Treatment in perfect balance: For the successful dental practice by Sirona Dental Systems

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August 2017

Treatment in perfect balance ÂŠ conrado/Shutterstock.com

For the successful dental practice Do it yourself!

Everything at a glance

Twelve practical insider tips on ergonomics

Poster of six optimal treatment positions

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Sinius

Efficient to the roots

Content

3 EDITORIAL 4 INTRODUCTION 8 DENTAL PROFESSIONAL AND PATIENT 18 TREATMENT POSITIONS AT A GLANCE 20 ERGONOMICS MEETS DESIGN

The Sinius treatment center is not only ultra-compact – it also delivers clear gains in terms of time and treatment flexibility. The integrated endodontic function guarantees a better workflow and thus greater treatment success. With the integrated reciprocating file systems available only for Dentsply Sirona treatment centers, Sinius offers you a fast and simple way to use all standard file systems. The file library can be easily supplemented with other file systems. With Sinius you have a perfect overview of the entire workflow and can work absolutely hygienically, confidently, and efficiently.

30 TREATMENT IN BALANCE

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Editor in chief: Dipl.-Kff. Antje Isbaner Phone: +49 341 48474-120 a.isbaner@oemus-media.de Printed by Silber Druck oHG Am Waldstrauch 1 | 34266 Niestetal Publishing law and copyright: The magazine and the contained articles and figures are protected by copyright. Any use without the publisher’s consent shall be improper and liable to prosecution. This shall apply in particular to duplications, translations, microfilming as well as the storage and processing in electronic systems. Reprinting, even of extracts, shall be permitted only with the publisher’s consent. If articles are sent to the editorial department, consent to full or partial publication shall be implied, unless noted down otherwise. Upon sending in the manuscript, the right to publication as well as the right to translation and to award rights to reprint in English or German, to electronic storage in data bases to make special editions and photocopies shall be transferred to the publishing company. The publisher does not assume any warranty for books and manuscripts sent in unsolicited. Articles marked with other initials or names than those of the editorial staff members reflect the opinion of the authors, which does not necessarily correspond to that of the editorial staff. The author of such an article shall bear the responsibility. Special sections and adverts marked as such are not the responsibility of the editorial staff. The publisher does not assume any warranty for association, business, and market information. The liability for consequences of incorrect or flawed presentations shall be excluded in any case. The place of jurisdiction is Leipzig.

Company Dentsply Sirona – The Dental Solutions Company™ www.dentsplysirona.com www.sirona.com

Editorial

Ergonomics: A captivating account at last â&#x20AC;&#x153;Yet another person, telling me how to sit.â&#x20AC;? This or similar is the frequent reaction to lectures or articles focusing on ergonomic processes in dental surgeries. The subject is perceived as patronizing, and does not trigger any type of reward pattern in the brain. Instead, a bad conscience nudges the frontal lobe. Most practitioners know that mistakes are being made in their own practice in regard to ergonomics, but the unknown is how to improve the situation without having to give up long-established and preferred behavioral patterns. For these reasons, it is hardly worth the effort to make changes. Even though a physiotherapist friend of mine once told me that he can recognize dentists from their posture from a distance, I can hardly believe that dentists are attentive to how they treat themselves and their bodiesâ&#x20AC;&#x201D;at least not before it is too late. In the dense daily routine at the practice, the individual ergonomic aspects may easily get lost in the abundance of the full range of dental treatments. They are regarded as insignificant enough to disregard them or simply rationalize them away. The

conclusion is that we need to reconsider ergonomics to really determine its importance for dental professionals in enjoying working and being able to work. And this is exactly what this booklet is intended to accomplish: Raise awareness of the factors of success in a dental surgery that do not originate from the broad range of therapeutic offers, but from how the daily workflow is organized and designed. In short: the proper balance of interaction between man, machine, and space. Enjoy reading!

