Introduction to Operative

Dentistry and Dental

Team Positions
 Learning Outcomes
• Define Operative Dentistry

• Enlist Objectives of Operative Dentistry

• Discuss Dental Team positions in Operative

Dentistry

• Recognize the general considerations in dentistry

OPERATIVE DENTISTRY
• It is a branch of dentistry dealing with
diagnosing, eliminating, and preventing of hard
tooth structure defects and restoring the lost
tooth structures.
• The defects may be:
• Caries
• Tooth wear ( Attrition, erosion, abrasion,
Abfraction)
 Cont:
• Dental trauma
• Developmental defects
 Acquired conditions
 Enamel hypoplasia, Molar-incisor hyphomineralization,
 Intrinsic staning ( Fluorosis, Tetracycline)
 Hereditary conditions ( Genetic, Familial history)
 Hyphodontia
 Amelogenisis imperfecta
 Dentinogenesis imperfecta
Amelogenesis imperfecta:
(Hereditary abnormality)
i. Insufficient amount of enamel
ii. Soft enamel
iii. Friable and easy lost
Dentinogenesis imperfecta:

(hereditary condition)

Teeth appear yellow-brown to gray

Enamel is fractured easily due to

poor support provided by the
abnormal dentin
WHY do we RESTORE TEETH ?
• To remove diseased tissue.
• To restore:
– The function of the tooth.
– The appearance of the tooth.
– The integrity of tooth surface and the
arch.
Objectives of operative dentistry:

• Diagnosis
• Prevention
• Interception
• Preservation
• Restoration
• Proper diagnosis of defect, (including their
location and extent), is important for:

Treatment planning.

Design of the tooth preparation.

Selection of restorative materials and

procedures.
• Every step of operative procedure should care about
disease prevention.
e.g. the location of the margins of tooth preparation and
the shape (contour) of the final restorations
Bringing the margins of the final prepared to the
self-cleansable areas of the tooth by including
the non self-cleansable areas in the cavity of the
tooth
• This refers to preventing further loss of tooth

structure by stopping an active disease process.

•Change in Patient’s home care habit.

• Removal of the Lesion.
•Altering Tooth form.
•Recontouring of tooth
•Correct Occlusion etc.
• During the tooth preparation for

restoration , it is essential to preserve the:

• the vitality and anatomy of remaining tooth

structure is of great importance.

• This may include restoration of form,
function, phonetics, esthetics and
occlusal stability.
Dental stool

• Back rest for lumber support.

• Can be adjusted at any height

by lever control.

• Rotates freely 360 degrees.

• Foot supporting ring with

adjustable height.
• It is important that patient and
operator are properly positioned.

PROPER POSITIONS IS a
MUST

Why ?
• The 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.

• This improves their efficiency of the dental team and

allow more efficient instrument exchange.
DENTAL TEAM POSITIONS
• Operator must be able to perform delicate
skills with limited access
Basic Issues of Interest in Dentistry

• Minimizing stress and fatigue for the dentist

• Increase productivity while maintaining high

quality standards
4-Handed Dentistry Reduces Stress

• Increases the efficiency and the productivity

PATIENT’S POSITION
PATIENT POSITION
• Patient position varies with the operator, the
type of procedure, and the area of the mouth
involved in the operation.
• In the almost supine position, the patient's
head, knees, and feet are approximately the
same level.
• Patient's head should not be lower than his
feet
PATIENT POSITION
• The most common patient positions for operative
dentistry are almost supine or reclined 45 degrees
OPERATOR’S POSITION
 Characteristics of Balance Posture for
Operator
• Operators thighs parallel to floor
• Entire surface of seat used to
support weight
• Backrest supports back without
interference
• Forearms parallel to floor when
hands are in operative position
• Elbows close to the body
• Back and neck reasonably
upright with top of shoulders
parallel to floor
 OPERATING ZONES
• For the efficient, comfortable practice of team dentistry
RIGHT HANDED DENTIST
LEFT HANDED DENTIST
OPERATORS POSITIONS

• For a right-handed operator, there are essentially

three positions in his working zone

• Right front -7 o'clock positions

• Right – 9 o'clock positions

• Right rear - 11o'clock positions.

OPERATORS POSITIONS

• A fourth position, direct rear or 12-o'clock

position, has application for certain areas of the
mouth
OPERATORS POSITIONS

• All of the positions may be used from the

standing or seated operating position
• Seated worker uses 27% less energy
• Seated worker has 17% greater life expectancy
• Production increases from 33 – 78%

• most dental treatment is delivered from a

seated position, to relieve stress on the
operator's legs and support the operator's
back.
RIGHT FRONT POSITION (7 o'clock)
• This right front position facilitates work on
a) mandibular anterior teeth
b) mandibular posterior teeth (especially on
the right side)
c) maxillary anterior teeth.
• It is often advantageous to have the patient's
head rotated slightly toward the operator.
RIGHT FRONT POSITION (7 o'clock)
 RIGHT POSITION (9 o'clock)
• The operator is directly to the right of
the patient

• This position is convenient for

operating on

a) facial surfaces of the maxillary and

mandibular right posterior teeth

b) Occlusal surfaces of the mandibular

right posterior teeth.

RIGHT REAR POSITION (11 o'clock)
• Position of choice for most
operations

• 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 position positioned
around the patient's head.
 Cont.:
• When operating from this
position, the lingual and incisal
(occlusal) surfaces of the
maxillary teeth are viewed in the
mouth mirror.

• Direct vision may be used on

mandibular teeth, particularly on
the left side, but the use of a
mouth mirror is advocated for
light reflection, retraction, and
visibility.
 DIRECT REAR POSITION (12 o'clock)
• This position is 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.
FOR LEFT HANDED
• LEFT FRONT/5.00 Clock:-
a) Mandibular anterior and Posterior
b) Maxillary Anterior.
• LEFT/3.00 Clock :-
Facial surfaces of Lt Maxillary and Mandibular Posterior Teeth
and occlusal surfaces of Lt Mandibular Posterior Teeth.
• LEFT REAR/11.00 CLOCK:-
a) By using mirror lingual and incisal(occlusal)surfaces of
maxillary teeth seen
b) Direct vision for mandibular teeth
 GENERAL CONSIDERATIONS
• The operator can rotate the patient's head backward
or forward or from side-to-side for better access and
visibility of the operating field
• When working in the maxillary arch, the occlusal
surfaces should be approximately perpendicular to
the floor.
• When operating in the mandibular arch, the occlusal
surfaces should be approximately 450 degrees to the
floor
• The face of the operator should not come
in close proximity to that of the patient.
The ideal distance is similar to that for
reading a book.

• However, small, detailed, or inaccessible

tooth preparations may require closer
proximity for adequate visibility.
• Minimize body contact with the patient.
• Do not rest forearms on the patient's shoulders or
hands on the patient's face or forehead.
• The patient's chest should not be used as an
instrument tray.
• 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.