Endodontics: Prelims#1
HISTORY Handle closed: Punch stylus meets punch plate
• 1182
- SS White: Introduced Rubber dam puncher
- Dr. Delous Palmer: Introduced set of rubber dam clamps which
could be used for different teeth
• 1864
- Stanford Christie Barnum: Demonstrated for the first time the
advantages of isolating the tooth with rubber dam sheet
“Cleaning, Shaping, disinfection and obturation of all canals are
accomplished using an aseptic technique with dental dam isolation
whenever possible”
- Quality assurance guideline
Arnaldo Casellucci
“When it is not possible, the clinician has two options: one is to make
it possible and the other one is to extract the tooth.”
RUBBER DAM
A rubber dam is a thin sheet of rubber material that is used
to isolate the desired tooth/teeth
Advantages:
1. The patient is protected from ingestion/aspiration of instruments,
dental fragments, irrigating sol. Or irritant substances
2. The opportunity to operate in a clean surgical field
3. Retraction and protection of the soft tissues (gums, tongue, lips,
and cheeks) which are sheltered from cutting action of the bur
4. Better visibility in the working area
5. Moisture control
6. The dentist and dental assistant are protected against infections
which can be transmitted through patient’s saliva
7. Better tactile sensitivity during cleaning and shaping procedure
8. The patients are more comfortable as they do not feel the
instruments, materials and the hand of the dentist
9. Provide patient comfort by reducing the amount of water and
aerosols caused by the air turbine hand piece
10. Protects clinician from litigation
Parts of clamp
1. Bow
- Partly encircles over the tooth.
- Varies between clamps and is flexible so that the clamp can have a
firm hold on the tooth
2. Jaw
- Hold it firmly around the cervical portion of the tooth
- Can be serrated fr retention or smooth to prevent tissue trauma, and
can be curved to fit subgingivally
11. Prong
- The pointed area at the end of the jaw
12. Forcep hole
- Where the rubber dam clamp forceps attach to the clamp for
placement
Rubber dam clamp forcep
1. Beaks
- fits into the holes of rubber dam clamp for secure placement
13. Handle
- shaped to allow a firm palm grasp by the operator
- Work with spring action when handles are squeezed together
14. Suding ring
- allow forceps to lock when placing the clamp and to be released
when removing the clamp
15. Punch stylus
- Pierces a hole in the rubber dam sheet
Creating clean punch on rubber dam sheet
Rubber dam napkin
- It prevents skin contact with rubber to reduce the possibility of
aerosoles
- Absorbs saliva seeping at the corners of the mouth
- Acts as cushion
- Provides a convenient method of wiping the patient’s lips on
removal of rubber dam
Lubricant
- Facilitates placement of rubber dam sheet without tearing
Dental floss
- Draws the rubber dam sheet on the proximal surfaces
- Allowing the rubber dam sheet to encircle the cervix of the tooth
Sterilization
- Instruments made of metal: autoclave
- Can’t withstand steam under pressure: UV light
- Other materials: Cold sterilization
TECHNIQUES
1. Single tooth isolation
16. Multiple tooth isolation
Methods of isolation
Method 1: Clamp and rubber dam sheet together
Method 2: Clamp first then Rubber dam sheet
Method 3: Sheet first then clamp
Method 1 steps
1. Remove calcular deposits on tooth surfaces
17. Select appropriate clamp and check if it is fit on tooth to be
isolated (Flat jaw clamps fits into the cervical 3rd of the tooth
crown. Festooned clamp if it does not adapt)
18. Designate the area to punch hole on the rubber dam sheet using
rubber dam stamp/template
19. Punch a hole on the rubber dam sheet appropriate for size and
location of the tooth
20. Lubricate the inner surface of the RD sheet with Vaseline to allow
it to slide better over the contours of the tooth and contact areas
closely and tightly around the cervix
21. Attach the wings of the clamp to rubber dam sheet over the area of
punched hole
22. With the clamp forcep, clip the clamp with rubber dam sheet
beyond the greatest contour of crown
23. Release the clamp from forcep and adapt RD sheet around the
cervix of the tooth
24. With hand instrument, release RD sheet from wing of clamp to
allow sheet to constrict around the cervix of the tooth
25. After placement of clamp and RD sheet, a dental floss may be
used to draw sheet through proximal contact area
26. Place RD napkin under RD prior to placement od RD frame
27. Stretch RD sheet on RD frame to provide soft tissue retraction
28. Swab the isolated tooth and adjacent structures with disinfectant
Method 2 steps:
1. Remove calcular deposits on tooth surfaces
29. Select appropriate clamp and check if it is fit on tooth to be
isolated (Flat jaw clamps fits into the cervical 3rd of the tooth
crown. Festooned clamp if it does not adapt)
30. Designate the area to punch hole on the rubber dam sheet using
rubber dam stamp/template
31. Punch a hole on the rubber dam sheet appropriate for size and
location of the tooth
 Endodontics: Prelims#1

