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Tandlægeuddannede kasserer ofte hurtigt gummidæmningen. Men det forbliver en vigtig del af isolationen, især i den forreste del. Prøv disse kliniske tips.
24. januar 2022
Efter tandlægeskolen kasserer dimittender ofte kofferdamen hurtigt. Selvom der findes alternative metoder til isolation, gummidæmningen forbliver en af hvis ikke de bedste. Dette er især tilfældet i den forreste region.
Figur 1: Præoperativ billede; bemærk papillens position
Nogle tips til brug af en forreste gummidæmning
• Remove decay first and then place the dam, especially if there is a chance that caries will progress subgingivally. This negates the need to replace the dam if it gets torn or shredded during caries removal with rotary instruments.
• Consider nonlatex rubber dams, as this lessens worries about contact dermatitis or other possible allergic reactions.
• A heavy rubber dam is preferred as it will not only isolate from crevicular fluid, but it will also retract the papilla, allowing access to the subgingival areas. This is important not only for caries removal, but also procedures when emergence profiles need to be addressed, such as black triangle resolutions or diastema closures. Figure 1
Figur 2: Papillær tilbagetrækning opnået, når den tunge-gauge-dæmning vendes om
viser den præoperative situation. Bemærk papillens position. Figur 2 viser mængden af papillær tilbagetrækning opnået, når den tunge-gauge-dæmning vendes om.
Figur 2: Papillær tilbagetrækning opnået, når den tunge-gauge-dæmning vendes om
• Even if only one tooth is being restored, it is often better to isolate several teeth adjacent to the one being restored. This will lessen the tension on the target tooth, making it easier to invert. If incisors will be treated, the dam is typically placed from first premolar to contralateral premolar.
Figur 3: Premolar klemmer placeret over dæmningen for at fastgøre den
• A custom dam can be created by placing the dam over the teeth with enough tension to allow the outline of the teeth to be seen. The assistant can then mark the center of the incisal edge of the incisors with a pen or marker. Similarly, mark the tip of the cuspid and the buccal cusp tip of the premolars, and punch the holes. This is useful for teeth that may be rotated or mispositioned within the arch form.
• It is often unnecessary to anesthetize all the teeth to be isolated. Place a topical anesthetic on all teeth; place the rubber dam over the teeth and invert. To affix the dam, premolar clamps can be placed over it (figure 3). Alternatively, a rubber cord, such as Coltene's Wedjets, can be flossed between the contact of the most distal teeth to be isolated and left in place (figure 4).
Figur 4: En gummisnor, såsom Wedjets (Coltene), kan flosses mellem kontakten af de mest distale tænder, der skal isoleres og efterlades på plads.
• If single-tooth isolation is preferred, or needed for root canal therapy, a 210, 211, 212, 90N, or Brink B4-B6 can be considered. Clamp tines can be bent as needed for enhanced access to the operative field.
Editor's note: This article first appeared in Through the Loupes newsletter, a publication of the Endeavor Business Media Dental Group. Læs flere artikler and subscribe to Gennem lupperne.