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

Course Author(s): Betty Ladley Finkbeiner, CDA-Emeritus, BS, MS

Instrument Transfer 

Skillful instrument transfer has become a primary result of time and motion studies in dentistry. Use of an efficient instrument transfer is one of the basic skills every dental team must learn 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. Note, in the Zones of Activity section, the transfer zones are indicated for the left and right -handed operator. 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 recent years there has been a diminished emphasis on formal education in the basic principles of a 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. A dental assistant who has graduated from a Commission on Dental Accreditation (CODA) dental assistant program will be educated in instrument transfer procedures. The assistant can modify this procedure at chairside. Proper instrument transfer techniques serve to:

  1. conserve motion
  2. increase the smooth flow of the procedure
  3. 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. The transfer is dictated according to instrument design to ensure safety during the transfer and ensure that the objectives of proper technique, as listed below, are realized:18,19,

  • 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; from their left hand for right -handed operators and the right hand for left-handed operators.
  • The assistant holds the oral evacuator in the hand not being used to transfer the instrument; right hand for the right-handed operator and left hand for the left-handed operator.
  • When using the air/water (A/W) syringe it is held in the hand opposite the hand holding the oral evacuator; that is the transfer hand.
  • When the transfer occurs the A/W syringe is transferred to the opposite hand holding the oral evacuator. For a short period of time, the tip of the A/W syringe can be grasped with a couple of fingers while simultaneously holding the oral evacuator.
  • 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 firmly to the operator. The operator must feel the instrument in their hand and the assistant must account for a slight reduction in this tactile sense due to wearing gloves.
  • The operator can 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 A/W 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.
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