Rubber Dam Placement Research Articles

Comparing the Efficacy of EMLA-Infiltrating-Anesthesia for Rubber-Dam Placement

Comparing the Efficacy of EMLA-Infiltrating-Anesthesia for Rubber-Dam Placement

Sealing efficacy of various rubber dam barrier materials used for isolation procedures: A randomized controlled trial

ABSTRACT Aim: The aim of the study was to assess the sealing efficacy of three dam seal materials. Methods: Ninety participants were enrolled after obtaining consent. After the placement of rubber dam (RD), a stream of air was applied at the interface area and visualized at ××6 magnification to identify sealing ability. Dam seal materials were divided into Group A: Liquid Dam, Group B: Kool-Dam, and Group C: OraSeal caulking putty substance. Leakage was assessed using self-designed criteria such as sealing ability, retention, ease of adaptability, and removal. The data were tabulated and analyzed using IBM SPSS 20 software. Results: Kool-Dam (Group B) demonstrated superior effectiveness in controlling saliva seepage around the clamp and teeth (P = 0.039) compared to other groups. In addition, it was evident that Kool-Dam (Group B) had greater effectiveness as compared to Liquid Dam and OraSeal (Group C) with relation to the retention of dam seal material (P = 0.039). There was no statistically significant difference (P < 0.05) in the ease of adaptation or removal of dam seal material. Conclusion: This study highlights the importance of dam seal materials as an adjunct material to establish a tight seal over a RD placement. From the present study, it was evident that Kool-Dam exhibited superior performance over Liquid Dam and OraSeal dam seal material in terms of better sealing ability and retention of the dam seal materials.

Assessing Confidence Levels in Endodontic Procedures Among Senior Undergraduate Dental Students at Qassim University, Saudi Arabia: A Cross-Sectional Observational Study.

Background This study aimed to determine the confidence of senior dental students in Qassim University's undergraduate dentistry program in Saudi Arabia regarding their capacity to perform endodontic procedures. The study's objective was to pinpoint areas of weakness and offer suggestions for potential improvement of endodontic and clinical training for dental students. Methodology Using anonymous survey forms, 120 senior dental students were surveyed. Students' self-reported levels of confidence in performing various endodontic procedures, such as periapical radiographs, rubber dam placement, endodontically treated tooth restoration, anesthesia, broken instrument removal, and endodontic retreatment, were studied in this survey. A Likert-style rating scale of 1 to 5 was used in the survey, with 1 denoting high confidence and 5 denoting low confidence. Results The majority of senior dental students at Qassim University reported high levels of confidence in taking periapical radiographs, with 64.04% indicating a high level of confidence. The second most assured field was rubber dam installation, with 47.6% of students expressing high levels of assurance. Confidence levels were noticeably lower during more difficult procedures such as endodontic retreatment and the removal of broken instruments. While 12% of students expressed high confidence in endodontic retreatment, only 3.46% of students expressed high confidence in removing broken instruments. According to Pearson's correlation (r = 0.352, p = 0.001), there was a significant and favorable correlation between competency level and confidence in performing various endodontic procedure-related steps. Conclusions The study's findings suggest that senior dentistry students at Qassim University might benefit from additional training and assistance in some endodontic treatment areas. The lack of confidence displayed during more challenging procedures, such as the removal of broken instruments and endodontic retreatment, demonstrates the need for additional training and supervision in such cases. The results of this study may be useful for educators in other dental colleges who wish to consider developing new teaching techniques, utilizing simulators and digital learning tools, and increasing opportunities for hands-on training and supervision to improve dental students' self-confidence and skills.

