In the placing of any of the various filling materials in permanent teeth, the preparation of the operating field is important. It will expedite and simplify most operative procedures if the rubber dam is used wherever practical.

The dam is first cut into six by six inch squares. It is then thoroughly washed in a hot soap suds solution, rinsed, dried, and powdered. This preparation seems to make the rubber more flexible, softer and generally more compatible with the patient. Holes are then punched to line up with the pattern of the teeth; liquid soap is applied to the holes, and, after the contact points of the teeth are checked with floss, the teeth are dried with warm air, and the dam is slipped over them.

A soft rubber dam napkin is used, and the saliva ejector is placed through a small hole punched in the dam so that the dam, rather than the soft glandular tissues adjacent to the tongue, carries the weight of the ejector. Suitable clamps are used if necessary, and they are always blocked securely with compound so that they are fixed and do not damage the tissues by movement. No ligatures are used to hold the dam.

A field, so prepared, is free from the secretions of the mouth, and debris can be removed with the warm air without discomfort to the patient. Gagging ceases to be a problem. The patient is relaxed and quiet, and he does not interrupt the operating procedure by having to empty his mouth of saliva and debris. The use of a rubber dam is advisable because it saves a great deal of time, increases visibility, and protects the soft tissues from any medicaments, such as silver nitrate or phenol. With the help of a well-trained assistant and a little practice, any operator can place a rubber dam and be ready to work by the time anesthetic will permit operating.

It is difficult to believe that there is any field of operative dentistry which will give the operator more lasting pleasure in his work than the placing of gold foil. Any average operator with sufficient practice, patience, and persistance can enjoy that pleasure if he wishes.

The study of foil work will improve all of his operating ability including baked porcelain, inlays, alloys, acrylic resins, and silicates—if he continues to do acrylic resins and silicates. In short, the successful manipulation of gold foil requires an exact technic, which develops a dexterity and skill in the hands of the operator, and that well-developed skill is soon reflected in all other phases of his work.

Foil gold is especially indicated in Class I, III and V cavities, namely: simple occlusals, proximals in the anterior region, and gingivals on the labial and buccal surfaces.

In the Class I, or simple occlusal, cavities, the tooth structure is conserved and recurrence of decay is inhibited when foil is used. This procedure is comparatively simple, and, with the use of the right-angle Hollenbeck pneumatic mallet, it is not difficult to condense the foil in the upper or lower second molars.

Class V, or gingival, cavities lend themselves beautifully to foil. They shape themselves naturally as far as outline is concerned. The typical form is that of a truncated cone with the base toward the occlusal or incisal surface; the mesial and distal walls flare away from the axial wall; the gingival wall is slightly undercut, and the occlusal or incisal wall is at right angles to the axial wall. All point and line angles should be sharply defined. The gingival wall is usually placed beyond the cemento-enamel junction, and great care must be exercised when finishing the foil in this area. When the correct contour is obtained by the use of knives, files, and fine disks, the foil is highly polished with flour of pumice and jewelers white rouge. When correctly finished, there is a complete absence of gingival irritation around this type of filling; the gum returns to and remains in a normal healthy state.

The average foil operation requires from an hour to an hour and one-half.

Without premedication, the great majority of patients are completely relaxed during the operation; many of them doze, and some of them actually go to sleep.

Perhaps the monotony of the rhythmic malleting contributes to the state of ease.

It is not uncommon to see foil fillings still giving good service after thirty or forty years. They may exhibit marks of malleting so that they resemble hammered brass, but the margins are still good, and the patient remembers and is grateful to the operator who placed that filling many years ago. Operative dentistry of this type, carried on with our modern technic, is certainly worth. while.

915 Selling Building Portland 5, Ore.

Reprinted from DENTAL SURVEY, February 1953