HAND INSTRUMENT TECHNIQUES

There are 4 grasps used with hand instruments: 1. Modified pen 2. Inverted pen 3. Palm -and -thumb 4. Modified palm and-thumb. The conventional pen grasp is not an acceptable instrument grasp.

1)Modified pen grasp

MODIFIED PEN GRASP

y Permits greatest delicacy of touch. y Pads of thumb ,index , and middle fingers contact the instrument ,while the tip of the ring finger is placed on a nearby tooth surface of same arch as a rest. y Palm of hand facing away from operator. y Pad of middle finger placed near topside of instrument ;by this finger working with wrist and forearm .cutting pressure generated on the blade.

y Instrument should not b allowed to rest on or near the

first joint of the middle finger as in conventional pen grasp ; because it limits d application of pressure. y A balanced instrument design allows application of suitable force without the instrument tending to rotate in the fingers.

2)INVERTED PEN GRASP

y Finger positions are same as that for modified pen

grasp. y Hand is rotated ,so that the palm faces more towards the operator. y Used mostly for tooth preparations employing the lingual approach on anterior teeth.

Inverted pen grasp

3)Palm and thumb grasp

y Similar to that used for holding a knife while paring

the skin from an apple.

y Handle is placed in the palm of the hand ,grasped by all

fingers , while the thumb is free of the instrument , and the rest is provided by supporting the tip of thumb on an nearby tooth of same arch or on a firm ,stable structure .
y For suitable control , this grasp requires careful use during

cutting.

Palm and thumb grasp

4)Modified palm and thumb grasp

 Used when it is feasible to rest thumb on tooth being prepared or adjacent tooth .  Handle of instrument held by all 4 fingers , whose pads press the handle against the distal area of palm and the pad and first joint of thumb.  Grasping handle under 1st joint of ring and little fingers acts as a stabilizer ; this grip fosters control against slippage.

y It is usually employed in area of maxillary arch

and is best adopted when the dentist is operating from a rear chair position.

y The modified pen grasps and inverted pen

grasps are used practically universally.

RESTS
y A proper instrument grasp must include a firm rest to steady the hand during operating procedures . y When modified pen and inverted pen grasps are used ,rests are established by placing the ring and little fingers on a tooth of same arch and as close to the operating sites as possible. y The closer the rests are to the operating area .the more reliable they are .

RESTS
y When palm and thumb grasps are used , rests are created by placing the tip of thumb on tooth ,or on a convenient area of same arch. y In some instances , its impossible to establish normal rests on tooth structure , and soft tissues must b used . y Neither soft tissue rests nor distant hard tissue rests afford reliable control , and they reduce the force power that can be used safely.

y Indirect rest may be gained by using index finger

of opposite hand to rest on shank of instrument.

y Operating hand rests on opposite which rests on

stable oral structure.