HUNDREDS. NEW QUALITY STANDARD?
For many patients, the word rabberdam or cofferdam (synonyms) is new. What kind of device is this and why does a dentist use it? This is today’s article.
It’s no secret that dentistry has made a tangible “step forward” over the past few years. New technologies are replacing old ones, new companies are entering the market, equipment is being improved, materials are becoming more aesthetically and more durable. There is a lot of money in dentistry (despite the crisis), so progress is inevitable and it is wonderful. One side. On the other hand, such a quick change of generations of “equipment” (equipment) requires the doctor to keep abreast all the time, to monitor the latest events, trends, to know how to apply these innovations in their practice to make it better. And do no harm.
Composite materials (composite “light fillings”) appeared in our country in the early 90s, if I am not mistaken, and the use of the composite began to gradually become widespread. Why did it happen?
Before the composite, the teeth were filled with cements (phosphate, glass ionomer, etc.) or an amalgam. These are good materials that have proven themselves, but cements and amalgam had a number of drawbacks, which subsequently led to the transition of most dentists to composite materials. It was difficult or impossible to simulate anatomy with cements; some of them caused toxic and thermal effects on tooth tissues during “hardening”, and some insulating and “healing” “pads” had to be made. Amalgam also did not differ in full biocompatibility and ease of use (not to mention aesthetics). In addition to all this, the materials of the “past generation” required classical preparation, usually for this the doctor had to excise not only caries, but also healthy tissues in order to create retention points to hold such a filling. All undercuts (overhanging edges) were also prescribed to be eliminated – otherwise the risk of fracture is high.
Why did dentists gladly switch to “light fillings”? Firstly, of course, aesthetics. Nobody wants a metal seal, everyone wants a “little white” 🙂 Secondly, compared to amalgam and cements, it was much easier to work with composite. You don’t have to mix anything, knead, the consistency of the composite allowed you to simulate it as much as you like, and then “light up” with a lamp and the seal is ready! No need to wait 2 hours to eat, the seal is beautiful, you do not need a second visit to the polishing, as with an amalgam. Vobschem fairy tale.
But not everything turned out to be so simple. In addition to the composite itself, an adhesive system is also used in this technique for filling (restoring) teeth. Her role was greatly underestimated by dentists, as this has never been used before. In simple terms, the adhesive system is the “glue” with which the composite seal “sticks” to the surface of the tooth tissue. This “glue” has a very complex chemistry (and over the years it is becoming more complicated) and many factors influence the process of “gluing” a filling with a tooth. And one of the main factors is the cleanliness of the working field. That is, the absence of any “polluting” factors (blood, saliva, food plaque, etc.), including moisture. To “seal” “stuck”, it should be not only clean, but also dry. Otherwise, the fillings “fall out”, “darken”, the teeth hurt after treatment, thin walls break, etc. With the correct adhesive restoration technique, the tooth does not need to be excessively prepared to create “retention points” and “additional sites” for “holding” the filling in place. This is a big plus of composite materials, coupled with their biocompatibility and aesthetics. But often doctors “do not believe” in adhesion (gluing) and prepare the teeth “in the old way”, as with cement or amalgam fillings. But this is still half the trouble. If the conditions for the adhesive restoration technique are violated, the composite often behaves worse than cements and amalgam, which leads to complications even faster than when using “old materials”. Pain after treatment, “falling out” fillings, wall fractures, secondary caries – this is most often the result of a violation of the technique of using the composite and the adhesive system. After many complications arose, many doctors even appeared skeptical of compositional restorations.
Great introduction. But without it, you would not be able to fully appreciate the significance of such a simple, but at the same time indispensable device, like rabberdams (cofferdams).
Rabberdam (eng. Rubber – rubber, dam – a barrier) is a system of isolation of a working field in stomatology. Rabberdams are latex shawls that are fixed on the teeth with special metal clips, “clamps”. Oddly enough, but to the rabbers, this is not at all a newfangled “lotion” in the dentistry market. The technology is quite old and it is already nearly 150 years old! The American dentist Sanford Christie Barnum invented this system in 1864. Why are we returning to this technology now? And why was she “forgotten”? The answer lies in my voluminous introduction. The reason is the change of technology.