GOOD MORNING

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CHAIR POSITIONS

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 Planning of dental treatment is a challenging and rewarding
undertaking for the dentist. This endeavor is no longer the sole
province of the treating dentist, however. Heightened patient
awareness and interest in personal health has resulted in
increased participation by the patients in decisions about
treatment.
 Pretreatment considerations consisting of patient assessment,
examination, diagnosis and treatment planning are the
foundation of sound dental care. In preparation for a clinical
procedure it is important to ensure that patient and operator
positions are properly selected, that instrument exchange
between the dentist and assistant are efficient, and that
magnification is used if needed.

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 PATIENT AND OPERATOR POSITIONS

The patient & operator position should be

effective
 For welfare of both.

 Patient is comfortable, more relaxed, has less

muscular tension , more cooperative
 Operator experiences less physical strain &
fatigue & reduced risk of developing
musculoskeletal disorders.

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Chair and patient position:
 Patient should have direct access to the chair.
 Chair height should be low, backrest upright, armrest
adjusted to allow the patient to get into the chair.
 Head rest cushion is to support head and elevate chin
slightly away from chest. Neck muscle strain is
minimal & swallowing is facilitated.
 Common position  Supine position or reclined to
45 degrees.
 Head should not be lower than feet except in
emergency as when patient is in syncope.
 When operation is complete chair should be placed in
upright position so that patient can leave the chair
easily preventing loss of balance.

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 OPERATING POSITION

Ideal position for operator is one in which he is seated well back on stool & feet flat on floor
,legs relaxed & relatively together & thighs parallel to the floor.
Teeth to be treated should be at level of elbow.
Optimal eye to work distance 16 – 18 inches.

RIGHT HANDED

 Right front (7o’clock)  Mandibular anterior

 Maxillary anterior
 Mandibular posterior (right)

 Right (9o’clock)  Facial surface of maxillary and mandibular posterior (right)

 Occlusal surface of mandibular posterior (right)

 Right rear (11o’clock  Lingual and occlusal surface of maxillary teeth (indirect
vision)
 Mandibular teeth (left) (direct vision)

 Direct rear position  Lingual surfaces of mandibular anteriors

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 Left handed operators

 (Substitute left for right)

—— Left front (5 o’clock)
—— Left (3o’clock)
—— Left rear (1 o’clock)

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 ZONES OF ACTIVITY
Four “Zones of activity are identified using the patient’s face as
the face of a clock. :
1. The Operator’s zone,
2. Assistant’s zone,
3. Transfer zone,
4. Static zone.

The operator’s zone for a right handed person :

 Operator zone extends from - 7 to 12 ‘O’clock
 Static zone from - 12 to 2 ‘O’ clock,
 Assistant’s zone from - 2 to 4 ‘O’clock
 Transfer zone - 4 to 7   ‘O’clock

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 Hand Instrument Techniques
(Grasps, Rests & Guards)

Grasps Modified Pen Grasp

Inverted Pen Grasp
Palm & Thumb Grasp
Modified Palm & Thumb Grasp
Modified Pen Grasp – allows greatest delicacy of touch
-Pads of thumb, index and middle finger contact instrument
while ring finger and little finger are placed close to the tooth
surface of the same arch as rest.
-The palm of the hand faces away from operator
- by the working of middle finger with the forearm and wrist cutting
or cleaving pressure is generated on the blade.
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 Inverted Pen Grasp - This grasp is used similar to modified
pen grasp except the palm faces towards the operator
- Used mostly for tooth preparations utilizing the lingual
approach on anterior teeth

 Palm and Thumb Grasp – handle is placed in the palm of the

hand and grasped by all fingers while thumb is free of the
instrument; rest is provided by tip of thumb on a nearby tooth of
same arch
e.g. holding a handpiece cutting incisal retention for a Class III
maxillary preparation on maxillary incisor
 Modified Palm & Thumb Grasp – used in maxillary arch
especially when operator is operating from a rear chair position
handle is held by four fingers and first joint and pad of thumb.
Prevents slippage of instrument

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PEN GRIP

PALM GRIP

FINGER GRIP
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 PEN GRASP
Two Handed instrumentation

FINGER
REST

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PEN GRASP WITH
FINGER REST

PEN GRASP
PEN GRASP
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 RESTS – are established by placing the ring or little
finger or both on tooth surface adjacent or opposite
site
 Closer the rest areas to the operating site more is the
control
 Forefinger of other hand is placed on the shank of the
instrument and thus reinforces stability – Indirect rest

 GUARDS – they are hand instruments or

interproximal wedges used to protect soft tissues
from injury while using sharp cutting or abrasive
instruments
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