Posterior_Direct_Restorations Salvatore_compressed
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FIG 4-22 (a to k) Step-by-step guide to tying a ligature. (l to o) The ligature is stabilized with a drop of flowable composite.
Removing the dam
To remove the dam, it is stretched buccally (Fig 4-23a), and the interdental septa are carefully cut (Fig 4-23b). Then the clamp is removed.
FIG 4-23 (a and b) Removing rubber dam.
Tips and tricks
When isolating a maxillary quadrant, remember that the maneuvering space is limited when the mouth is fully open due to rotation of the mandibular coronoid process (Fig 4-24a), which prevents insertion of the forceps and clamp. If the patient is made to close the mouth slightly, the coronoid process moves distally, and buccal space is increased (Fig 4- 24b).
FIG 4-24 (a) The buccal space is reduced (black arrow) when the mouth is fully opened (white double arrow). (b) Buccal space can be increased by having the patient slightly reduce mouth opening (white double arrow).
Sometimes, particularly in young patients, the equator of the tooth to be isolated is not very visible (incomplete eruption). This makes the clamp unstable. The problem can be overcome by making supplementary retainers out of composite (Fig 4-25). The surface is cleaned with pumice and chlorhexidine, followed by etching and then bonding. After polymerization, strips of composite are applied, preferably in a contrasting color to facilitate subsequent removal. Removal is initially carried out with diamond burs and then with multiblade debonding burs.
