ERGONOMICS FOR PERIODONTAL MICROSURGERY

By Martin A. Boudro, D.D.S., M.S.D

Silverdale, WA

12 O'clock Position- Direct Observation

Surgical Site	Facial Upper Anterior	Facial Lower Anterior	Buccal Upper Left	Buccal Lower Left	Lingual Lower Right
Patients Head	Center	Center	To Right	To Right	To Right
Chair Back	Horizontal	Horizontal	Horizontal	20-35 Degrees	20-35 Degrees

12 O'clock Position- Mirror Observation

Surgical Site	Palatal Upper Anterior	Palatal Upper Right	Palatal Upper Left	Lingual Lower Anterior
Patients Head	Center	Center	Center	Center
Chair Back	Horizontal	Horizontal	Horizontal	45 Degrees

	9 O'clock Position- Direct Observation
Surgical Site		Buccal Upper Right	Buccal Lower Right	Lingual Lower Left
Patients Head		To Left	To Left	To Left
Chair Back		Horizontal	20-35 Degrees	20-35 Degrees

General Conditions

1.       Use direct vision when possible to free both hands for instruments (e.g. scissors/tissue forceps). Recognize that direct vision is not always possible.

2.       Put entire surgical field in a plane perpendicular to microscope objective to minimize depth of field limitations when possible.

3.       Position patient and microscope to permit a relaxed upright operator position minimizing physical stress.  Microsurgery requires fine motor movements easiest to accomplish when operator is relaxed.

4.       Extension or flexion of the patient's neck should be adjusted in any position for maximum visibility.

5.       Effective utilization of the mirror and selection of appropriate mirror size enhances visualization of the surgical field.  This greatly reduces the need for constant repositioning of the microscope, patient, or operator.  Small mirrors (00) enable visualization of interproximal root surfaces.  Large diameter mirrors (#5) are useful in visualization of the distal surfaces of terminal molars.  Mirrors must be premium quality front surface for maximum light transmission.

6.       This list of useful positions is not exhaustive.  However, mastery of them will develop the ability to position for a given circumstance.