32. Lubricate the inner surface of the RD sheet with Vaseline to allow 53. Round bur
it to slide better over the contours of the tooth and contact areas 54. Tapered fissure bur
closely and tightly around the cervix 55. Gates glidden drill (1,2,3-multirooted; 4,5,6- mono rooted)
33. Place the clamp on the tooth crown using the clamp forcep 56. Sterile cotton pellet
34. Slide and stretch the rubber dam sheet over the bow of the clamp 57. Irrigating syringe
35. Slide and stretch the rubber dam sheet over the under jaw and 58. Irrigating solution (sodium hypochlorite)
prong of the clamp 59. Aspirating syringe
36. After placement of clamp and RD sheet, a dental floss may be
used to dram the sheet through the proximal contact area ROOT CANAL PREP

Method 3 steps: A. Working length registration

1. Remove calcular deposits on tooth surfaces 1. Smooth broach/path finder
37. Select appropriate clamp and check if it is fit on tooth to be 2. Rubber stopper
isolated (Flat jaw clamps fits into the cervical 3rd of the tooth 3. Endo ruler
crown. Festooned clamp if it does not adapt) 4. Xray film
38. Designate the area to punch hole on the rubber dam sheet using
rubber dam stamp/template B. Pulp extirpation - complete removal of pulp tissue
39. Punch a hole on the rubber dam sheet appropriate for size and 1. Smooth broach
location of the tooth 2. Barbed nerve broach
40. Lubricate the inner surface of the RD sheet with Vaseline to allow 3. Irrigating syringe
it to slide better over the contours of the tooth and contact areas 4. Sodium hypochlorite/EDTA
closely and tightly around the cervix 5. Aspirating syringe
41. Slide the rubber dam sheet over the contours if the tooth
42. With the forcep, clip the crown beyond the greatest contour of the C. Cleaning and shaping
crown 1. Files
43. Release the clamp from the forcep and adapt the RD sheet around 2. Irrigating syringe
the cervix of the tooth 3. Sodium hypochlorite
44. Draw the floss 4. Aspirating syringe
45. Place RD napkin under RD prior to placement od RD frame 5. Paper points/absorbent points- dries root canal
46. Stretch RD sheet on RD frame to provide soft tissue retraction
47. Swab the isolated tooth and adjacent structures with disinfectant D. Intraoral medicaments
1. Calcium hydroxide
Rubber Dam Isolation 6. Eugenol
- A procedure wherein the tooth to be treated is isolated from saliva 7. camphored(?)
and other structures in the oral cavity Temporary cement- Hydrophilic cement (Fermin)

Rubber dam sheet E. Obturation

RD template 1. Gutta percha points
RD clamp 6. Root canal sealers (ZOE, sealapex, endoseal)
RD clamp forcep 7. Lentulo filler/lentulo spiral
RD puncher 8. Finger spreader/ finger plugger
RD frame
RD napkin
Disposable saliva ejector tip
Basic instruments for endodontics

Rubber dam sheet

• Thin- 0.15 mm
• Medium- 0.20 mm
• Heavy- 0.25 mm
• Extra heavy- 0.30 mm
• Special heavy- 0.35 mm
• Latex/Non- latex

Rubber dam template

- may be stamped in RD sheet to assist in punching
Basic Endo instruments
1. Mouth mirror
48. End explorer- negotiate canal opening; tip is sharp
49. Sickle explorer
50. Endo excavator- allows curretage of pulp chamber when
conventional excavators can’t reach floor of the chamber
51. Endo locking pliers- facilitate…
52. Woodson plastic filling instrument

Endodontics entries
1. Handpiece