Evaluating Skills and Confidence Status of House Officers in Managing Dental Patients: A Mixed Method Study in a Private Dental Institute of Karachi

Objective: To evaluate the skills and confidence status of house officers in managing dental patients.
 Study Design: Mixed method (Sequential-explanatory) study.
 Place and Duration of Study: Altamash Institute of Dental Medicine, Karachi Pakistan, from Mar 2019 to Mar 2020.
 Methodology: A self-administered questionnaire was developed for the 1st phase of the study. After validation from the content experts, a pilot test was run on 18 house officers before administering the questionnaire. It included 46 dental procedures; participants rated their skills and confidence in performing them using a Likert scale of 1 to 5 points ranging from poor to excellent. In the 2nd phase, sixteen face-to-face interviews were conducted to explain the reasons for acquiring skills and confidence status.
 Results: The response rate was 100%. Fifty-eight house officers filled out the questionnaire. Participants with multiple rotations reported significantly above average confidence status with multiple rotations of retainer insertion (81%), treatment of malocclusion using removable appliances (82%), fissure sealants (78%), anterior endodontic (80%), posterior amalgam (69%), oral hygiene (69%), and diagnosis of caries (67%), TMJ disorders (69%), rubber dam placement (71%) and properly prescribed recommended medicine (65%) when compared to the single rotation. The most important high-confidence status themes in evaluating skills were practising the procedures and internal motivation.
 Conclusion: Multiple rotations with repeated practice sessions enhanced house officers' skills and confidence status.Procedures that were least practised scored the lowest in overall mean confidence.Keywords: Confidence status, Curriculum, Dental graduates, Dental procedures, Evaluation, House officers, Skills.

Resin-bonded attachments made of monolithic zirconia ceramic: a minimally invasive and esthetic treatment approach.

The aim of this case report was to present a minimally invasive and esthetic treatment approach for the replacement of missing teeth removable partial dentures retained by zirconia ceramic resin-bonded attachments. The resin-bonded attachments were digitally designed and milled using CAD/CAM technology from monolithic 3Y-TZP zirconia ceramic. The resin-bonded attachments had an optimized attachment design approved for zirconia ceramic. The preparation was based on general preparation guidelines for resin-bonded attachments and resin-bonded fixed dental prostheses (RBFDPs). After placement of rubber dam, the resin-bonded attachments were bonded with a phosphate monomer-containing luting resin. The presented resin-bonded attachment-retained removable partial denture was successful over 30 months of clinical observation without any complications. The patient was satisfied with the minimally invasive treatment procedure. Zirconia ceramic resin-bonded attachments fabricated with a special attachment design are an esthetic and minimally invasive treatment approach. However, clinical data on the long-term outcome of zirconia resin-bonded attachments are still needed. (Quintessence Int 2023;54:220-226; doi: 10.3290/j.qi.b3819523).

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial

AimThe aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment. Materials and methodsThis is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS). ResultsThe study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used. ConclusionsVR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.

Microbiological analysis of sterile and nonsterile gloves before and during root canal treatment procedures

Objective: To evaluate the microbiological contamination of sterile (SG) and non-sterile (NSG) gloves before and during different stages of endodontic treatment. Methodology: Five brands (n = 10 per brand) of NSG (Supermax, UniGloves, Lemgruber, Nugard and Embramac) and four brands (n = 10 per brand) of SG (Sensitex, Sanro, Mucambo, Madeitex) were analyzed. Microbiological collections were performed at 3 different time-points: immediately after opening the packages (S1); after performing rubber dam placement (S2); and at the end of root canal treatment (S3). In the NSG group, to assess possible contamination by exposure to the clinical environment, samples were also collected within 24 hours (S4) and 7 days (S5) after opening the packages. After smearing the gloves with sterile swabs, the samples were immediately placed in test tubes containing specific BHI culture medium. These samples were incubated for 24 and 48h and the turbidity of the medium was evaluated. For turbid samples, bacterial identification was performed through culture and biochemical tests. Results: At S1, only the NSG UniGloves and Nugard brands showed contamination, while no contamination was observed in the SG. After S2 and S3 all brands showed contamination. In the NSG assessments, 24h after opening the packaging (S4) only the UniGloves brand showed no contamination, but this was not observed after 7 days (S5). The most observed species were Staphylococcus aureus, Staphylococcus ssp, Staphylococcus intermedius, Neisseria ssp, Escherichia coli and Pseudomonas aeroginosa. Conclusion: The NSG can be contaminated after opening the packaging and their exposure to the dental office environment can make it contaminated. SG are sterile but can also become contaminated during procedures. In the trans-operative period of root canal treatment, both NSG and SG can be contaminated by Gram-positive and Gram-negative bacteria.

