Posterior_Direct_Restorations Salvatore_compressed

FIG 4-4 (a) A sector with tooth misalignment requiring isolation. (b and c) The maxillary right sector is marked using the Pac-Dam, and a dot is added lingual to the second premolar site. (d to g) The buccal dot is deleted using alcohol, and the dam is perforated. (h and i) Dam application.

Dam punch

The dam punch (see Fig 4-1b) incorporates a disk with holes of different diameter (Fig 4-5). The wide range of holes can satisfy all needs. Beginners are advised to use only one diameter in the beginning (for molars or premolars) because this is simpler, wastes less time, and makes it possible to concentrate on intraoral maneuvers. Forceps with a longer slot allow it to reach further onto the dam when it is stretched on the frame (Fig 4-6). Perforating the dam once fitted to the frame is recommended for everyone, particularly beginners. The hole made by the punch must be accurate, otherwise the dam may tear during application. Worn or defective disks or punches can be replaced on some forceps.

FIG 4-5 Dam punch disk. The largest setting (A) is to be used mainly for the “clamp first” technique on molars. The molars or universal setting (B) is for clinicians who have never used isolation and should be used for all teeth, until learning how to be more selective. There are also premolar (C), canine (D), and incisor (E) settings.

FIG 4-6 (a) Although these two dam punches are both excellent, the one on the left (A) can be inserted 5 cm onto the dam as opposed to 2.4 cm for the other (B). (b) This greater extension allows for easier perforation of the dam when stretched over the frame.

Clamp forceps

IV-type or lightweight forceps (Fig 4-7a) offer considerable advantages over Palmer (Figs 4-7b and 4-8a) or Brewer (Fig 4-8b) forceps. Firstly, greater separation power can be achieved for the same effort because the fulcrum is closer to the clamp (see Fig 4-7). IV-type forceps also have horizontal surfaces at the terminals that fit into the clamp holes (arrows in Figs 4-8c and 4-8d). These prevent the clamp from tilting and angling, which makes it difficult to insert the clamp, particularly for more distal teeth.

FIG 4-7 Difference between IV-type (also called lightweight) forceps (a) and Palmer (or Brewer) forceps (b). The effort arm is longer in the IV-type (compare green bars).