One of the most critical factors in the success of posterior composites is adequate isolation. Our ability to achieve acceptable bond strengths and prevent marginal breakdown and leakage are dependent on it. Blood and saliva are the enemy during any adhesive procedure. There are numerous options that all allow us to achieve proper isolation. The tried and true is still placing a rubber dam, and even as I type this I know people are cringing at the thought of it. With practice and proper technique rubber dam placement can become easy and efficient. In addition there is also the option of utilizing a split dam technique. In this approach one large slit is created that goes over multiple teeth and is anchored by a clamp on the most posterior tooth and flossed between the anterior abutment teeth.
I had a patient in today to complete crown preparations and take final records for a full lower quadrant. I completed my preps on both lower molars and the second bicuspid, placed my retraction cord and was ready for the impression. At the beginning of the appointment we had taken a full upper impression for our opposing and a facebow. Using full arch models and mounting them on an articulator will allow the lab to return restorations to me with both the MIP and the excursive movements adjusted in and I will have minimal work to do to finalize the occlusion during the seat appointment.
With this in mind we had all the materials set out to take our impression. I was about to remove the Isolite, when I stopped and wondered about taking the impression with it in. I have had several occasions in the last few months when attempting to get good flash beyond the margins of multiple preps that I have not gotten everything in the first impression.
I find that I don’t have enough hands when I work on anterior teeth.I need one hand to hold my handpiece, another for the mirror, and that leaves me with no way to retract the patient’s lips. For year I would cradle my mirror hand, so a few fingers worked as retractors and two were left to position the mirror.
Recently I started to use a product called OptraGate by Ivoclar. I will admit, the first few times I felt like we were wrestling with it and the lips to get it in place. I kept at it though, because once positioned, it is incredibly effective at retracting the lips and creating a clear field of view to work in. I also, played being the patient, and had my assistant place one on me. The OptraGate is remarkably comfortable, and I could still move my lips around a close a bit to get more comfortable.