The Acceptance of Rubber Dam Isolation by Patients undergoing Endodontic Treatment and Its Feedback: A Questionnaire Based Survey

Objective: The study was done to evaluate the average time taken by the operators to apply the rubber dam, procedure time and the acceptability or rejection of placement of rubber dam by the patients during endodontic treatment procedures.
 Design: The study was carried out on 450 patients requiring endodontic treatment reported at department during the time interval of May, 2021 to August, 2021. Out of 450 patients, 180 patients were randomly selected for the study by lottery method. All the endodontic procedures were performed under rubber dam isolation and rubber dam application time and time for isolation was determined. Further, a questionnaire survey was performed to evaluate the patient’s acceptance or rejection of procedures rubber dam and various reasons for rejection.
 Results: The highest number of respondents belonged to 21-30 years of age group i.e. 26.6% followed by 31-40 years i.e. 26.11%. Average rubber dam application time and procedure time were estimated as 4.04 and 44.07 minutes respectively. More than 90 % of the participants were willing to accept the procedure under rubber dam isolation in future. However, on contrary, only 9.44 % of the participants rejected the procedure under rubber dam isolation and the most common reasons for rejection were uneasiness felt by the patient and difficulty in breathing.
 Conclusions: The acceptability of rubber dam isolation while performing endodontic procedures/ treatments was quite significant among the patients. Very few patients had allergy to the latex material of rubber dam sheets and respiratory disorders.

Isolation with rubber dam: Knowledge, training and attitudes of final year dental students

Background/Aim. Good undergraduate education is necessary to overcome the reluctance of dentists to use the rubber dam (RD). The aim of the study was to assess dental students? knowledge, training skills, attitudes, and opinions concerning the use of RD in order to isolate an operation field. Methods. A 34-item original questionnaire was distributed to 130 final-year students of the Faculty of Dental Medicine, University of Belgrade. The questions were divided into four segments: general information, RD-related knowledge and training skills, opinions and attitudes regarding the use of RD, and opinions on the intended future use of RD. Results. All students confirmed that they had theoretical lessons about RD and that its advantages were pointed out. During practical courses, 34% of students observed RD placement and 10% of them placed RD on their own or with assistance. Most (88%) of the students did not feel capable of using RD on their own. Less than half of the students (38%) believed that adequate isolation of the operating field is possible without RD. Sixty-four percent of students considered that RD was not uncomfortable for the patients. More than half of the students were willing to use RD in their future practice. Almost all of them planned to gain additional postgraduate training with RD. Conclusion. Students have solid theoretical knowledge about RD; they are aware of its importance and have a positive attitude toward RD use. However, their practical training and skills are poor and insufficient for independent RD use in order to isolate an operation field.

Evaluation of Patient Attitude towards Rubber dam use in Endodontic Treatment

Background: Rubber dam is an indispensable tool to isolate teeth during dental treatment, but its application can be disagreeable for some patients. Aim: to determine the patient’s attitude to rubber dam use during endodontic procedures. Methods: Cross-sectional study was carried out in Operative Dentistry, Lahore Medical and Dental College, from 31st August 2021 to 21st October 2021. Using convenience sampling, 130 proformas were dispersed amongst house officers and postgraduate residents, who were performing endodontics under rubber dam. Questionnaires consisting demographic information, participant’s previous and current experience of rubber dam use, the treating doctor, time taken to apply rubber dam and duration of procedure. 126 completed forms were returned. Chi-square test was done for proportionate variables to determine statistical significance. Results: 46 patients (36.5%) answered their current experience was better with rubber application, 41 (32.5%) said about the same experience as compared to their previous rubber dam experience, and 11 (8.7%) had a worse current experience. Current experience of rubber dam use was: (i) pleasant/comfortable= 56 (44.4%), and (ii) uncomfortable/painful= 70(55.6%). The results further demonstrated that middle aged patients were more receptive to reapplication of the dam for future endodontic use. Statistically significant finding was that the postgraduate trainees applied the dam faster. Conclusion: Patient acceptance increased as the operator became more experienced, in lieu, more efficient in rubber dam placement. MeSH words: Rubber Dams, Endodontics, Patient

