Cov Lus Qhia Ceev Rau Kev Siv Roj Hmab Sab Hauv Tsev

Cov kws kho hniav kawm tiav feem ntau ceev nrooj pov tseg cov roj hmab dam. Tab sis nws tseem yog ib feem tseem ceeb ntawm kev sib cais, tshwj xeeb tshaj yog nyob rau hauv lub anterior. Sim cov tswv yim kho mob no.

Arthur R. Volker, DDS

Peb Hlis 24, 2022

Tom qab tsev kawm ntawv kho hniav, cov kawm tiav feem ntau ceev nrooj pov tseg cov roj hmab dam. Txawm hais tias muaj lwm txoj hauv kev ntawm kev cais tawm, cov roj hmab dam tseem yog ib tug ntawm yog tsis zoo tshaj plaws. Qhov no yog tshwj xeeb tshaj yog nyob rau hauv lub anterior cheeb tsam.

 Daim duab 1: Preoperative saib; nco ntsoov txoj hauj lwm ntawm papilla

Qee cov lus qhia rau kev siv cov roj hmab anterior dam

• 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 

Daim duab 2: Papillary retraction tau txais thaum hnyav -gauge dam yog inverted

qhia txog qhov xwm txheej ua ntej. Nco ntsoov txoj hauj lwm ntawm papilla. Daim duab 2 qhia txog tus nqi ntawm papillary retraction tau thaum lub hnyav -gauge dam yog inverted.

Daim duab 2: Papillary retraction tau txais thaum hnyav -gauge dam yog inverted

• 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.

Daim duab 3: Premolar clamps muab tso rau ntawm lub pas dej ua ke kom affix nws

• 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). 

Daim duab 4: Ib txoj hlua roj hmab, xws li Wedjets (Coltene), tuaj yeem sib tsoo ntawm qhov sib cuag ntawm cov hniav feem ntau kom cais tawm thiab tawm hauv qhov chaw.

• 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. Nyeem ntawv ntxiv and subscribe to Los ntawm Loupes.