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

Course Number: 643

Strategies to Ensure Effective Four-Handed Dentistry


To effectively implement the concepts of true four‑handed dentistry each member of the dental team must assume individual as well as team responsibilities. The team must be aware of each other’s needs, recognize the need to reposition the patient and operating team, as necessary, to reduce strain, improve access and visibility, and reduce unnecessary movement by transferring instruments only within the transfer zone.3

Strategies for the Operator2

  • The dentist/operator must develop a standardized routine for basic dental procedures.

  • Develop a non verbal signal denoting a need to exchange an instrument.

  • When necessary, offer advanced, distinct verbal direction to communicate a need for a different instrument or material.

  • The dentist/operator must be willing to accept input from the assistant when it is noted that chair positions need to be adjusted.

  • The operator must maintain a working position within the operator’s zone.

    • Avoid legs interfering with the static or assistant’s zone.

    • Confine eye focus to the field of operation.

    • Confine hand and arm movement to the transfer zone.

  • Avoid twisting and turning to reach instruments by relying on the assistant to change burs and to transfer needed instruments.

  • Exchange instruments only in the transfer zone.

  • Avoid removing instruments from the preset tray by returning instruments to the assistant.

Strategies for the Dental Assistant1

  • Develop a thorough understanding of the procedure.

  • Monitor and recognize the patient’s needs.

  • Anticipate the operator’s need and recognize any change in the procedure.

  • Be seated as close to the patient as possible with legs parallel to the long axis of the patient’s body.

  • Be attentive to changes in operator position and determine a non verbal signal to indicate that chair positioning needs to be improved.

  • Maintain the order of both the instruments and dental materials according to their sequence of use.

  • When transferring a dental instrument to the operator, orient the working end of the instrument so it is pointing up for maxillary functions and down for mandibular functions.

  • Work with the operator to establish and follow a safe, standardized, and predictable instrument transfer protocol.

  • Employ excellent moisture control techniques including dental dam application, cotton roll isolation, and evacuation with efficient rinsing and drying.

  • When practical the dental assistant should change burs in the handpiece and maintain a “ready position” for delivery of the handpiece

  • Remove debris from instruments before returning them to the preset tray.

  • Always maintain a clean and organized work area.

Communication between the operator and the assistant is vital to successfully implement the concepts of true four‑handed dentistry.