Attitude of Dental Students towards the Rubber Dam Use in Operative Dentistry

Aim:Operative dentistry and endodontics are the two major areas where rubber dam is used extensively with special emphasis to train students on its application during dental curriculum. The purpose of the present study was to evaluate the attitude of dental students toward the use of rubber dam in operative dentistry clinics along with emphasis on evaluation of its prospective application after graduation.Materials and Methods:A structured questionnaire-based analysis was performed among internship students of a dentistry program, Batterjee Medical College, Jeddah, Saudi Arabia. The questions were based on training, latex allergy, and selection of jaws for application of rubber dam and prospective use of rubber dam during practice.Results:A completed questionnaire by all participants (n = 110) was analyzed and subjected to statistical analysis. Around 80.9% of the students agreed that adequate and satisfactory training for rubber dam placement was imparted while 59.1% agreed that they enquire about latex allergy before placement of rubber dam. Further, 85.5% of the students planned to use rubber dam for all procedures after graduation.Conclusion:A promising response was exhibited by this group of future dentists toward the application of rubber dam during restorative procedures.

Response to the Letter.

Response to the Letter.

Morphological analysis of cementoenamel junction in premolars of Sri Lankans.

Cementoenamel junction is an anatomical landmark which indicates the meeting point of enamel of the crown and the cementum of the root. It is an important reference point in clinical dentistry as well as in dental radiography. The present study is done to describe the distribution of the mineralized tissue at the cementoenamel junction in relation to various surfaces of the premolars. The study sample consisted of 89 permanent maxillary and mandibular premolars from both males and females extracted for orthodontic reasons. They were stained with carbol fuchsin and observed under a dissecting microscope to identify the following tissue interrelationships at the cementoenamel junction: cementum overlapping the enamel; edge-to-edge relationship between enamel and cementum; gap between the enamel and cementum and enamel overlapping the cementum. The cementum overlapping the enamel interrelationship was predominant in the buccal and lingual surfaces of both first and second maxillary premolars, while the edge-to-edge relationship and the presence of a gap between the enamel and the cementum relationship were abundant in distal and mesial sides. Enamel overlapping the cementum was recorded only in a very small proportion of the sample. A good understanding about the morphological variations at the cementoenamel junction area is very important and this area should be handled carefully during routine dental procedures such as dental bleaching, orthodontic treatment, placement of rubber dam and placement of dental materials.

Practice with confidence: Analyzing confidence level of final year dental students from four Saudi dental colleges in Riyadh.

ObjectiveTo investigate the confidence level of final year dental students in Riyadh.MaterialsCross-sectional study was conducted at four dental colleges in Riyadh (N = 312, 220 and 70,5% responded). Oneway ANOVA and post hoc Tukey-Kramer was used.ResultsThe greatest self-reported confidence scores were for pit fissure sealent (4.6(0.7)). Whereas, students reported least confidence in conducting surgical extractions (2.7 (1.2)). Females were found more confident in conducting preventive resin restorations, oral hygiene instructions, and rubber dam placement as compared to male who were more confident in surgical extraction, copy dentures, veneer preparation and managing orthodontic emergencies.ConclusionAll students were confident in performing essential dental procedures however higher confidence was observed in performing simple procedures compared to more complex ones.

Preprocedural Pool Testing Strategy for Dentistry during the COVID-19 Pandemic.

