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

Pre endodontik build-up dengan teknik canal projection pada gigi insisif lateral rahang atas disertai kerusakan mahkota yang sangat luasPre endodontic build-up with canal projection technique on maxillary lateral incisors with extensive crown damage

Pendahuluan: Gigi dengan kerusakan mahkota yang sangat luas sering menimbulkan masalah dalam perawatan endodontik seperti kesulitan dalam penempatan klem rubber dam sehingga isolasi yang kurang memadai serta kemungkinan terjadinya kebocoran koronal yang mengakibatkan risiko kegagalan perawatan endodontik. Gigi dengan keadaan tersebut membutuhkan restorasi sementara pre endodontic agar dapat dilakukan isolasi yang memadai, penempatan klem yang efektif selama perawatan dan pemulihan estetik sementara selama perawatan saluran akar. Tujuan laporan kasus ini untuk menjelaskan pembuatan pre endodontic build-up menggunakan alat tip plastik sekali pakai selama perawatan saluran akar pada gigi insisif rahang atas dengan kerusakan mahkota yang sangat luas. Laporan kasus: Pasien perempuan berusia 53 tahun datang ke Klinik Konservasi Gigi RSGM Unpad dengan keluhan gigi seri rahang atas kiri patah saat makan. Gigi tersebut pernah dirawat saluran akar satu tahun yang lalu namun tidak selesai. Pemeriksaan klinis menunjukkan kehilangan mahkota sampai batas servikal, dan terdapat gambaran radiolusen yang difus di area periapikal. Diagnosis berdasarkan American Association of Endodontics (AAE) adalah previously initiated therapy disertai periodontitis apikalis asimptomatik. Pembuatan pre endodontic build-up dengan teknik canal projection dilakukan untuk mendapatkan isolasi sekaligus sebagai restorasi sementara dan dilanjutkan dengan perawatan saluran akar dan pembuatan mahkota all porcelain dengan fiber post. Simpulan: Pembuatan pre endodontic build-up menggunakan teknik canal projection berhasil dilakukan selama perawatan saluran akar gigi insisif lateral kiri atas dengan kerusakan mahkota yang sangat luas. Pre endodontic build-up dengan teknik canal projection pada kasus ini dapat memberikan isolasi yang memadai, memudahkan penempatan klem rubber dam serta memberikan pemulihan estetik yang baik selama periode antar kunjungan. ABSTRACTIntroduction: Extensive crown damage often causes problems in endodontic treatment, such as difficulty placing rubber dam clamps, resulting in inadequate isolation and the possibility of coronal leakage, which results in treatment failure risk. This condition requires pre-endodontic temporary restorations to provide adequate isolation, effective clamping during treatment, and temporary aesthetic restoration during root canal treatment. The purpose of this case report was to describe the fabrication of a pre-endodontic build-up using a disposable plastic tip device during root canal treatment of a maxillary incisor with extensive crown damage. Case report: A 53-year-old female patient came to the Conservative Dentistry Clinic of Universitas Padjadjaran Dental Hospital to complain of a fractured left maxillary incisor that occurred while eating. The tooth had a root canal treatment one year prior but was not completed. Clinical examination revealed crown loss to the cervical margin and a diffuse radiolucent appearance in the periapical area. According to the American Association of Endodontics (AAE), the diagnosis was previously initiated therapy with asymptomatic apical periodontitis. Therefore, the pre-endodontic build-up using the canal projection technique was performed to obtain isolation and temporary restoration, continued with root canal treatment and the manufacture of an all-porcelain crown with fibre post. Conclusions: The pre-endodontic build-up with canal projection technique has been successfully performed during root canal treatment of the maxillary left lateral incisor with extensive crown damage. Pre-endodontic build-up with canal projection technique can provide adequate isolation, facilitate the placement of rubber dam clamps, and provide good aesthetic recovery during the period between visits.

