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CHAPTER IV.

GAINING ACCESS.

Definition. Gaining access is the term applied to those proced-
ures necessary to make sufficient room for the proper introduction
of the filling.
Sufficient Access is Important, that we may have the advantage
of space to properly handle the instruments and appliances used
in the procedures of making a filling, that we may be able to intro-
duce the filling into the cavity, that there may be complete contour
restoration of tooth form and that the desired contact relation may
be established to the adjacent tooth.
Access to the Tooth is the first consideration and will involve
the opening of the mouth to a sufficient degree to permit of the
free use of the usual appliances. The proximal spaces used for the
adjustment of the dam should be examined to make sure that the
rubber and ligatures will pass to the gingival line without injury.
A sufficient number of teeth should be isolated, say four or five,
to give a clear and unobstructive view of the cavity and surround-
ing teeth.
The operator must be able to bring the cavity into full view.
Cases where there has been considerable decaj^ sub-gingivally, and
tumefaction of the gum septa has taken place, proper access Avill
involve the packing of the cavity with a tampon of cotton which
has been dipped in chlora-percha, or a packing of gutta-percha,
for a period of twenty-four or forty-eight hours, to crowd the en-
croaching gum tissue from the cavity. A neglect of this considera-
tion of access will often make proper management of the gingival
wall and margin most difficult or impossible.
Surgical Access may be practiced on the cavity margins, when
all tooth structure thus removed will subsequently be replaced with
filling material. It may be practiced on the gum septa when there
has been excessive tumefaction in the proximal space.
Formerly this method Avas practiced with Class Five cavities
Avhere the decay was to a marked extent subgingival, and it was
desired to make a cohesive gold filling. However, much of this
questionable practice may now be avoided bj^ the use of the gold
inlay, made from the wax model, as the presence of the overlying
gum is no considornl)le hindrance.
Access as Related to Restoration of Proximal Space. As tooth
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