Is scanning under rubber dam isolation a feasible approach for the execution of indirect restorations? / O escaneamento sob isolamento absoluto é uma técnica viável para execução de restaurações indiretas?

Objective: The aim of the study was to report the aplicability of intraoral scanning while rubber dam isolation is in place. Material and Methods: Female patient, 50 years old, required restorative procedures on teeth 35 and 37. An intraoral scan was initially performed on both arches. Isolation was carried out from 33 to 37, tooth preparation and immediate dentin sealing were carried out. A new scan with the rubber dam in place was performed and a CAD/CAM lithium disilicate hybrid block was digitally designed, milled, crystallized and cemented under the tooth surface with the rubber dam still in position. After completing this stage, the rubber dam was removed, the occlusion was verified, presenting excellent aesthetic and functional results. Results: The absolute isolation process used in the present study works as an excellent device for gingival retraction. Conclusion: The absolute isolation can be recommended in clinical activities of intraoral scanning favoring the quality of the final result of treatments (AU)

Objetivo: O objetivo do estudo foi relatar a aplicabilidade do escaneamento intraoral sob isolamento absoluto. Material e Métodos: Paciente do sexo feminino, 50 anos, necessitou de procedimentos restauradores nos dentes 35 e 37. Uma varredura intraoral foi inicialmente realizada em ambos os arcos. O isolamento absoluto foi feito de 33 a 37, permitindo a realização do preparo dentário e selamento imediato da dentina. Um novo escaneamento com o dique de borracha colocado foi realizado e um bloco híbrido de dissilicato de lítio CAD/CAM foi projetado digitalmente, fresado, cristalizado e cimentado sob a superfície dentária ainda com o dique de borracha em posição. Após a finalização dessa etapa, o dique de borracha foi removido, a oclusão foi verificada apresentando ótimos resultados estéticos e funcionais. Resultados: O isolamento absoluto utilizado no presente estudo funciona como um excelente dispositivo para retração gengival. Conclusão: O isolamento absoluto pode ser recomendado em atividades clínicas de escaneamento intraoral favorecendo a qualidade do resultado final dos tratamentos (AU)

The use of rubber dam in the survival of RMGIC restorations in primary molars: a 30-month randomized controlled clinical trial

Abstract This study was a randomized controlled clinical trial with two parallel arms and the objective was to compare the survival of resin modified glass ionomer (RMGIC) restorations in primary teeth using rubber dam or cotton roll isolation after a 30-month follow-up period. Ninety-two children (mean age 6.8 ± 1.37) and 200 primary molars with occlusal or occluso-proximal cavitated dentin caries lesions were randomly assigned into two groups: cotton rolls and rubber dam. All lesions were restored using RMGIC (RIVA Light Cure) after selective caries removal. Restorative failure and lesion arrestment were evaluated by two independent, trained, and calibrated examiners through clinical and radiographic examinations. The Kaplan-Meier test was used to assess the survival of restorations and Cox regression was used to assess the association of risk factors with restorative failure. There was no significant difference in survival rates between groups (p = 0.17). Older age (HR = 2.81 [95%CI: 1.47-5.44]) and higher rate of gingival bleeding (HR = 0.47 [95%CI: 0.23-0.99]) were associated with restorative failure. No patient had painful symptoms, pulp outcomes, or radiographic changes compatible with lesion progression. The use of rubber dam isolation did not increase the survival rate of occlusal and occluso-proximal restorations using RMGIC in primary molars after 30 months of follow-up. Since the survival is not influenced by the type of isolation, the professional can safely choose the appropriate technique for each case, considering his experience and preferences, as well as those of the patient.

