5. chair positions class.ppt

8/14/2019 5. chair positions class.ppt

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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.

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