ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Rubber Dam Usage Increases Success When Placing Prefabricated Posts in Endodontic Treated Teeth
Clinical Question In patients that will have prefabricated posts placed following endodontic therapy, does the use of a rubber dam compared to no rubber dam use, result in a better clinical outcome by preventing recontamination of the canal space?
Clinical Bottom Line Rubber dams should be used when placing posts following root canal treatment to prevent recontamination of the canal space and to ensure the highest level of clinical success.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24238433Goldfein/2013185 patients that had prefabricated posts placed following endodontic therapy at Tufts University School of Dental MedicineRetrospective study
Key resultsTwenty-six patients (30 teeth) had a post placed with the use of a rubber dam while 159 patients (174 teeth) had a post placed without the use of a rubber dam. These patients had an average recall of 2.7 years to assess for the incidence of a new periapical lesion (periapical index score > 2) after root canal therapy and prefabricated post placement. In the group without rubber dam usage, 73.6% (128 teeth) were considered successful at follow-up compared to 93.3% (28 teeth) in the group that used a rubber dam. The use a of a rubber dam during post placement following endodontic therapy produces statistically significant (P= .035) better clinical outcomes and higher success rates compared to not using a rubber dam by almost 20%.
Evidence Search “endodontic therapy and rubber dam”
Comments on
The Evidence
Validity: This was a well-designed study that had a very good sample size for statistical significance despite not being a higher level of evidence. Meta-analysis, systematic reviews and randomized clinical trials were not available for this subject when searched. However, in this study, human subjects were used and the results support that rubber dam isolation and aseptic procedure techniques are important when restoring root canal-treated teeth and that you can increase success by 20% when using a rubber dam. Perspective: The use of a rubber dam when placing posts in root canal-treated teeth compared to no rubber dam use in a randomized controlled study would provide more validity and is needed in future studies.
Applicability The use of a rubber dam during endodontic therapy is considered the standard of care. Despite being the standard of care, Anabtawi et al. in 2013 (PubMed ID 23372134), found that only 44% of dentists use a rubber dam every time they perform root canal therapy. According to the American Association of Endodontists (AAE) position statement, “Tooth isolation is the standard of care; it is integral and essential for any nonsurgical endodontic treatment…only the dental dam isolation minimizes the risk of contamination of the root canal system by indigenous oral bacteria.” In this study, only 14% of posts were placed with rubber dam isolation by dental students, however, if dental faculty do not encourage its use, it is likely that graduating dental students will not incorporate its use in their own dental practice. Rubber dam isolation is already the standard of care during endodontic treatment; it should also be the standard of care during post placement as to avoid recontamination of the canal space, to ensure the best clinical outcome and success, and because it is a material that is readily available in dental practices.
Specialty/Discipline (Endodontics) (General Dentistry)
Keywords Endodontic therapy; prefabricated post and core; root canal treatment; rubber dam
ID# 2777
Date of submission: 11/25/2014spacer
E-mail Gharavi@livemail.uthscsa.edu
Author Lilley Gharavi, DMD
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author James Ball, DDS
Faculty mentor/Co-author e-mail ballj@livemail.uthscsa.edu
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