1 Preparation to Place a Filling

Chapter 1:

1.1 Placing a Rubber Dam video

1.2 Placing a Matrix Band video

1.3 Supplies

1.4 Transcripts


1.1 Placing a Rubber Dam

This video demonstrates how to place and remove a rubber dam including common safety precautions.

See transcript below.

1.2 Placing a Matrix Band

An introduction to the tofflemire holder and matrix band.  This video demonstrates how to load and place a tofflemire band on a typodont. It covers wedging, working parts, and proper orientation of the matrix and tofflimer. This technique is applicable to amalgam and composite restorations.

See transcript below.

1.3 Supplies

Click the links below for lists and descriptions of the supplies needed for the procedures explained in the videos above.

  1. Amalgam Set Up: List and description of the supplies needed to place a two surface amalgam filling as described in Chapter 2.
  2. Composite Set Up: List and description of the supplies needed to place a two surface composite filling with a tofflemire band as described in Chapter 3 videos.
  3. Rubber Dam Set Up: List and description of the supplies needed to place a rubber dam

1.4 Transcripts

Video Transcript: 1.1 Placing a Rubber Dam

Using a rubber dam protects the patient from harmful dental materials and makes it easier to keep a clean dry field.

Review the materials and tools needed.

Stamp the dam with a punch guide.

It’s good practice to make a guide mark in the upper right quadrant. It’s easy to get turned around when the dam is partially inserted.

Choose the correct hole size

Make clean punch holes without rips.

Punch holes one place behind the prep through one past the midline.  We will be working on #29 so, in this case,  punch 30- 24.

Choose the proper clamp and place a ligature on the arch with a simple cow hitch also known as a larks head knot.  The ligature is always on the buccal side to keep it out of your way while working. And the larks head knot allows you to move it from side to side if  needed.

Use the clamp forceps to place the clamp one tooth behind the prep.  Check that it is secure and does not rock. If it does, reposition or get a different clamp.

Thread the ligature through the rubber dam in the #30 slot and gentilly wiggle the clamp loop through the hole. It’s ok to use a non bladed instrument to help with this steep.

Use the guide hole to orient the dam and place the upper right frame pin in it.. Pull the other corners tight and secure.

Stretch the dam and slide each tooth into the corresponding hole pushing it into the occlusal embrasure.

Carefully floss each section through the contact.

secure the final tooth with a widget if needed.

Finally invert the rubber dam into the gingiva to create a seal with a plastic instrument

Now you’re ready to place a filling!

To remove the dam, loop an explorer through two holes and pull tight to expose the interdental piece.  This makes it easy to cut the dam out without accidentally cutting your patient.

When all the interdental pieces are cut, remove the dam, frame, and clamp checking that no pieces are left behind.

It’s just that easy!

Video Transcript: 1.2 Placing the Matrix Band

You will need a tofflemire holder, matrix band, cotton pliers, wedge, and ball burnisher.

Know the parts of the Tofflemier holder.

The outer knob adjusts the spindel while the inner knob adjust the diagonal slot holding the matrix band. Turning the right tightens and turning to the left loosens.

Begin with the outer slot holder close to the inner slot holder and the spindle pin removed from the diagonal slot.

When placing the matrix band, consider the shape. Gently press the outer edges of the matrix band, aligning them together. This will create a circle.

The smaller circumference will face the gingiva. Place the ends of the matrix band with the smaller circumference facing the slots being careful not to pinch the matrix band as this will leave a crease.

Orientate the matrix band through the outer slots straight.

Bring the band close to the tooth you’ll be working on. Determine whether the matrix band should come from the right or the left knowing that it will need to end with the slots down and the smooth surfaces up towards the crown.

Adjust the matrix band toward either the right or left orientation using the outer knob to loosen the hold in the diagonal slot of the matrix band if needed.

Now tighten the outer knob making sure that the diagonal slot is close to the outer slots.

Using the smooth part of the ball burnisher stretch the matrix band from the mesial and distal aspect so that the loop is longer from mesial to distal than buccal to lingual.

Now you’re ready to place this on your tooth.

The tofflemire will rest on the buccal side with the slots pointing toward the gingiva.

Pull the tofflemire toward the buccal closing the gap.

Now adjust the knob to reduce the circumference of the matrix band while checking to make sure the outer knob is still secure.

Now you’re ready to wedge the tooth.

Grasp the wedge with the cotton pliers on the square end. Aiming the pointed end toward the gingiva move from the lingual to the buccal inserting the wedge in the embrasure space.

Once it is secure, flip the cotton pliers to the flat end to push the wedge into place.

Overwedging will make the contact too tight while under wedging will leave the contact too loose.

When the wedge is properly inserted, the gap between the matrix band and the floor of the prep will close.

Let’s watch that again.

Now you’re ready to burnish the contact.

Failure to burnish will result in a contact that is not tight, and an embrasure space that is not well shaped.

Use the ball burnisher side to side and up and down, burnishing the matrix band along the contact of the adjacent tooth.

This will leave a small mark in the matrix band.

And now you’re ready to place a filling.

License

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Restorative Mastery for the Dental Hygienist by Renee Alexandre and Rick Aronstein is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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