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Chapter 34, Dental Dam and Tofflemire Retainer

And it’s uses in Dentistry. Chapter 34, Dental Dam and Tofflemire Retainer. Indications For Use. Infection control Accidental aspiration Moisture control Visibility Efficiency Retract lips, tongue, and tissue Protects tooth from contamination (Saliva). Contraindications For Use. Asthma

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Chapter 34, Dental Dam and Tofflemire Retainer

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  1. And it’s uses in Dentistry. Chapter 34, Dental Dam and Tofflemire Retainer

  2. Indications For Use • Infection control • Accidental aspiration • Moisture control • Visibility • Efficiency • Retract lips, tongue, and tissue • Protects tooth from contamination (Saliva)

  3. Contraindications For Use • Asthma • Respiratory congestion • Allergies to latex • Herpetic Lesions • Lesions of the commissures • Claustrophobic • Bad experience

  4. Before Placement • Explain procedure to patient • Check medical history for latex allergy • Tooth should be free of plaque and debris

  5. Dental Dam Material • Made of latex or latex free materials • Sizes, Thickness, Color, and Scents • Adult 6x6 • Children's 5x5 • Thin is usually for RCT. • Medium is used for restorations. • Thick is used as needed for stronger tissue retraction.

  6. Dental Dam Materials • Dental Dam Napkins • A disposable napkin is placed between the patients face and the dam. • Helps to absorb moisture and increase the patients comfort. • Protects the patients face from direct contact with the dental dam to decrease latex sensitivity.

  7. Dental Dam Materials Dental Frames Plastic U shaped Frame Otsy Frame Young's‘ Frame

  8. Dental Dam Stamps and Templates • A stamp is can be used to mark the dental dam with predetermined markings to be punched out by the assistant.

  9. Dental Dam Stamp and Template • Template • A template has holes where the teeth should be marked. It’s placed on the dental dam and a pen is used to mark through the template to indicate the location where to punch the hole.

  10. When Punching holes: Remember • IF holes are: • Too big – Dam will not fit tight • Too small – Dam will tear when going over teeth • Too close – Dam will stretch to far – leakage • Too Far apart – too much material between teeth – will bunch

  11. Dental Dam Clamps • Clamps to the Anchor tooth • Stabilizes the dental dam • Opposite end of the dental dam must be stabilized (also called ligating the dam) a. Can use another clamp. b. Can use a stabilizing cord-Wedget. c. Can use dental floss or tape.

  12. Fitting the Dental Dam Clamp • Clamps are available in many sizes. • Winged clamp • Extra extensions for better retraction and retention • Help retain the dental dam in place because the wings are angled toward the gingival. • Used during the one-step dental dam placement method.

  13. Fitting clamps cont… • Wingless Clamps • Do not have any projections. • Names usually begin with a W (ex. W7) • Used during the two-step dental dam placement method. • Clamps that begin with “A” have jaws that bend sharply downward toward the gingiva. • Clamps without the “A” have jaws that are on a flat plane

  14. Posterior Clamps • Universal means that the same clamp may be placed on the same type of a tooth in the opposite quadrant.

  15. Anterior Clamps • Also called Cervical clamps or 9 and 9W. • Designed to: • Retract gingiva or facial surface gum tissue. • Improves visibility for the restoration of a cervical class V cavity. • Isolates anterior tooth during RCT procedures.

  16. Parts of the clamp • Bow • Arched metal • Jaw • Expanding • Forceps hole • Forceps attach • Jaw points • Contact tooth

  17. Dental Dam Punch • Punch plate • Stylus

  18. Dental Dam Forceps • Beaks • Lock – sliding bar • Never leave in locked position

  19. Steps after placing the Dental Dam Clamp • Lubricate the patients lips. • Inversion- tuck the dental dam around the tooth. • Stabilizing cord- Wedgets • Ligatures- Means to tie down, can use floss or tape. • Single tooth isolation- A one hole punch.

  20. Steps Continued.. • Multiple tooth isolation • 6 to 8 isolated teeth provides the most stability. • Remember to include 1-2 teeth posterior to the tooth being treated.

  21. Removing Dental Dam • Missing fragments • Tears in the material • Cut or ripped septa • Always check the interproximals of all the teeth involved, and if you should discover cut or ripped septa in between the teeth, gently floss it out.

  22. Steps for Dental Dam Placement • Tell the Patient what you’re about to do, and explain the steps. • Select the proper clamp for the tooth that you’re going to anchor. • Punch the desired holes for the arch that you are working on. • Decide whether you’ll use a one step or two step procedure in placing your rubber and clamp. • Using the forceps, place the clamp on the tooth. • Then your frame. • Then stretch your holes over the teeth and use a wedget to secure it. • Floss the dental dam down in between the teeth, and use your greg 4/5 to invert the material. • Dry the surface of the dental dam and prepare to begin procedure.

  23. Use of the Matrix Band • When preparing a tooth for a restoration often there are times we will need to have an artificial wall in place of the missing wall of surface.

  24. Use of Matrix Bands • Replaces the missing walls of the tooth. • Restores natural contours to the tooth structure. • Prevents excess materials from getting near the gum tissues (gingiva).

  25. Types of Matrix bands • Tofflemire matrix- Used with a tofflemire retainer, to replace the walls of the prep. • Automatrix- A preformed band that is placed around the tooth, and tightened with a tightening device. • Clear Mylar strips- A clear strip that placed around the anterior teeth to hold and form the composite in the prep. • Shell matrix- Premolar and molar size.

  26. Purpose for Tofflemire Retainers • Tofflemire retainers are most commonly used when the posterior amalgams are placed ex. (Class ll) • The larger circumference is the occlusal edge. • The smaller circumference is the gingival edge. • The center of the matrix band must be shaped in the proximal contact area so it will make contact with the tooth next to it.

  27. Wedges • Triangular or round wedges. • Made of plastic or wood. • Placed into the embrasure to position matrix band firmly against gingival margins of the preparation of the surface to be restored. • They also slightly separate the teeth when necessary.

  28. Wedges Cont…. • Placed with • Hemostat • Cotton Pliers • Howe Pliers • Placed from the lingual surface

  29. Wedges Cont….. • The results of an improperly placed wedge and band- a. Overhang- excess restoration material extending beyond the preparation. b. Cupping- a gap of indention in the restoration.

  30. Conclusion… Have Fabulous Day!

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