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CHAIR POSITIONS- HANDEDDENTISTRY
INSTRUMENT GRASPS
ANDFINGER RESTS
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The concept of four-handed dentistrydescribed by Dr. G.E.Robinson
Research shows that production can beincreased by 100% and simultaneouslystress and fatigue will be reduced by 50%
-70%.
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The Benefits Include:
Increased efficiency
Decrease in the muscularstresses involved with thepractice of dentistry throughconservation of muscularactivity, adherence to theprinciples of balanced posture.
The dentist is able toconcentrate their skill and
judgment on the tasks directlyassociated with patient care.
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Goals of work simplification Decrease the number of instruments to be used for a
procedure.
Sequence the instruments on a tray by their use.
Minimize the stress and fatigue by using correctpositioning of the patient, dentist and assistant.
Use of appropriate moisture control techniques.
Transfer of instruments and dental materials as necessary.
Use the least amount of motion during the transfer ofinstruments and materials.
Allow the assistant to perform expanded functions.
Team Dentistry
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POSITIONING THE PATIENT ANDTHE OPERATIVE TEAM
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Objectives of a Favorable
Seated Position Access to the operative field
Good visibility
Comfort for the operative team- reducedstress and increased efficiency
Relative comfort and safety for the patient
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Position should permit
direct or indirect vision
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ZONES OF ACTIVITYPatient in a supine positionUsing center of patients face as a clock
Zones designated as time
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The dentist will normally work within a range from
the 12 oclock to the 7 oclock position relative to the
patients head.However, most operative procedures are completed
from, at, or near, the 12 oclock position.
The dental nurse will normally remain in a fixed
position at 4 oclock .
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Maxillary incisor labial
surface 7 o clock
Maxillary incisors lingual
surface 12 o clock
Maxillary posteriors 12
o clock
Mandibular incisorslabial surface- 7 o clock
Mandibular posteriors
9 o clock and 7 o clock
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Characteristics of Balance
Posture for Operator Operators thighs parallelto floor
Entire surface of seatused to support weight
Backrest supports backwithout interference
Forearms parallel to floorwhen hands are in
operative position Elbows close to the body
Back and neck reasonablyupright with top of
shoulders parallel to floor
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Distance ofapproximately 14 18 inches betweenthe operators noseand the patients oralcavity maintained
Operative field isoperators midline
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Positioning the Patient in
the Working Position Oral Cavity at height of operators elbow
Head placed at upper end of chair and slightly
to operators side of chair All patients are seated from the head down
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Tilt seat portion back so foot rest is raisedapproximately 6 to 8 inches
Lower back of the chair until patient is about
way toward a horizontal position Pause to allow patient to adjust
Continue lower chair back until following
relationships exist Imaginary line from patients chin to the top of
ankles is parallel with floor
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Once seated Observe
Patient Lying flat with little bending at waist
Similar to sleep position
Legs slightly lower than head if highermight cause pt. Anxiety/circulationproblems.
Patient in supine position
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Lower chair to operators lap
Approximately 1 inch above knees of operator
Plane of the patients forehead is also parallel withthe floor
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Patient Dismissal
Patient dismissal should be accomplished byreversing the steps of seating the patient
Remember to pause for the patient on theway up as well
Most important patient dismissal precaution
Encourage the patient to remain seated to
reestablish their equilibrium
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Position of Assistant 3 4 oclock position for all
quadrants Right handed operator
9 oclock position for all quadrants
Left handed operator
Stool positioned so edge toward
the top of patients head is in line
with the patients oral cavity
Stool as close to chair as possible Stool elevated to top of assistants
head is 4 6 inches higher than the
dentist
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Standardization of Work Procedures
and use of transfer zone
Contributes to effective teamwork by being able toanticipate the dentists needs & increasingefficiency/production
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Benefits Standardized operating sequence.
Reduces the amount of time in the dental chair forthe patient.
Increased productivity.
Less fatigue and stress.
I nstrument Transfer and Exchange
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Principles of instrument transfer
The assistant must understand the sequence of thetreatment procedure and anticipate when an instrumenttransfer will be required.
The transfer of instruments should be accomplished with a
minimum of motion involving only the fingers, wrist, andelbow.
Instruments are transferred in the position of use.
An instrument is transferred so the dentist can grasptheinstrument for its appropriate use.
The instrument being transferred must be positioned in thedentist's hand firmly.
The assistant will transfer dental instruments and dentalmaterials with his or her left hand.
I nstrument Transfer and Exchange contd
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Variations in instrument transfer
Mirror and explorer
Cotton pliers
Handpiece
Instruments with hinges
I nstrument Transfer and Exchange contd
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Sit Down Dentistry
Body mechanics/task performance studies
Seated worker uses 27% less energy
Seated worker has 17% greater life expectancy
Production increases from 33 78%
Seated in a balance posture concept
the efficiency of a D.A. Is the result ofworking with a well-organized dentist whopractices 4-handed dentistry
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Instrument
Grasps
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Pen Grasp
With the pen grasp
hold the instrument the way
you would hold a pen whenwriting. Grasp the handlewith your thumb and first whileyour middle finger supports theinstrument from beneath.
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Inverted Pen Grasp
Inverted Pen Grasp. Thefinger positions of theinverted pen grasp are thesame as for the modified
pen grasp.However, the hand is rotatedso that the palm facesmore toward the operator(Fig).
This grasp is used mostly fortooth preparations utilizingthe lingual approach onanterior teeth.
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Palm and thumb
grasp
PALM GRASPWhen using the palm grasp, the index, middle, ring, andlittle finger hold theinstrument so that it rests in
the palm of your hand. Yourthumb remains free tostabilize your hand in thepatient's mouth, or it may beused to support an instrument when sharpening (fig).
This grasp is rarely used in themouth and only whenexceptional force is needed.
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Modified Palm-and-Thumb Grasp
The modified palm-and-thumbgrasp may be used when it isfeasible to rest the thumb on thetooth being prepared or theadjacent tooth (Fig.).
The handle of the instrument isheld by all four fingers whosepads press the handle againstthe distal area of the palm, aswell as the pad and first joint ofthe thumb.
Grasping the handle under thefirst joint of the ring and littlefingers acts as a stabilizer.
This grip fosters control againstslippage.
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Finger grip
The instruments are
grasped using the
fingers and the thumb
is used to guide theinstrument .
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Finger Rests
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Finger rests Intra oral
Intra arch
Two finger restSingle fingerNo rest
Inter arch
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Extra oral
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Under these circumstances, instrument controlmay be gained using the forefinger of the
opposite hand on the shank of the instrument or
using an indirect rest, (i.e., the operating handrests on the opposite hand, which rests on astable oral structure)
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Conclusion
Advantages of 4 handed dentistry Better ergonomics
Better efficiency
Lesser stress on operatory team and patient
Ergonomics is the science of designing the
job, equipment, and workplace to fit the
worker. Proper ergonomic design is necessary
to prevent repetitive strain injuries, which can
develop over time and can lead to long-term
disability.