colored dam is slightly transparent, unlike the other colors, which may be helpful in positioning the intraoperative radiograph. The quality of the dam sheets deteriorates with time; in particular, they lose elasticity. To test them, one can perform the same test as that to check the adequacy of the dam punch: just after punching a hole in the dam, it is stretched in different directions to confirm that it does not tear.

Several brands are available. Nonetheless, it is necessary to check whether the dam opening is exactly round, without irregularities. To determine this, it suffices to punch a hole in a dam sheet and then enlarge this opening by stretching the sheet in different directions. The dam should not tear. The old S. White rubber dam punch of the XIX century. A modern rubber dam punch. The clamps are classified as winged or wingless. The dentist may choose those with which he feels more comfortable.

Clamps for the front teeth. Clamps for the premolars Clamps for the molars. Clamps for the molars. The positioning techniques vary slightly, but the final result is the same. Sometimes wingless clamps are preferable, inasmuch as they are less bulky and may be used easily in the posterior sectors in patients with particularly thick cheeks. The most commonly used are:.

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Dr. Arnaldo Castellucci



ARNALDO CASTELLUCCI-Endodontics Volume 1



Endodontie (vol.2 cap.13-27) - Arnaldo Castellucci


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