Dental Instrument Setups

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2-14. GENERAL

The dental assistant in the Restorative Dentistry Section performs duties common to all specialists. His duties are largely related to assisting the dentist in cavity preparation, placement of restorations, and fabrication, and placement of crowns.

a. Procedures Vary. Procedures followed in restorative dentistry vary with the operator, location and extent of the tooth structure to be replaced, and restorative material to be used. Local anesthesia is used routinely by most dentists. Rubber dam is routinely used by many. Some operators make wax patterns for gold alloy restorations directly in the prepared teeth (direct method), while others make the wax patterns on dies or models produced from impression of the prepared teeth (indirect method).

b. Instrument Setups Vary. Each restorative procedure requires a different instrument setup and a different sequence of steps. dentists have their individual variations of procedure and favorite instruments. For that reason only typical instrument setups and procedures are described in this lesson (see Appendix A). Each dental assistant must learn variations desired by the dentist he is assisting. The dental assistant will learn, through instruction and experience, to anticipate dental treatment requirements. He will be able to assist and to have instruments and materials ready when needed without being reminded. As a quick reference, the various instruments used for each step of the restorative procedure are listed in Appendix B.

c. Support Duties Vary. When not directly assisting the dentist, there are always support duties that must be done by the dental assistant, such as cleaning and sterilizing instruments; cleaning and straightening the instrument cabinet; sharpening cutting instruments; replenishing supplies; cleaning and lubricating handpieces; changing soiled linens; charting records and making administrative entries in dental records and other forms.

d. Assisting During Cavity Preparation. There is no phase of dental treatment in which a dentist can better use another set of hands, than in the performance of restorative procedures. Ways in which the dental assistant can help during cavity preparation follow:

(1) Attend to the patient's needs.

(2) Maintain an orderly arrangement of instruments and materials in the work area.

(3) Adjust the light.

(4) Remove from the operative area instruments and materials, which are no longer needed. As time permits, these items should be removed and cleaned.

(5) Wipe instruments free of blood and debris with sterile gauze as they are used.

(6) Provide instruments needed for the next step before they are needed.

(7) Anticipate the dentist's needs. Using the left hand, be ready to place the next instrument in the dentist's working hand in the position in which it will be used.

(8) Be familiar with methods of passing instruments.

(9) Use the water and air syringes as desired by the dentist. Some dentists employ a water-air coolant spray attachment on the handpiece. Others have the dental assistant direct a stream of water or air into the cavity to reduce the frictional heat of rotating cutting instruments and to keep the cavity free of debris. A stream of air sprayed upon the mouth mirror may be helpful in keeping the mirror free of water and other material so that it does not interfere with the dentist's vision. The dentist will occasionally stop to inspect his work. Then, the assistant usually is expected to dry the cavity with the air syringe so that it may be seen better.

(10) Keep the operative site free of saliva, water, blood, or debris by proper use of the dental evacuator.

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