Articulo Endodoncia Aislamiento Con Prótesis Ferulizados

0099-2399/95/2104-0208503.00/0 JOURNALOF ENDODONTICS Copyright © 1995 by The American Association of Endodontists

Printed in U.S.A.

VOL.21, NO. 4, APRIL1995

CLINICAL AIDS Manipulation of Rubber Dam Septa: An Aid to the Meticulous Isolation of Splinted Prostheses
William H. Liebenberg, BSc, BDS (Rand)

Splinted prostheses are a problem in endodontic isolation. The traditional solutionof resorting to a slit-dam technique results in an unrestrained curtain of rubber dam which not only allows for saliva seepage but can serve to compromise the endodontic access opening. This article introduces a simple, yet effective, method of improving the seal of isolated splinted prostheses. It relies on the manipulation and ligation of rubber dam septa with dental floss. Two pictorialclinical reports depict the technique and demonstrate the ease of attaining isolation with splinted prostheses.
FIG 1. Rubber dam applied to a mandibular fixed bridge in preparation for endodontics to the mesial and distal abutment teeth. Although the retaining clamps provide sufficient primary rubber dam retention, the isolation is compromised by the solder joints.

The rubber dam is the customarymode of isolation during endodontic treatment (1). Clinicians providing endodontic therapy will at some time be called upon to isolate every possible dental restorative permutation. Isolation complications include an extensive loss of coronal tissue, poor retentive form, fragile restorations, fixed partial prostheses, teeth with abnormal axial inclinations, and orthodontically involved arches. Thevariability of presentation constants makes endodontic isolation the most challenging of all isolation procedures (2). Furthermore, unlike other operative procedures, application difficulty is not considered reasonable cause for not using rubber dam. There are many descriptions of rubber dam application skills in the literature. Optimum endodontic solutions often requires creative adaptation ofthese isolatory skills. The alternative endodontic isolation techniques have in general focused on innovative rubber dam applications to crownless and cone-shaped teeth (3-5). The aim of this article is to introduce a method of achieving adequate isolation of splinted prostheses through manipulation of the rubber dam septa. This report is submitted as further justification for the opinion thatisolation solutions are as infinite as the problems that spawn them (6). Isolation of the fixed partial dentures (Figs. 1 to 4) has been included as an example of the ease of attaining isolation using this technique, while isolation of the

orthodontically active case (Figs. 5 to 8) demonstrates the scope and adaptability of the procedure. It is accepted that the focal point of our isolation effortsshould be the prevention of aspiration or ingestion of endodontic hand instruments (7, 8), but isolation should also include the quest for canal space asepsis. Fors et al. (9) have demonstrated that microbiological leakage between the dam and the tooth in routine endodontic treatment was found in 53% of cases which clinically appeared to be free from saliva leakage. These data suggest the need fora more thorough approach to isolation of splinted prostheses during endodontic therapy. There is presently some debate over the issue of asepsis in endodontics. Nevertheless, it is indisputable that patients need to be protected from the unpleasant taste of canal irrigants. In addition, it is important to note that the requirements for successful endodontic therapy go far beyond asepsis and themandatory protection of the patient. Successful endodontics relies on procedural perfection. Precise biomechanical instrumentation involves procedural manipulations which depend on a complete and unobstructed approach to the working field (10). The slit-dam solution (general field isolation) to splinted prostheses often results in an unrestrained curtain of rubber dam which obstructs endodontic...