КЛІНІЧНИЙ ВИПАДОК ЗАСТОСУВАННЯ СИСТЕМИ «ICON-INFILTRANT» В ТЕРАПЕВТИЧНІЙ СТОМАТОЛОГІЇ

Modern scientific and technological progress offers a new standard of treatment of odontopathology - infiltration of enamel with resins to seal cracks, chips and to level the surface in the affected area. The aim of the research is to introduce a conservative method for caries treatment using the polymer system "Icon" in the practice of therapeutic dentistry. Patient P., 20 years old, applied to the Department of Propaedeutics of Therapeutic Dentistry of PDMU with complaints of a tingling sensation from chemical stimuli, which disappeared immediately after their removal and the appearance of white matte spots on the vestibular surface of the maxillar teeth in the frontal area. From the anamnesis - the spots appeared after removing the brace system, which the patient had been wearing for 3 years. After the clinical examination, we diagnosed acute superficial dental caries 13,12,11,21,22,23. The treatment was performed in one visit with the Icon Vestibular system. Teeth are cleaned of plaque with a brush and fluoride-free toothpaste "Depural Neo". Under application anaesthesia with Sol. Lidocaini 10%, we isolated teeth with the rubber dam system. The lesions were treated with etching gel (Icon-Etch) 15% hydrochloric acid solution, left for 2 min, then washed off with water for 30 seconds, dried with dry air. To ensure high-quality adhesion of polymer resins, complete moisture removal was performed using ethanol-containing conditioner "Icon-Dry" for 30 seconds, followed by thorough air drying. To infiltrate the lesion, the vestibular nozzle was wound on the syringe "Icon-Infiltrant", infiltrate was carefully applied with a small excess on the etched enamel and left for 3 minutes. Excess was removed with floss and photopolymerized using "Icon-Infiltrant" for 40 seconds. For the second time, having screwed a new vestibular nozzle onto the "Icon-Infiltrant" syringe, the resin was applied for 1 minute. Excess material was removed and polymerized with ultraviolet light for 40 seconds. The rubber dam system was removed. The oxygen-inhibited layer was removed and the vestibular surfaces of the teeth were polished with the help of polishing discs and heads. As a result of the treatment, most of the stains disappeared, the colour, the shine of the tooth enamel 13,12,11,21,22,23 and the surface relief were restored. In 1 and 3 months after treatment, the visual and tactile examination of the vestibular surfaces of teeth revealed that the achieved aesthetic result slightly improved – the sizes of spots, which had been noticeable on the day of treatment decreased. The obtained result satisfied the patient both on the day of infiltration and in the long term. Follow-up examinations every 3 months during the year are recommended. Thus, this method allows us to stop the development of caries and non-carious lesions. It does not require anaesthesia; during treatment, intact areas of tissue are preserved and not damaged. Consequently, a high therapeutic and aesthetic result is achieved, several teeth can be cured in one session, and treatment lasts for an average of 15 minutes.

Knowledge and Attitudes of Undergraduate Dental Students regarding rubber dam use at Qassim University

Background: Improving our clinical skill and training through the scientific evidence is essential so that one can provide the highest quality of care to the patients. In both, endodontic and restorative procedures, proper isolation is very essential prerequisite for its long term success. Rubber dam is considered as a gold standard for isolation in dentistry hence its preclinical training to dental students is of uttermost importance. Aim: To evaluate the knowledge and attitude of dental students in regard to placement and usage of rubber dam Methodology: This is a questionnaire based descriptive cross-sectional study that was conducted on the third, fourth and fifth year undergraduate dental students at Qassim University College of Dentistry. The questions were based on knowledge and attitude of participants regarding the practicality of rubber dam use. Data was organized and analyzed by utilizing Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Overall response rate was 59.5%. Around 97.7% of the students agreed upon the importance of using rubber dam. 92% gave positive response regarding use of rubber dam in future restorative and operative cases while 72.7% were willing to gain knowledge about rubber dam through workshops and seminars. Conclusion: This study reaffirms the need for educational methods to be formulated to improve the attitude of dental students towards the used of rubber dam during undergraduate training and after graduation KEYWORDS: Attitude, Knowledge, Dental Students, Rubber dam

Behavior of Children during Dental Care with Rubber Dam Isolation: A Randomized Controlled Study

Background: The establishment of the dental dam improves dentist working conditions and patient protection. The purpose of this study was to analyze the behavior of the child during dental care with or without a dam. Methods: In this interventional randomized study, 51 patients are divided into two groups, one with a rubber dam and the other with cotton roll isolation. Their behavior was observed during the treatment of temporary molars. The duration of the treatment, the patient’s feeling with a visual analogue scale (VAS), the behavior (B) of the child measured with a hetero-evaluation scale (modified Venham scale) and the cardiac frequency (CF) were measured. Results: The group treated with a rubber dam has a significant decrease in the various stress parameters that have been identified (B, p value = 0.034; CF, p value = 0.015). Subgroups of patients with and without nitrous oxide sedation were compared and similar results were obtained. Conclusions: Isolation with a rubber dam reduces child’s stress during dental care. Although it is slightly more time-consuming and training is necessary for a quick and effective placement, it allows dentists to perform dental care in the best possible conditions, while reducing dental anxiety in young patients.