preliminary considerations

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Preliminary Considerations for Operative Dentistry Preoperative patient and dental team considerations

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Page 1: Preliminary Considerations

Preliminary Considerations for Operative Dentistry

Preoperative patient and dental team considerations

Page 2: Preliminary Considerations

I. PATIENT AND OPERATOR POSITIONS

• Patient who is in a comfortable position is more relaxed, has less muscular tension, and is more capable of cooperating with the dentist.

• By using proper operating positions and good posture, the operator experiences less physical strain and fatigue and reduces the possibility of developing musculoskeletal disorders.

Page 3: Preliminary Considerations

Chair and patient positions

The most common patient positions for operative dentist are:

a. almost supinethe patient’s head, knees, and feet are

approximately the same levelb. reclined 45˚

Page 4: Preliminary Considerations

Operating zones“clock concept”

Operator’s zone

Right-Handed Dentistry

Operator’s zone 7 to 12 0’clockis the area where the operator is positioned to access the oral cavity and have the best visibilityTransfer zone 4 to 7 o’clockIs the area where instruments and dental materials are exchanged from the dental assistant to the dentistAssistant’s zone 2 to 4 o’clockIs the area where the dental assistant is positionedStatic zone 12 to 2 o’clockIs directly behind the patient, with a rear-delivery unit that holds the handpieces, air-water syringe

Transfer zone

Assistant’s zone

Static zone

Page 5: Preliminary Considerations

Operating zone for a left-handed operator

Operator’s zone

12 to 5 o’clock

Transfer zone5 to 8 o’clock

Assistant’s zone

8 to 10 o’clock

Static zone10 to 12 o’clock

Page 6: Preliminary Considerations

Operating Positions• Right handed operator

Three essential positions:1. 7 o’clock - right front – mandibular anterior teeth, mandibular

posterior teeth (especially on the right side), and maxillary anterior teeth

2. 9 o’clock - right – operator is directly to the right of the patient. Convenient for operating on the facial surfaces of the maxillary and mandibular right posterior teeth and the occlusal surfaces of the mandibular right posterior teeth.

3. 11 o’clock – right rear – position of choice for most operators. Most areas of the mouth are accessible and can be viewed directly or indirectly using a mouth mirror. The operator is behind and slightly to the right of the patient. The left arm is positioned around the patient’s head. Lingual and incisal surfaces of the maxillary teeth are viewed in the mouth mirror. Direct vision may be used for mandibular teeth

Page 7: Preliminary Considerations
Page 8: Preliminary Considerations

• Left handed operator1. 5 o’clock – left front2. 3 o’clock – left3. 1 o’clock – left rear

12 o’clock position – direct rear – primarily used for operating on the lingual surfaces of mandibular anterior teeth. The operator is located directly behind the patient and looks down over the patient’s head.

• As a rule, the teeth being treated should be at the same level as the operator’s elbow.

Page 9: Preliminary Considerations

General Considerations regarding chair and patient positions:

The operator should not hesitate to rotate the patient's head backward or forward or from side to side to accommodate the demands of access and visibility of the operating field.

AS A RULE, WHEN OPERATING IN THE MAXILLARY ARCH, THE MAXILLARY OCCLUSAL SURFACES SHOULD BE ORIENTED APPROXIMATELY PERPENDICULAR TO THE FLOOR. WHEN OPERATING IN THE MANDIBULAR ARCH, THE MANDIBULAR OCCLUSAL SURFACES SHOULD BE ORIENTED APPROXIMATELY 45° TO THE FLOOR.

Page 10: Preliminary Considerations

The face of the operator should not come in close proximity to that of the patient.Minimize body contact with the patient.From most positions the left hand should be free to hold the mouth mirror to reflect light onto the operating field to view the tooth preparation indirectly or to retract the cheek or tongue.

Page 11: Preliminary Considerations

When operating for an extended period, the operator will find a certain amount of rest and muscle relaxation can be obtained by changing operating positions.

Page 12: Preliminary Considerations

II. PAIN CONTROLA. Local anesthesiaInjection is used to achieve local anesthesia in restorative dentistry.Administration of local anesthesia to all tissues in the operating site is recommended for most patients to eliminate pain and reduce salivation associated with tooth preparation and restoration.

Page 13: Preliminary Considerations

• Therapeutic dose of a drug – is the smallest amount that is effective when properly administered and does not cause adverse reactions.

• Overdose of a drug – is an excessive amount that results in an overly elevated local accumulation or blood level of the drug, which causes adverse reactions.

Page 14: Preliminary Considerations

• Normal healthy patient can receive as many as five to eight cartridges of anesthetic per appointment.

• Each 1.8 ml cartridge contains anesthetic, either with or without a vasoconstrictor ( lidocaine 2 % (anesthetic) with epinephrine 1:100,000 (vasoconstrictor)- lidocaine 2% plain (no vasoconstrictor)

• The number of permissible cartridges increases as body weight increases

Page 15: Preliminary Considerations

• The maximum recommended dose (MRD) of 2% lidocaine with epinephrine 1:100,000 is 4.4 mg/kg or 2.0 mg/lb, to an absolute maximum of 300 mg.

• Local anesthetics have different durations of action for both pulpal and soft tissue anesthesia.- pulpal (deep) anesthesia varies from 30 to 90 or more minutes - soft tissue anesthesia varies from 1 to 9 hour depending on the specific agent and whether a vasoconstrictor is included.

Page 16: Preliminary Considerations

• Anesthetics are available in amide and ester types

• Hypersensitivity and allergic reactions in affected patients are much less frequent with the amide type of local anethetic.

Page 17: Preliminary Considerations

Benefits of local anesthesia

• Cooperative patient• Salivation control• Hemostasis – is the temporary reduction in blood

flow and volume in tissue (ischemia) where a vasoconstrictor is used.- alpha effect of vasoconstrictor causes constriction of the small blood vessels; thus the affected tissue bleeds less if cut or abraded.

• Operator efficacy

Page 18: Preliminary Considerations

B. Analgesia (inhalation sedation)- use of nitrous oxide and oxygen is one method of inhalation sedationC. Hypnosis

Page 19: Preliminary Considerations

III. ISOLATION OF THE OPERATING FIELD

Goals of Isolation:1. moisture control

- refers to excluding sulcular fluid, saliva, and gingival bleeding from the operating field. Preventing the hand piece spray and restorative debris from being swallowed or aspirated by the patient.

- rubber dam, suction devices and absorbents are effective in moisture control

- rubber dam is the recommended technique for moisture control

Page 20: Preliminary Considerations

2. retraction- rubber dam, high-volume evacuator,

absorbents, retraction cord, and mouth prop are used for retraction and access.

- provides maximal exposure of the operating site and usually involves maintaining an open mouth and depressing or retracting the gingival tissue, tongue, lips, and cheeks.3. harm prevention – “ Do no Harm”4. local anesthesia

Page 21: Preliminary Considerations

Other Isolation Techniques:1. Throat Shields2. High volume evacuators and saliva ejectors3. Retraction cord4. Mirror and evacuator tip retraction5. Mouth props6. Drugs

Page 22: Preliminary Considerations

Cotton roll isolation is the use of a tightly formed absorbent cotton preshaped to be positioned close to the salivary gland ducts to absorb the flow of saliva and close to the working field to absorb the flow of water.

Maxillary placement of the cotton roll.

Position the cotton roll in the mucobuccal fold closest to the working area

Mandibular placement of the cotton roll

Placing cotton roll for the mandibular anterior, bend the cotton roll before placement for better fit.