Chapter 34, Dental Dam and Tofflemire Retainer

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Chapter 34, Dental Dam and Tofflemire Retainer

• And its uses in Dentistry.

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Indications For Use

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

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Contraindications For Use

• Asthma
• Respiratory congestion
• Allergies to latex
• Herpetic Lesions

• Lesions of the commissures
• Claustrophobic
• Bad experience

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Before Placement

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

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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.

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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.

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Dental Dam Materials

• Dental Frames
• Plastic U shaped Frame
• Otsy Frame
• Young's Frame

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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.

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Dental Dam Stamp and Template

• Template
• A template has holes where the teeth should be
  marked. Its placed on the dental dam and a pen
  is used to mark through the template to indicate
  the location where to punch the hole.

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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

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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.

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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.

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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

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Posterior Clamps

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

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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.

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Parts of the clamp

• Bow
• Arched metal
• Jaw
• Expanding
• Forceps hole
• Forceps attach
• Jaw points
• Contact tooth

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Dental Dam Punch

• Punch plate
• Stylus

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Dental Dam Forceps

• Beaks
• Lock sliding bar
• Never leave in locked position

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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.

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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.

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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.

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Steps for Dental Dam Placement

• Tell the Patient what youre about to do, and
  explain the steps.
• Select the proper clamp for the tooth that youre
  going to anchor.
• Punch the desired holes for the arch that you are
  working on.
• Decide whether youll 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.

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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.

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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).

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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.

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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.

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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.

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Wedges Cont.

• Placed with
• Hemostat
• Cotton Pliers
• Howe Pliers
• Placed from the lingual surface

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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.

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Conclusion

• Have Fabulous Day!