|Year : 2017 | Volume
| Issue : 2 | Page : 80-84
Dimensional comparison of rubber dam clamp prongs with cervical mesiodistal dimension of primary second molar
Seema Bargale, Akash Ardeshana, Bhavna Dave, Anshula Deshpande, Anuradha Karri, Nikhil Patel
Department Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Vadodara, Gujarat, India
|Date of Web Publication||28-Apr-2017|
Department of Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Piparia, Gujarat
Source of Support: None, Conflict of Interest: None
Background: The stability of the rubber dam (RD) basically depends on the selection of a properly fitting clamp corresponding to the tooth. There are significant differences in tooth size between various races. This implies that the commercially available RD clamps may fit well to teeth of one population but not to another.
Aim: The aim of this study was to obtain standard measure of mesiodistal widths at the cervical level of primary second molars in Gujarat children and to compare them with commercial RD clamps commonly used in paediatric dentistry.
Materials and Methods: A total of sixty children were selected on the basis of selection criteria. The mesiodistal widths of primary second molars were measured at the clinical cervical level for buccal and lingual sides, respectively, by a digital Vernier caliper. It was compared with mesiodistal with of RD clamps no. #14A, #7 and #13A/12A. Statistical tests independent sample t-test and single sample t-test were applied.
Results: All clamps width show significant difference either buccal or lingual side with their respected teeth (P < 0.05). #14A and #7 clamp show <1 mm discrepancy for mandibular second molar while for maxillary second molar discrepancy were more than 1 mm. #13A/#12A show large discrepancy for mandibular second molar.
Conclusion: Cervical mesiodistal dimensions of primary mandibular molars were generally larger than those of primary maxillary molars. #14A and #7 can relatively fit to primary mandibular second molar and #13A/#12A for primary maxillary second molar.
Keywords: Cervical mesiodistal dimension, dimensional adaptability, primary molars, rubber dam clamps
|How to cite this article:|
Bargale S, Ardeshana A, Dave B, Deshpande A, Karri A, Patel N. Dimensional comparison of rubber dam clamp prongs with cervical mesiodistal dimension of primary second molar. Adv Hum Biol 2017;7:80-4
|How to cite this URL:|
Bargale S, Ardeshana A, Dave B, Deshpande A, Karri A, Patel N. Dimensional comparison of rubber dam clamp prongs with cervical mesiodistal dimension of primary second molar. Adv Hum Biol [serial online] 2017 [cited 2020 Jun 2];7:80-4. Available from: http://www.aihbonline.com/text.asp?2017/7/2/80/205386
| Introduction|| |
Effective tooth isolation is one of the significant factors, which affects the retention of restorative material. Rubber dam (RD) is considered as an optimum isolation technique. Its use has been dated back to more than 100 years and encourage within the specialty of paediatric dentistry for almost as long.
The use of RD has many advantages which include providing an aseptic environment and preventing microbial contamination during root canal treatment. It also improves operator and assistant visibility and reduces the time of operative care. RD plays an important role in preventing any possible ingestion or aspiration of foreign bodies and further helps in medico-legal protection. It also helps in reducing ambient nitrous oxide level during conscious sedation procedure. It protects the gingiva and the surrounding oral soft tissues from possible irritations and also helps in retraction of the surrounding soft tissue.
Despite the importance of RD use, dentists are yet not using it enough, especially for restorative or preventive procedures. A survey by Schorer-Jensma and Veerkamp  showed that the RD was used more significantly by the paediatric dentists as compared to general dentists. Patient's acceptance was one of the common reasons cited by the dentists who chose not to use RD.
There are many issues with poorly fitting RD clamps. The improper fitting of RD clamps can cause impingement of gingiva, discomfort and leakage of saliva, which can lead to unfriendly cooperation of children. Soft tissue topical anaesthesia is required before the placement of RD clamp which may reduce discomfort from clamp placement.
The stability of the RD basically depends on the selection of a properly fitting clamp corresponding to the tooth and its accurate positioning. However, to choose an appropriate clamp, the clamp has to be manufactured according to specific size and anatomy of the tooth on which to be applied. According to Moorrees and Reed, the size of the teeth depends on different race and sex. The study done by Harris and Lease  also showed significant difference in tooth size between various races.
This implies that the commercially available RD clamps which are commonly used may fit well to teeth of one population but not to another. However, many previous studies have mentioned about the mesiodistal widths of teeth which were measured the greatest distance between contact points., Most of them were done in purpose of orthodontic space analysis or descriptive tooth studies.
Limited information is available with regard to the mesiodistal widths at the clinical cervical level of a tooth, where RD clamps are actually placed. Thus, the aim of this study was to obtain standard measure of mesiodistal widths at the cervical level of primary second molars in Gujarat children and to compare them with commercially available RD clamps used in paediatric dentistry.
| Materials and Methods|| |
The study was carried out in the Department of Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Vadodara, Gujarat, India. The study was approved by Institutional Ethical Committee of Sumandeep Vidyapeeth (SVIEC/ON/DENT/RP/15124). Detailed information regarding the study was explained to the participant parents, and written consent was obtained from the participant's parents.
