Posterior_Direct_Restorations Salvatore_compressed

clamp is then applied. (c) Tension is then released in the dam.

Other Considerations

Contralateral dam retention

Figure 4-21 shows different approaches to retention of the dam at the termination of the isolated region (contralateral to the clamp).

FIG 4-21 (a to d) Contralateral retention with dam trimming. (e) Contralateral retention with dedicated retainer. (f) Contralateral retention with clamp. If positioned on the dam, this may be less painful for the patient. (Photos e and f are courtesy of Dr G. Sammarco, Trento, Italy.)

Ligatures

Ligatures are used to increase exposure of the cervical area and are only useful if it is necessary to apicalize the isolation. A relatively effective ligature can easily be tied by means of a simple knot on a loop (Figs 4- 22a to 4-22c). The tooth is inserted into the remaining “noose” (Figs 4- 22d to 4-22g). Before tightening both ends, hold the floss in the opposing neck area using an instrument (usually a spatula) (Fig 4-22h). This spatula, held by an assistant, should only be removed when the knot is fully tightened in the neck area (Figs 4-22i to 4-22k). Even though a knot of this kind is relatively strong, the seal can be reinforced by impregnating the newly tied knot with a drop of flowable composite (Figs 4-22l to 4- 22p). Excess floss can be trimmed.