Introduction:Aerosol-generating procedures (AGPs) put the dental health care professionals (DHCPs) at a greater risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In late June 2020, the Centers for Disease Control and Prevention advised elective dental procedures provision to asymptomatic patients while mandating strict infection control protocol and suggested the use of preprocedural testing as an adjunct. A cost-effective method for mass preprocedural testing is pool testing, which has specificity and sensitivity similar to polymerase chain reaction. This article aims to assess the outcomes and utility of incorporating preprocedural testing protocol for SARS-CoV-2 in dental clinics before providing AGPs.Method:The patients who were recommended AGPs where rubber dam placement was not possible were advised to undergo preprocedural testing for SARS-CoV-2. Pool testing strategy was employed, and patients were asked to get tested 48 h before the day of the procedure.Results:Out of a total of 1,000 patients, who presented from June 2020 to late July 2020, 464 were recommended dental procedures. In 194 of 464, AGPs could not be performed under rubber dam isolation; therefore, the patients were advised to get a preprocedural pool test. In total, 111 patients deferred the procedure and testing. Out of 83 who got tested, 7 were positive for SARS-CoV-2, 5 of whom were tested in early June 2020 and 2 in late July 2020.Conclusion:Pool testing within its limitations can be a useful preprocedure test in asymptomatic low-risk patients for AGP in dentistry, especially when the disease prevalence is low or moderate (<10%). It has the potential of reducing testing costs significantly while conserving reagent and other resources. Preprocedure testing, however, also gives rise to certain ethical concerns that also need to be addressed.Knowledge Transfer Statement:The results of this study can be used by clinicians when deciding which preprocedure testing approach they wish to use when performing aerosol-generating procedures in asymptomatic patients with consideration of cost sensitivity and specificity values.

Evaluation of undergraduate dental students self-perceived confidence level regarding endodontic procedures: A questionnaire survey

Introduction: Students' perspectives regarding their educational experiences play an essential role in curriculum planning and to evaluate effectiveness of dental courses being taught. The current study was aimed to assess the undergraduate dental students' self-perceived confidence level while performing different stages of endodontic treatment. Materials and Methods: A 30-item e-questionnaire was sent to 96 4th and 5th year dental students. The students were requested to grade their self-confidence level regarding various stages of endodontic treatment. Moreover, questions related to endodontics discipline difficulty level and students' preferences of file systems were also asked. Data were statistically analyzed. Results: The response rate was 94.8%. The students reported the highest confidence level for treating maxillary anterior teeth (4.39 ± 0.94) and the lowest confidence score was noted for maxillary molars (2.75 ± 1.00). Regarding different stages of endodontic treatment, students exhibited the highest confidence level for rubber dam placement (4.43 ± 0.70) while the lowest confidence was documented for managing inter-appointment flare-up (3.45 ± 0.92). A significant association was noted between the level of the academic year and stages of endodontic treatment for the items related to root canal obturation (P = 0.004) and restoration of endodontically treated teeth (P = 0.01). Considering various endodontic indications, 82.4% of the students were confident/very confident while treating the patients with irreversible pulpitis. Contrary to this, the students were least confident while managing the teeth with immature apices (16.5%). Conclusion: Undergraduate dental students exhibited higher confidence for performing different stages of basic endodontic treatment. Conversely, they reported lower confidence for carrying out more complex procedures.

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Emma Farrell talks us through implant nursing and rubber dam placement in a COVID-19 world

Evaluation of a new e-learning resource for calibrating OSCE examiners on the use of rating scales.

