Awgrymiadau Cyflym ar gyfer Defnydd Argae Rwber Blaenorol

Mae graddedigion ysgol ddeintyddol yn aml yn taflu'r argae rwber yn gyflym. Ond mae'n parhau i fod yn rhan bwysig o ynysu, yn enwedig yn y tu blaen. Rhowch gynnig ar yr awgrymiadau clinigol hyn.

Arthur R. Volker, DDS

Ionawr 24, 2022

Ar ôl ysgol ddeintyddol, mae graddedigion yn aml yn taflu'r argae rwber yn gyflym. Er bod dulliau eraill o ynysu yn bodoli, yr argae rwber yn parhau i fod yn un o'r goreuon os nad. Mae hyn yn arbennig o wir yn y rhanbarth blaenorol.

 Ffigur 1: Golwg cyn llawdriniaeth; nodi lleoliad y papila

Rhai awgrymiadau ar gyfer defnyddio argae rwber blaenorol

• 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 

Ffigur 2: Tynnu'n ôl papilari a geir pan fydd yr argae mesurydd trwm yn cael ei wrthdroi

yn dangos y sefyllfa cyn llawdriniaeth. Sylwch ar leoliad y papila. Mae Ffigur 2 yn dangos faint o dynnu'n ôl papilari a geir pan fydd yr argae mesurydd trwm yn cael ei wrthdroi.

Ffigur 2: Tynnu'n ôl papilari a geir pan fydd yr argae mesurydd trwm yn cael ei wrthdroi

• 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.

Ffigur 3: Claddau premolar wedi'u gosod dros yr argae i'w gosod

• 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). 

Ffigur 4: Gall llinyn rwber, fel Wedjets (Coltene), gael ei fflosio rhwng cyswllt y dannedd mwyaf distal i gael ei ynysu a'i adael yn ei le.

• 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. Darllen mwy o erthyglau and subscribe to Trwy'r Loupes.