The children between the age group of 4–10 years with fully erupted deciduous teeth were considered for measurement. Children with the absence of dental anomalies and caries were included in the study. Good-quality dental casts were preferred for the measurement of cervical mesiodistal dimensions (C-MDs). Children with any medical history or having any dental implications, molars treated with preformed crowns and infra-occluded teeth as well as teeth with severe destructions or restorations in interproximal surfaces were excluded from the study. After considering all the inclusion and exclusion criteria, a total of sixty subjects were selected.
Appropriate impression tray was selected and alginate (Snap CR – Italy) impressions for both upper and lower jaws were taken and poured immediately with dental stone (Dutt Products – India). The entire tooth measurements were carried out using electronic digital Vernier calipers (Neiko tools, USA) by a single investigator. Only five models per day were measured to avoid any visual fatigue.
Mesiodistal widths were measured at the clinical cervical line for buccal and lingual sides, respectively, at points considered ideal for RD clamp prongs to be placed for stable adaptation. The following criteria were used to measure the C-MD for buccal and lingual side of primary second molars. Mesial point: Middle between the mesial contact point and mesial line angle. Distal point: Middle between the distal contact point and the distal line angle [Figure 1] and [Figure 2].
|Figure 1: Cervical mesiodistal dimension. Measurements were done by measuring the distance between the two points: (1) Middle between mesial contact point and the mesiobuccal (mesiolingual) line angle, (2) middle between the distal contact point and the distobuccal (distolingual) line angle at the level of clinical cervical line.|
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The RD clamps no. #12A/#13A, #7, #14A (Hu-Fredy, USA) [Figure 3] were selected for the comparison with primary second molars. The width of RD clamps was measured by measuring the mesiodistal distance between prongs of RD clamps at buccal and lingual sides, respectively [Figure 4]. Then, the C-MD of primary second molars was compared with mesiodistal widths of RD clamps prong.
|Figure 3: Rubber dam clamp for primary second molar, (a) #14A, (b) #7, (c) #12A/#13A.|
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|Figure 4: Measurement of mesiodistal width of the rubber dam clamp prong.|
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The data obtained were subjected to statistical analysis. The mean and standard deviation were estimated from the sample for each study group. Independent sample t-test and single sample t-test were used for the comparison of mean. Repeatability test was also performed by randomly selecting twenty dental casts from the boys and from the girls. These data were assessed using intraclass correlation coefficient test.
| Results|| |
A total of sixty children comprising 31 males and 29 females were included in the study. [Table 1] shows mean value of the C-MD of primary maxillary and mandibular second molars. These results showed that C-MD measured at buccal surfaces was larger than those measured at lingual surfaces for all primary second molars.
C-MD of primary mandibular second molars was generally larger than those of primary maxillary second molars. There was significant difference found in C-MD of primary second molars and available clamps.
Here, averaged C-MD of right and left second molars was used for further analysis with clamps [Table 2]. In [Table 2], the positive difference between C-MD and clamp prong width was suggested that C-MD of teeth was larger than clamp prong width and the negative result was suggested that C-MD of primary molars were smaller than clamp prong width. For maxillary second molars, #14 clamp showed difference of −0.24 and −1.01 for buccal and lingual surface, respectively. #7 shows difference of −0.41 and −1.18 for buccal and lingual surface, respectively. #13A/#12A clamp show difference of 0.85 mm and 2.34 mm on buccal and lingual surfaces.
|Table 2: Difference between mean cervical mesiodistal dimension and commercial clamp size|
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For mandibular second molars, #14 clamps show difference of 0.9 and 0.15 for buccal and lingual surface, respectively. #7 shows difference of 0.73 and −0.31 for buccal and lingual surface, respectively. #13A/#12A clamp show difference of 2 mm and 3.21 mm on buccal and lingual surface, respectively. Hence, here #13 A clamps also showed significant difference with respected teeth. These differences were larger for lingual surface in comparison to buccal surface.
All the buccal and lingual surfaces showed significant difference with corresponding width of RD clamp, except lingual surface of mandibular second molar with #14A clamp.
| Discussion|| |
RD is considered as standard isolation method in paediatric dentistry. RD is most often used by paediatric dentist to maintain an isolated field and minimise salivary contamination. They are least often used due to patient fear, anxiety of suffocation and their potential to be a painful stimulus. A standard clamp can utilise undercuts of teeth for its retention only when the undercuts have a definite depth, shape and location. For better retention, a clamp has to be pushed towards the gingiva beyond the greatest cervical contour of the tooth; sometimes into the gingival sulcus.
Such subgingival advance of a clamp may result in discomfort to patients without anaesthesia. It may also cause gingival haemorrhage, injure to the gingival attachment, or cause nicking of the cementum on the root surface.
In paediatric patient to achieve good cooperation of child, selection of appropriate clamp is very important. If the width of the clamp prongs is larger than mesiodistal width of the tooth, there will be chances of gingival impingement and trauma. In such a situation, complete isolation is difficult around the anchored tooth.
