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The Concepts of Four-handed Dentistry Including Ergonomic Instrument Transfer and Exercises for Stress Reduction

Course Number: 643

Basic Principles

Successful instrument transfer is predicated on a set of principles that require organization and planning in advance. These principles include:

  1. Work from a well defined treatment plan so that instruments and materials required for a planned procedure can be prepared in advance.

  2. Team members must thoroughly understand the procedure to be performed to anticipate the sequence in which the instruments and materials will be used.

  3. Develop a standardized routine for the performance of most dental procedures that is followed routinely.

Additional strategies such as the delegation of all material preparation and instrument transfer to the assistant as well as the delegation of expanded/advanced functions to legally qualified clinical assistants will maximize the use of the dentist’s time. Using ergonomically designed equipment and placing the patient in a supine position improves access and visibility for the operating team. Placing supportive equipment and supplies within a 21 inch radius of the assistant’s hands as well as confining movements to the oral cavity and the adjacent transfer zone over the patient’s chest will result in the conservation of time and motion during the procedure.2


To ensure a successful instrument transfer, each member of the team must assume specific but often related responsibilities.

To maximize the efficiency of an instrument transfer technique, the operator should maintain a fulcrum for his/her working hand in the oral cavity so the actual location of the transfer between team members will be predictable. The number of instrument exchanges during a typical restorative procedure may exceed 100. By making an instrument exchange predictable, there is no need for the operator to look away from the oral cavity during the procedure. Follow these guidelines for smooth safe transfers.