Influence of Isolation Technique on the Survival of Resin-Modified Glass-Ionomer Restorations in Primary Molars: A 9-Months Randomized Controlled Trial

ABSTRACT Objective: To compare the survival of occlusal and occlusal-proximal restorations performed with resin-modified glass-ionomer cement (RMGIC) in deciduous molars using rubber dam and cotton rolls isolation. Material and Methods: Ninety-two patients were included and 200 deciduous molars with cavitated occlusal or occlusoproximal dentin caries lesions were randomized into two groups: cotton rolls (n = 100) and rubber dam (n = 100) and RMGIC restorations were placed. At baseline and in the follow-up visit, presence, severity and activity of caries lesions were registered. Two independent, blinded examiners evaluated the treated teeth clinically using the USPHS criteria and radiographically after 9 months. Descriptive analysis, survival curve (log-rank test) and Cox regression were performed to assess risk factors related to failure. Results: Out of the 179 teeth (92 cotton rolls group and 87 rubber dam group) evaluated at 9-month follow-up period. No lesion progression was observed radiographically. The overall treatment success rate was 85.47% (83.47% for cotton rolls and 87.35 rubber dam group). No significant difference between isolation methods was observed in the log-rank test (p = 0.16). Cox regression showed no risk factors related to failure. Conclusion: No difference was found in the survival of occlusal and occlusal-proximal restorations performed with RMGIC in deciduous molars using a rubber dam and cotton rolls isolation after a 9-month follow-up period.

Improving patient care: alternative rubber dam isolation methods / Melhorando o cuidado ao paciente: métodos alternativos de isolamento absoluto

Adhesive techniques are more sensitive than conventional techniques and it is mandatory to isolate the operatory . To accomplish this goal, rubber dam isolation is the gold standard procedure. In root canal treatment, use of a rubber dam is found to be the standard of care, however, it is usually abandoned by professionals as time progresses from graduation to professional life, since the prevalence of rubber dam use is found to be low in many studies. To increase the use of rubber dams, adaptations of traditional techniques have been suggested. One possible way of reducing gingival trauma and pain promoted by isolation clamps during rubber dam usage would be the application of a thin layer of a soft material between the clamp and the tooth/gingival tissue. Objective: The purpose of the present work is to present alternative methods of rubber dam isolation, thus improving patient care. Description: Two methods are described: 1- Dam Coverage Method- Clamping the rubber dam over the tooth (putting the clamp over the dam and the teeth at the same time, without including the clamped tooth in the operatory ); 2- Silicone Coverage Method: Inter positioning of a heavy (high viscosity) silicone impression material between the tooth and the clamp. Conclusions: The current authors purposed two simple methods for absolute operatory isolation using a rubber dam. These methods reduce sensitivity, provide little or no gingival trauma and better comfort to the patient during rubber dam isolation as well as in the postoperative period, thus improving patient care.

Técnicas adesivas são mais sensíveis do que as convencionais, neste contexto, isolar o campo operatório é fundamental e o isolamento absoluto é o procedimento padrão-ouro. No tratamento endodôntico, o uso de um dique de borracha é reconhecido como padrão em cuidado de atendimento, no entanto, este é geralmente abandonado com o passar do tempo. Para aumentar a utilização de diques de borracha, adaptações das técnicas tradicionais têm sido sugeridas. Uma maneira possível de reduzir o trauma e a dor gengivais promovidos por grampos de isolamento seria a aplicação de uma fina camada de um material macio entre o grampo e o tecido dentário / gengival. Objetivo: O objetivo do presente trabalho é apresentar métodos alternativos de isolamento absoluto, melhorando assim o atendimento ao paciente. Descrição: Dois métodos são descritos: 1 - Cobertura com o Dique, que consiste na apreensão do dique de borracha sobre o dente (colocando o grampo sobre o dique de borracha e os dentes, ao mesmo tempo, sem a inclusão do dente no campo operatório), 2 - Cobertura com Silicona: consiste no posicionamento da silicona de condensação ou adição do tipo massa densa (alta viscosidade) entre o dente e o grampo. Conclusões: Os autores apresentaram dois métodos simples para o isolamento absoluto do campo operatório usando um dique de borracha que podem reduzir a sensibilidade e minimizar ou até mesmo evitar o trauma gengival provocado pelos grampos de isolamento, oferecendo assim conforto para o paciente durante e após o procedimento, melhorando a qualidade do atendimento prestado ao mesmo.