proximal contact when the floss is carried through.
Floss placed on the rubber dam itself tears the dam and
requires the passing of two thicknesses of the dam
through the contact. Once the floss passes the contact
of the teeth, release the lingual end of the floss. Loop
this end toward the opposite end and floss through the
contact again. Now, gently remove the floss by pulling
it from the side horizontally, rather than attempting to
pull the floss back up through the contact vertically.
Continue using the floss to invert the inter-proximal
septum, mesially and distally as well. Inversion of the
rubber dam turns the edges of the dam inward or under,
around the isolated teeth, to provide a seal. After this is
completed, pass the rubber dam clamp forceps and
attached clamp to the dentist for final placement on the
tooth. Adjustment of the rubber dam material on the
frame can be made at this time to ensure a smooth and
stable fit. Wrap the ligature attached to the clamp
around a projection on the side of the frame. This
prevents the clamp from becoming a dangerous
projectile if it should spring off the tooth. Pass a dull
instrument, such as a stellite instrument, to the
provider for inversion of the rubber dam on the facial
and lingual areas of the exposed teeth. Dry the exposed
teeth with air from the three-way syringe as needed to
assist in the inversion.
The second method places the rubber dam clamp
on the tooth first. Then slip the rubber dam material
over the clamp. Next, in either order, attach the frame
and expose the remaining teeth through the holes.
Secure the clamp ligature to the frame. Then invert the
mesial and distal septum with floss, and the facial and
lingual areas with a dull instrument accompanied with
air from the three-way syringe.
In the third method, the clamp is held in the rubber
dam forceps and the rubber dam placed over the bow of
the clamp. Holding the edges of the rubber dam with
your fingers, use the forceps to carry the dam and
clamp into the patients mouth. Place the clamp on the
tooth and remove the forceps. Continue the placement
as in the second method. The last two methods of
rubber dam placement are valuable when a rubber dam
must be placed by one individual rather than two.
After the restoration is placed, remove the rubber dam.
Before the rubber dam is removed, use the water
syringe and high-volume evacuator (HVE) to flush out
all debris that collected during the procedure. Rather
than pulling the septa through the contact of a newly
placed restoration, the septa is cut. Stretch the rubber
dam material outward in the facial area of the isolated
teeth. This pulls the septa facially to provide access for
cutting. Use a pair of small blunt-nose scissors to cut
each septum of the rubber dam from the facial aspect
(fig. 4-25). When all the septa are cut, gently pull the
dam lingually to free the rubber dam completely from
the interproximal spaces. Use the clamp forceps to
remove the clamp. Simultaneously, remove the clamp
ligature from the frame. Set the clamp forceps and
clamp aside. Now, remove the dam with the frame
attached. Wipe the patient's mouth, lips, and chin with
a tissue or gauze. Carefully inspect the dam on a flat
surface for missing pieces. If a fragment of the rubber
dam is missing, check the corresponding interproximal
area of the oral cavity with a mirror and explorer.
Pieces of the rubber dam left under the free gingiva
cause severe gingival irritation. Use dental floss to
remove any material stuck between the teeth. Rinse
the patients mouth with the water syringe and HVE to
remove all debris from the oral cavity.
Matrix retainers are used to hold the matrices
(metal bands or strips) firmly in place around a tooth.
Matrix retainers and metal bands are used in
combination for a temporary mold while the filling
material is being packed into place. The Tofflemire
retainer (or matrix retainer) is available in three
different designs: the universal straight, contra-angle,
and contra-angle junior (pedodontic) shown in figure
4-26. These retainers are practically maintenance free.
They can be heat sterilized along with other dental
instruments. Your part in maintaining matrix retainers
is to check them periodically and replace those with
badly worn screw threads. You are also expected to
attach the correct matrix band to the appropriate
retainer in anticipation of the dentists needs.
Figure 4-25.Cutting rubber dam septum.