Page 196 - My FlipBook

192 OPERATIVE DENTISTRY

whether a clamp is used or not and kind of clamp when one is used.
With the Anterior Teeth Ave do not generally use a clamp and the
rubber is placed by commencing at one side and then crowding the
rubber through each proximal space in the order they should go,
until the opposite side is reached. The rubber dam holder should
be applied to one side before commencing the adjustment, and, as
soon as the teeth have been forced through the holes, the other side
of the holder should be attached.
With Posterior Teeth the holder should be attached to the short
side of the rubber to prevent curling into the mouth, which would
be the same side of the dam as the teeth are situated in the mouth,
right or left. Adjust clamp to be used as this tooth receives first
attention, while the remaining teeth are one by one pushed through.
until the most anterior one is reached, when the remaining side of
the rubber is secured with the holder.
To Prevent Leakage Around the Teeth tlie edges of the holes
must turn toward the roots. This is accomplished by first pressing
the dam well against the gums while grasping the rubber on either
side of the tooth and drawing it tight, then releasing the rubber so
that it slackens and then gently moving it occlusally. This will gen-
erally have the effect of inverting the edges. If inversion is not
complete pass a small blunt instrument, as a spatula or dull ex-
plorer, around the gingival to turn the edge under.
The Use of the Ligature is to assist in inverting the edges of the
holes in the rubber dam and to secure the edges about the teeth in
this position against displacement by the movements on the part of
the patient or the operator.
Caution in the Use of Ligatures is most important as much per-
manent injury is done the gingival attachments by the careless crowd-
ing of these on the dental ligaments. This is particularly the case
where the proximal gum festoons are high as in these cases, espe-
cially with young people, the attachment to the tooth is also high.
A tight ligature tends to encircle the tooth in a straight line and
would thereby ride down the high proximal attachments, if the lig-
ature is crowded to the full height both labially and lingually. Hence
either the labial or the lingual should not be crowded to the full height
of the crown.
Ligatures Are Made of well-waxed floss specially prepared for
the purpose, cut into lengths of about five or six inches. Some econ-
omy may be practiced where three teeth are to receive ligatures by
starting with a piece about twelve inches long. Tie the first tooth
in the center of the strand and w'hen the ends are cut off enough re-