Lecture: Dentist position and grasping Dr.

AHMED ALQUZWEENI

Operative dentistry 3rd

stage

CHAIR AND DENTIST POSITIONS

CHAIR POSITION
• Chair position is a very important aspect in the success of any dental treatment.
• The correct positioning helps the operator to have a good visibility and accessibility
of the oral cavity.
• Proper positioning of the patient and the operator, illumination and retraction for
optimal visibility are the fundamental prerequisites to proper dental treatment.
• If operator maintains proper position and posture during treatment, the operator is
less likely to get strain, fatigue, be more efficient and less chances of getting
musculoskeletal disorders.

for restorative dental procedures, the most preferred operating positions are:
1. Upright position
2. Almost supine
3. Reclined 45 degree

the most common patient positions for operative dentistry are almost supine or
reclined 45 degrees.

the choice of patient position varies with the operator, the type of procedure, and the
area of the mouth involved in the operation.

UPRIGHT POSITION

this is the initial position of chair from which further adjustments are made.

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

ALMOST SUPINE
•in this, chair position is such that head, knees and feet are approx. at same level
• patient’s head should not be lower than feet except in case of syncopal
attack

REECLINED 45 DEGREES
in this position, chair is reclined at 45 degree mandibular occlusal surface is almost
45 degrees to the floor

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

OPERATING POSITIONS
once the patient has been comfortably positioned, the dentist and the assistant
should sit themselves in the proper positions for treatment. usually sitting
position is preferred to relieve stress on operator's leg and support the operator's
back. the level of teeth being treated should be placed at same level as the level
of operator's elbow.

for better understanding, sitting positions of operator are related to a clock. in this
clock concept, an imaginary circle is drawn over the dental chair, keeping the
patient's head at the center of the circle.
then the numbering to circle is given similar to a clock with the top of the circle at
12 o'clock.

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

accordingly, the operator's positions (right handed operator) 8 o'clock, 9 o'clock,

11 o'clock, and 12 o'clock left handed operator's positions, 4 o'clock, 3 o'clock
and 1 o’clock.

RIGHT FRONT POSITION (8 O'CLOCK)

1. it helps in examination of the patient 2.
working areas include:
a) mandibular anterior
b) maxillary anterior teeth
3. to increase the ease and visibility, the patient's head may
be turned towards the operator.

RIGHT POSITION (9 O'CLOCK)

1. in this position, dentist sits exactly right to the patient 2.
working areas include:
a) facial surfaces of maxillary and mandibular right posterior teeth
b) palatal surfaces of left maxillary and mandibular posterior teeth
c) occlusal surfaces of mandibular right posterior teeth.

RIGHT REAR POSITION (11 O'CLOCK)

1. in this position, dentist sits behind and slightly to the right of the patient and the
left arm is positioned around patient's head
2. this is preferred position for most of dental procedures
3. most areas of mouth are accessible from this position either using direct or
indirect vision
4. working areas include:
a) facial surfaces of the left maxillary and mandibular teeth.
b) palatal surfaces of right maxillary and mandibular teeth.
c)incisal (occlusal) surfaces of maxillary teeth.
d) mandibular teeth (direct vision).

DIRECT REAR POSITION (12 O'CLOCK)

1. dentist sits directly behind the patient and looks down over the patient's head
during procedure.
2. working areas are lingual surfaces of mandibular teeth.
3.labial and palatal surfaces of maxillary teeth.
4. this position has limited application.

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

Considerations while doing treatment for the patient

1. maintain proper working distance during dental procedure. this will lead to
increase cooperation and confidence among the patient.
2. operator should not rest forearms on the patient's shoulders and hands on the face
of the patient.
3. dentist should not use patient's chest as an instrument trolley.
4. the operator should leave left hand free during most of dental procedures for
retraction using mouth mirrors or fingers of left hand.
5. operator should keep changing position if procedure is of long duration to
decrease the muscle strain and fatigue.

Hand instrument grasps

Hand instrument grasps are the techniques of gripping the hand
instruments during dental practices. It is crucial for us to hold the hand
instruments in proper methods so as we can perform the dental
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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

practices efficiently and prevent the accumulation of unnecessary

strain on the operator. Correct hand instrument grasp enables the
maximized stability during instrumentation and it can improve the
tactile sensitivity. Besides that, it also helps to minimized operator
fatigue and patient trauma as well.

Pen grasp
Is a method that holding the instrument between thumb and forefinger.
Either third or third and fourth fingers are positioned on adjacent tooth
as rest; this method involves wrist movement for more flexibility of
movement and the position of middle finger is important for preventing
the hand instrument from slippage during manipulation. The
advantages of pen grasp are less power used, more comfortable and
flexibility of movement, limits the application of pressure, and greatest
versatility of movement.

Modified pen grasp

Involves the holding of instrument by forefinger and thumb; the

middle finger guides the instrument and provides tactile sensitivity; the
ring finger and little finger are placed on an adjacent tooth surface, this
technique is more effective and the power that used to the hand
instrument is under controlled.

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

Inverted modified
pen grasp
Is a technique that used
for the tooth preparation of
the lingual and labial
approach on
maxillary anterior
teeth; the palm is rotated
upwards with the
pad of the forefinger and
thumb close to each other.
However, the middle
finger is placed down the
shank.

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Lecture: Dentist position and grasping Dr.AHMED ALQUZWEENI

Palm and thumb grasp

Is a technique whereby handle of the instrument is held between the
palm and all four fingers firmly with the tip of the thumb acts as a rest
on nearby tooth of the same arch; It is a power grasp, which enable
more control and precision when grasping hand instrument. There is
limited movement available for this method; besides, it gives the
possibility of applying pressure precisely.