Rating scales have been described as better at assessing behaviours such as professionalism during Objective Structured Clinical Examinations (OSCEs). However, there is an increased need to train and calibrate staff on their use prior to student assessment. An online e-learning package was developed and made available to all examiners at the Institute of Dentistry at the University of Aberdeen. The package included videos of three OSCE stations (medical emergency, rubber dam placement and handling a complaint) which were recorded in two different scenarios; (excellent and unsatisfactory candidate). These videos were recorded to meet a pre-defined marking score. The examiners were required to mark the six videos using pre-set marking criteria (checklist and rating scales). The rating scales included professionalism, general clinical ability and/or communication skills. For each video, examiners were given four possible options (unsatisfactory, borderline, satisfactory or excellent), and they were provided with a description for each domain. They were also required to complete a questionnaire to gather their views on the use of this e-learning environment. Fifteen examiners completed the task. The total scores given were very similar to the expected scores for the medical emergency and complaint stations; however, this was not the case for the rubber dam station (P-value .017 and .036). This could be attributed to some aspects of the placement of the rubber dam being unclear as commented on in the examiners questionnaires. There was consistency in the selection of marks on the rating scales (inter-examiner correlation ranged between 0.916 and 0.979). Further studies are required on the field of e-learning training to calibrate examiners for practical assessment; however, this study provides preliminary evidence to support the use of videos as part of an online training package to calibrate OSCE examiners on the use of rating scales.

Anxiety and fear management in paediatric dentistry using distraction techniques.

Data sources PubMed, Web of Science, Scopus, Cochrane Library, Latin American and Caribbean Health Sciences Literature (Lilacs), US National Library of Medicine and Google Scholar. There were no limits on language or publication dates.Study selection Two independent reviewers performed the study selection of randomised controlled trials (RCT) investigating distraction techniques to manage dental anxiety & fear in patients under 18 years old compared to no interventionData extraction and synthesis Data were extracted by two independent reviewers using standardised data tables. Risk of bias was assessed using Cochrane Collaboration's Risk of Bias Tool. Study heterogeneity precluded meta-analysis. Qualitative analyses were performed.Results Twenty-one RCTs were included in this systematic review. Participant ages ranged from 4 to 16 years old. Distraction techniques included use of audio and audio-visual techniques, instrument camouflage, biofeedback therapy, dental operating microscope and toys. Data were collected pre- and post-dental procedures including: dental examination; prophylaxis; local anaesthetic administration; restoration placement; exodontia; and placement of rubber dam. Within studies, between one and six instruments were used to measure children's anxiety and dental fear. Objective measures with pulse oximeters and blood pressure cuffs were used most frequently.Conclusions The studies included in this systematic review suggest that distraction techniques might be useful to control children's anxiety and fear during dental appointments, however, the certainty of evidence is very low. There are no contraindications for the use of distraction techniques during children's and adolescents' dental appointments.

Guided Endodontics Modified for Treating Molars by Using an Intracoronal Guide Technique

The aim of this case report was to show the concept of guided endodontics in a maxillary first molar with limited interocclusal space. Guided endodontics involves merging cone-beam computed tomographic imaging and a surface scan of the tooth in order to create a guide to perform a drill path into the seemingly obliterated root canal. In the molar region, the interocclusal space is often too small to accommodate the guide, bur, and handpiece at once, and, therefore, a modified approach is presented. A 52-year-old man was referred because the dentist had failed to localize the distobuccal root canal of a maxillary molar (#3) associated with apical pathosis. After reopening and rubber dam placement, a glide path was established for both the palatal first mesiobuccal root canal and the second mesiobuccal using a size 10 hand file and coronal flaring. Further instrumentation to the working length was achieved by reciprocating file size 25. All 3 canals were temporarily filled with calcium hydroxide. For the distobuccal root canal, guided endodontics was chosen in order to avoid further impairment of the tooth because negotiation of the canal failed even with the use of the operating microscope. Following the merged data obtained from the cone-beam computed tomographic and surface scans, a translucent SICAT Optiguide (SICAT, Bonn, Germany) was constructed containing a sleeve representing the proper direction of a drill path in order to reach the distobuccal root canal. The access cavity was temporarily filled with a composite material made for light-curing. Before light curing, the Optiguide was replaced on the teeth, and a steel pin was pressed through the sleeve and the composite whereby the proper drill path direction was transferred into the composite. After polymerization and removal of the Optiguide and pin from the composite base sleeve, the guided drilling could be performed. This case report is the first on guided access preparation in a molar with pulp canal obliteration and limited interocclusal space. The demand for more interocclusal space was solved by transforming the virtual drill path into a composite-based intracoronal guide. The use of digital technology was essential.