Clinical evaluation of winged versus wingless rubber dam clamps in single tooth isolation - A randomized clinical study

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Both clamps showed acceptable clinical performance. Their use should be planned as per the requisite of the case and the position of the tooth.

Gingival trauma (P = 0.006) and postoperative pain were statistically significantly more in the wingless group at 6 h (P = 0.016) and 12 h (0.01). Statistically significant lower seepage of fluid (P = 0.017) was observed in the wingless group. Slippage was observed more with the winged group but was statistically insignificant.

After obtaining ethical approval and CTRI registration, a total of 60 patients with mild-to-moderate deep class I caries were included after obtaining informed consent and randomly allocated into two assigned groups: Group A – winged clamp and Group B – wingless clamp, with n = 30 per group. Local anesthesia was administered and the tooth was isolated using a rubber dam as per the standardized protocol. The postoperative evaluation was done for pain using the Verbal Rating Scale (VRS) at 6 and 12 h; trauma to the gingival tissues, sealing ability of the clamp, and slippage of the clamp were evaluated using criteria for clinical evaluation of rubber dam isolation.

Retention of the rubber dam is done with metallic or nonmetallic clamps for isolation. The two types of metallic clamps most frequently used are winged and wingless. The clinical efficacy of both clamps is needed to be compared.

INTRODUCTION

At present, restorative dentistry is referred to as bonded dentistry.[1] In restorative dentistry, obtaining complete isolation during treatment is essential to achieve a predictable result. The rubber dam is considered the gold standard method for attaining the same.[2] Sanford Christie Barnum first discussed the usage of the rubber dam in 1864 in New York after he had successfully isolated a tooth with a sheet.[3] Using a rubber dam, it is less likely that patients may swallow or inhale irrigants, instruments, or infected tooth debris. Rubber dams also limit the risk of cross-contamination and microbial contamination.[4] The final treatment result is improved by further improving visibility, visual access to the canal (s), and optimizing moisture control.[5,6,7,8]

Dental dams are frequently underutilized, although they have several benefits. According to numerous research, rubber dams are used somewhere between 10% and 15% of the times, even in developed nations.[9] Possible reasons for this could be the inability of the operator, the additional time required, the clamp's tightness, gingival tissue damage, clamp slippage, or fluid seepage.[10]

To improve the quality of our work, rubber dam should be placed in an appropriate position on the tooth with the help of clamps. Various types of clamps are available in the market. Among all, the winged type of clamps is widely used and is well-recommended for beginners. It has a horizontally directed metal jaw that anchors the tooth below the height of the contour with four-point contact with the axial angle of the tooth for proper stability.[11]

Despite their many advantages, winged clamps have demerits in certain clinical situations such as the horizontally directed metal jaws of the clamps are bulky which hamper their placement in patients with thick buccal pad, in case of disto-occlusal caries of posterior teeth, in partially erupted teeth and third molars, in deep class V caries where more tissue retraction is required. Additionally, they are difficult to be placed during tooth preparation and cementation procedures.[12,13,14] Many times jaws come in contact with patients' gingiva and root surfaces, which cause pain, gingival laceration with periodontal damage, and bacteremia after treatment. Slippage of the clamp during dental treatment can be a reason for the patient to jump due to pain.[15,16]

Wingless clamps are commonly referred to as tissue retractors or specialty clamps. Their jaws are positioned more apically close to the tooth's gingival border and are pointed apically. They apply apical pressure, which causes them to engage in the apical portion of the tooth's crown (near the cementoenamel junction) or occasionally the root, increasing retention. The absence of wings will provide the operator with more space and less obstruction. Chances of slippage of rubber dam clamp are very minimal due to its area of deep engagement.[17] The smaller jaw sizes are better suited for small-sized teeth, especially in female patients, since they are specifically made to enable sitting to the depth of the gingival sulcus without causing tissue laceration, which eventually results in more tissue retraction.[18]

Although both winged and wingless clamps have unique indications, wingless clamps are becoming more and more widespread as a result of their unique advantages. Both of these types of clamps have long been used by dentists, but no study has been done to compare their clinical effectiveness or patients' comfort. To assess the clinical effectiveness of winged versus wingless metal clamps during rubber dam isolation of permanent teeth, the present study was designed. A null hypothesis was developed, stating that there will no difference in the clinical effectiveness and postoperative pain of winged and wingless metal clamps during rubber dam isolation of permanent molars.