The utilisation of the digital Vernier calipers can decrease the measurement and calculation errors when compared with divider and calculator. Although some measurement errors may associate with the positioning of the calipers on the mesial and distal surfaces of the teeth, this method is certainly more reliable than manual measurements. In the present study, the tooth measurements were done by contact on the casts using digital Vernier calipers.
The definition of the cervical mesiodistal width (C-MD), which was previously described by Park et al., C-MD is referred to the mesiodistal width of a tooth measured at the clinical cervical line, between two points where the prongs of the RD clamp jaws to be placed between the contact point and the proximal line angle to avoid impingement on the papillary tissue. Under this assumption, the mesial and distal measuring points of C-MD were each defined as the point middle between the mesial contact point and mesial line angle and the point middle between the distal contact point and the distal line angle, respectively. The above-mentioned measurements were taken into consideration for the C-MD measurement of primary second molars.
The difference in tooth size is known to exist between populations of different race and the environment.,, According to Moorrees and Reed, teeth size depends on race and sex. The findings of Sugiyama  revealed that there were differences in the tooth size between Japanese and Chinese. In a worldwide survey by Harris and Lease, mesiodistal diameters of primary teeth are reported to be largest in native Australian aboriginals and smallest in Europeans. Anderson  made a comparison between European, American and African American norms, where he concluded that intra- and inter-racial sex differences exist in the primary teeth of both children, with few exceptions. This implies that C-MD would vary among different populations.
In the present study, the C-MDs measurements of buccal and lingual surface for primary maxillary second molars were 7.90 ± 0.47 mm and 7.13 ± 0.53, respectively. The C-MDs measurements of buccal and lingual surface for primary mandibular second molars were 9.05 ± 0.59 mm and 8.00 ± 0.65 mm, respectively. The Korean population had shown larger C-MDs dimension for primary maxillary second molars (buccal surface 8.16 ± 0.42 mm, lingual surface 7.43 ± 0.48 mm) and mandibular second molars (buccal surface 9.29 ± 0.50 mm, lingual surface 8.51 ± 0.52 mm).
The width of RD clamps prong #14A, #7 and #13A/#12A was compared with the primary second molars. As per the manufacture's manual, these clamps have been used for the permanent first molars. #14A and #7 clamps are relatively larger for maxillary teeth as compared to mandibular teeth.
For maxillary second molars, width of #14A and #7 was larger than C-MD which may associate with gingival impingement. Differences for buccal surface were <0.5 mm for #14A and #7 clamps while more than 1 mm for lingual surface. The clamp no, #14A shows less discrepancy as compared to #7 clamp. #13A/#12A clamp show discrepancy of 0.85 mm and 2.34 mm on buccal and lingual side, respectively. Here, more discrepancy was found with lingual surface. Width of #13A/#12A clamp was comparatively smaller than C-MDs of maxillary second molars; hence, in the case, if #14A and #7 clamps are larger for the maxillary second molars, #13A/#12A clamp can be used. For mandibular second molars, #14A and #7clamps show discrepancy <1 mm. #14A clamp shows discrepancy of 0.9 mm and 0.15 mm for buccal and lingual surface, respectively. #7 clamp shows difference of 0.73 mm and 0.31 mm; here, C-MD of mandibular second molars was larger than clamps width, except on lingual side for #7 clamps. This may associated with gingival impingement and discomfort. #13A/#12A clamp shows difference of 2 mm and 3.21 mm for buccal and lingual. This result is suggested that #13A/#12A are too small for mandibular second molars which may associate with instability of clamps.
Previously, a similar study had been done Park et al. in Korean population for second primary molars. They had compared the data with #203/204, #10/11 and #205 clamps (Dentech, Japan) while we have used Hu-Fredy clamps. They found that all teeth C-MDs showed statistically significant discrepancies to corresponding widths on clamps (P < 0.05). In our study, we also found significant different between RD clamps and C-MDs of primary second molars.
The data of this study suggested that better clamp selections are required for primary second molars. This study was confined to part of the Gujarati population. There are no studies available for other Indian population and one study had been done which was for Korean population. As we know, the difference in tooth size is known to exist between populations of different race and environment. Hence, there is a limited study for the comparison of the data. Another limitation of the study was that we have used RD clamp from only one manufacturer. Accuracy and reproducibility of the measurement are also one of the limitations of the study. Further study should be done with three-dimensional scanner for more accurate measurement; this also provides anatomical characteristics of the tooth like convexity and undercut which helps precise placement of RD clamp prongs.
| Conclusion|| |
The present study the cervical mesiodistal widths of primary second molars were measured in Gujarati population and compared them with commercial RD clamps commonly used in paediatric dentistry. C-MDs of buccal surface were larger than those of lingual surface, CMDs of primary mandibular molars were larger than those of primary maxillary molars and no significant difference was observed between C-MDs of male and female primary molars. #14 A and #7 can relatively fit to primary mandibular second molar and #13A/#12A for primary maxillary second molar.
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Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]