Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct-Dec;7(4):499-506.

Dental dam clamp adaptation method on carved gypsum cast

N C E Cazacu  1
Affiliations

Dental dam clamp adaptation method on carved gypsum cast

N C E Cazacu. J Med Life. 2014 Oct-Dec.

Abstract

Rationale: Dental Dam is the safest and most efficient isolation technique in endodontics and restorative dentistry, but it also used in esthetics, orthodontics, prosthetics, pedodontics and periodontology (for teeth immobilization). While in most cases the standard clamps are efficient, in some clinical situations clamp adaptation is mandatory in order to assure a tight contact on the tooth.

Objective: The purpose of this study is to list the elements of the clamp, which should be modified in order to assure a secure constriction of the clamp on the anchor tooth, by using the carved gypsum cast method.

Methods and results: 100 patients were examined, diagnosed and treated for various diagnoses like simple decay, gangrene, chronic apical periodontitis, and endodontic retreatments. The clamps used in this study were produced by Hu-Friedy, Hygenic, KKD, SDI, Hager & Werken. In 10 cases, the anchor tooth did not provide enough stability to the standard clamp--as provided by the producer. Therefore, we have done some adjustments to some of the elements of the clamp: the arch, the wings, the plateau, the active area, and the contact points. In 6 cases, major clamp adaptations on carved gypsum cast were imperative.

Discussion: The classic clamps cannot provide a grip to be enough in all the clinical cases due to the huge variety and position and implantation of the anchor teeth. Therefore, in such situations, the clamps should be adapted in order to provide stability and assure the safe isolation during the treatment. The modified clamps will be useful in similar cases, so they must be kept.

Keywords: Dental dam; carved gypsum cast; clamp adaptation; clamp elements; safe isolation.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
In 10% of cases the clamps requested adaptations: 4% minor adaptation and 6% major clamp adaptation on carved gypsum cast.
Fig. 2
Fig. 2
Clamp, dam, cervical ligatures on teeth 3.6 and 3.7, matrix, wedge; occlusal view; class II atypical cavity; group isolation
Fig. 3
Fig. 3
Clamp 212 standard
Fig. 4
Fig. 4
Clamp 212 modified
Fig. 5
Fig. 5
Detail: re-shaping the active perimeter; the contact points are close to one another
Fig. 6
Fig. 6
Clamp 212 modified by changing the jaws’ orientation (method described in the specific literature [,]).
Fig. 7
Fig. 7
1.2 coronal fracture; root canal treatment; the clamp applied
Fig. 8
Fig. 8
The clamp applied; detail, in the mirror: the contact area section. What is important to be noticed is the position of the active contact points on the cervical contour
Fig. 9
Fig. 9
Clamp, dam, cervical ligatures
Fig. 10
Fig. 10
4.6 simple buccal decay
Fig. 11
Fig. 11
4.6 simple buccal decay; clamp and dam applied; the buccal clamp contour pushes the gingiva, offering visibility to the hard dental tissue
Fig. 12
Fig. 12
4.6 unpolished filling
Fig. 13
Fig. 13
2.6 massive coronal destruction; gingivectomy performed with electro cauterization – image after the healing
Fig. 14
Fig. 14
Clamp 201: left - standard; right – modified at the level of the following elements: bow, plateau, active perimeter, contact points and jaws translation
Fig. 15
Fig. 15
Clamp 201 – mucosal view
Fig. 16
Fig. 16
Clamp, dam, ligature; supplementary sealer; fiberglass posts checkup and adaptation
Fig. 17
Fig. 17
Reinforced restoration with fiberglass posts; clamp 201 modified; supplementary sealer: Block Out Resin Ultradent
Fig. 18
Fig. 18
2.6 restoration ready to be prepared for the prosthetic reconstruction
Fig. 19
Fig. 19
1.4 massive coronal destruction; applying a standard clamp is difficult.
Fig. 20
Fig. 20
Buccal view
Fig. 21
Fig. 21
After the gingivectomy performed with electrocauterisation – occlusal view
Fig. 22
Fig. 22
The adapted clamp has been applied
Fig. 23
Fig. 23
Fiberglass posts checkup
Fig. 24
Fig. 24
Occlusal view over the restoration after the dental dam has been removed
Fig. 25
Fig. 25
Occlusal view over the restoration after the dental dam has been removed
Fig. 26
Fig. 26
1.6 grinded tooth, incomplete root canal treatment, via falsa in the floor of the pulp chamber
Fig. 27
Fig. 27
1.6 radiography realized before the treatment; incomplete root canal filling; via falsa in the floor of the pulp chamber incorrect filled; inflammation still present
Fig. 28
Fig. 28
Via falsa in the floor of the pulp chamber highlighted by the gutta percha points
Fig. 29
Fig. 29
1.6 Retreatment, via falsa has been filled by using MTA; final radiography
Fig. 30
Fig. 30
Marking the gingival contour on the gypsum cast
Fig. 31
Fig. 31
Standard clamp no. 1, KKD for upper premolars, being used unconventionally for the molar, because it has the elements which are most appropriate for the requirements of the clinical situation
Fig. 32
Fig. 32
Choosing the clamp with the most appropriate contour. It is obvious the buccal-distal contact point is not in contact with the tooth on the gypsum cast. The grip is not efficient!
Fig. 33
Fig. 33
Clamp no. 1 modified: active contour and contact points
Fig. 34
Fig. 34
Notice the difference between the initial contour of the standard clamp (drawn on the paper) and the modified one, according to the real contact section
Fig. 35
Fig. 35
Clamp no.1 for the upper premolar adapted has been applied on the grinded 1.6. Retreatment, via falsa correctly filled
Fig. 36
Fig. 36
Clamp and dam – the contact points are now in the right position, so they offer good stability during treatment
See this image and copyright information in PMC

References

    1. Baum L, Phillips RW, Lund MR. Isolation of the Working Field, Textbook of Operative Dentistry. Third Edition. Philadelphia: W.B. Saunders Company; 1995. pp. 187–220.
    1. Summit JB, Robbins JW, Hilton TJ, Schwartz RS, dos Santos J Jr. Field Isolation, Fundamentals of Operative Dentistry A Contemporary Approach. Third Edition. Illinois: Quintessence Publishing Co; 2006. pp. 156–180.
    1. Cazacu C. DIGA – Sistemul de izolare cu folie elastică a câmpului operator în stomatologie. Bucureşti: Editura InfoMedica; 2001. p. 50.
    1. Cazacu NCE, Cazacu C. Ghid de utilizare a sistemului de izolare cu folie elastică (diga) în specialitățile medico-dentare. București: Editura Universitară Carol Davila; 2009. pp. 26–99.pp. 75–78.
    1. Pertot WJ, Simon S. Le Traitement Endodontique. Quintessence International; 2004. pp. 37–46.

Substances

LinkOut - more resources