Increasing Productivity by Effective Use of Four-Handed Dentistry – Part 3: Instrument Transfer Technique
Introduction

Use of an efficient instrument transfer is one of the basic skills every dental team must learn in order to be productive and stress free. Instrument transfer is the process of transferring instruments and materials to and from the operator, within the transfer zone, at a precise moment of need (Figure 1). An important pre-requisite to successful instrument transfer is the ability of each member of the dental team to understand the procedure, anticipate each other’s needs, and when necessary develop some form of communication‑either verbal or non‑verbal to indicate a need for instrument exchange. This concept may seem basic, yet many dentists and assistants struggle to refine a smooth productive technique.

During the past several years there has been a diminished emphasis on formal education in the basic principles of true four‑handed dentistry concept including the use of efficient instrument transfer techniques. This has resulted in dentists not learning proper ergonomic strategies in dental school or following graduation due to fewer continuing education courses being offered on the subject. These dentists tend to engage in more time consuming movements during dental procedures than is necessary. Proper instrument transfer techniques serve to conserve motion, increase the smooth flow of the procedure, and reduce eyestrain by eliminating the need to look away from the brightly illuminated operative field during the transfer. It is advisable to re‑evaluate the instrument transfer techniques used during a dental procedure in order to ensure safety during the transfer and ensure that the objectives of a proper technique as listed below are realized:

• The assistant understands the sequence of the treatment procedure.
• The assistant anticipates the needs of the operator.
• The assistant transfers the dental instrument in the proper hand; the left hand for right handed operators and the right hand for left handed operators.
• The instrument is transferred to the operator in the position of use, which would result in the working end of the instrument downward for the mandible and upward for the maxilla so the operator is able to use the instrument once received without the need to reposition the instrument.
• The assistant delivers the instrument to the operator firmly.
• The operator is able to maintain vision on the operative field thus reducing eyestrain associated with changing light intensity and focal length accommodation.
• The used instrument is received back by the assistant without any entanglement of instruments.
• The operating team conserves time and motion during instrument transfers.
• There is a reduction in stress and strain on the operating team due to the uninterrupted flow of the procedure without the delays associated with locating and delivering instruments if an orderly system is not used.
• When instrument transfer is used in conjunction with the oral evacuator and the air/water syringe, the operative site will always be clean and the next instrument will be ready for use.
• Percutaneous injuries associated with use of dental instruments can be minimized using a prescribed transfer technique.