Posterior_Direct_Restorations Salvatore_compressed

FIG 4-12 Recommended wingless clamps. (a) Small molars and premolars. (b) Molars. (c) Small molars. (d) Molars.

FIG 4-13 Other recommended clamps. (a) Molars. (b) Mandibular molars. (c) Premolars. Very stable. (d) Premolars.

FIG 4-14 Soft clamps. These nontraumatic and extremely stable clamps are useful for ceramic restorations.

Second molars have variable cervical shapes and diameters, and a clamp designed for premolars is often ideal.

Some asymmetric clamps (eg, one jaw broader than the other) are designed for specific situations. For example, if used in the right mandible, the buccal jaw of 12A is larger than the lingual jaw (see Fig 4-11c). Sometimes different amounts of tissue remain on the tooth to be isolated buccally or lingually, the tooth is rotated, or other factors favor a broader lingual jaw, in which case the choice would be the counterpart of 12A, ie, 13A (see Fig 4-11d).

Clamps created and designed for mandibular teeth can work for maxillary teeth and vice versa.

Isolation Techniques in Posterior Sectors

Following are the step-by-step procedures:

1.Decide on the type of isolation (single tooth or by sector).

2.Mark the number of teeth to be isolated, and perforate the dam at the points identified using the template.

3.Clean the area to be treated (pumice and chlorhexidine or bicarbonate/glycine spray).

4.Check that the interdental spaces are clear using floss. If the floss can pass through the gap, rubber dam can also pass. If floss will not pass through an interdental gap, this may be due to poorly fitting restorations. In this case, the first step would be to open the interproximal space and then apply rubber dam. If the contacts are very tight, the best strategy is to use lubricant and a very fine dam material.

5.Isolate the distal tooth with the dam application method of choice (dam and clamp together, clamp first, or dam first).

6.If not already done, apply the dam to the frame to increase visibility and make things easier for the operator and patient.

7.Arrange the dam septa on the interdental spaces and try to pass them through by applying tension. The dam generally passes right through interincisal gaps without the aid of dental floss.

8.When using dam and clamp together, hook the clamp wings through