Michael Geil, CEO of Dentsply Sirona Bensheim and Group Vice President of Treatment Centers

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Introduction

Does ergonomics sound complicated? It is actually not! But what is behind the term? Why is ergonomics so relevant in the daily routine? And which connections can we make regarding fefficiency and freedom from stress in defining the key to the success of a dental surgery? The term ergonomics originates from the Old Greek terms ἔργον (ergon—labor, work) and νόμος (nomos—rule, law).1 As part of work sciences, ergonomics serves “(…) to optimally design work systems with regard to the coordination of man, machine, and working environment”. There is a connection between human workforce, healthy maintenance of this workforce, and economic yield.

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The simplified aim derived from this is that people should be able to do their work as successfully as possible without causing physical stress.1– 5 The body may tolerate overexploitation for some time—if, however, the limit is exceeded, job per formance deteriorates rapidly along with the aspect of (economic) yield and success.

Relaxation instead of tension Ergonomics can be understood as the inter face between man and machine. The following considerations and attempts will focus on the dental professional and the treatment center, with the top priority being comfortable, and pain and stress free treatment—not only for the patient, but also for the person providing treatment! The proverb does not say for nothing that health is the highest good of all—losing it has far-reaching consequences both personally and professionally.

Tips on ergonomics facilitating the daily routine at dental surgeries originate from Hamburg dentist Thomas Senghaas, and are based on his findings and experience gained over decades of professional life. Thomas Senghaas’ areas of expertise comprise endodontics, implantology as well as research and development, and guarantee inside knowledge of the very specific issues and challenges in daily dental work.

Ways to better efficiency

Dental surgery ZA Thomas Senghaas Dr. Katayoun Nadjmabadi Maria-Louisen-Straße 67 22301 Hamburg

Only a dental professional without physical troubles, meaning without an aching spine or tense neck—resulting from many years of strain during treatment—is able to pay full attention to and concentrate on his patients, purposefully and efficiently without any distractions, to achieve optimal results. Thus, one can provide more treatments per patient and treat more patients.

Success can be planned Ergonomic aspects reinforce success and make the difference between a dental surgery that is regarded as average and a dental surgery that is successful above the ordinary. Because success not only depends on WHAT you do, but also on HOW you do it.

The success of dental surgeries is made of three building blocks: medical, economic, and personal success. The three components are closely interlinked. Medical success is usually the basis of economic success. Economic success in turn contributes considerably to personal success. When you reach personal success, this again influences clinical and economic success.

Mandibular positions © Iakov Kalinin/Shutterstock.com

Building blocks of success

tip The necessity to position the patient’s head between one’s hands and knees results in the preferably horizontal adjustment of the backrest in particular with regard to mandibular positioning. Only then and by sufficient seat height will it be possible to access the lower jaw in an ergonomic way without twisting one’s spine.

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Introduction

tip

Greater seat height provides legroom

Working frequently with your torso twisted leads initially to muscle hardening and later to permanent medical conditions. The cause is insufficient seat height of the dental professional. The first and foremost rule of ergonomics is to create as much space between the hands and knees of the dentist as possible. There must be sufficient room for the patientâ&#x20AC;&#x2122;s torso and the backrest. In order to create sufficient room for the backrest and patient, in particular for mandibular treatments, the dentist needs to be seated in a high position and the patient arranged in an accordingly high and horizontal position. For this purpose, dental chairs with large lifting springs are required. For tall and big patients, even an additional saddle chair is recommended to achieve the necessary seat height and sufficient legroom for ergonomic treatment.

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Medical success Recognition in the clinical field is more easily achieved when the dental professional succeeds in convincing patients, uncompromisingly, of the best clinical therapy. If he is then able to reach the best results for the applied therapy, the patients’ trust increases. Based on this scenario, the dentist can better motivate his patients to per form adequate oral hygiene and prophylaxis measures.

Personal success

Is defined by satisfaction on the job, the degree of recognition by patients, team, colleagues, or the social circle, and not least the level of status achieved. Furthermore, the degree of decisionmaking autonomy is crucial for personal success and the safe future of the dental surgery.

Economic success This aspect often depends on how well you succeed in generating a higher yield per treatment, in applying more treatments per patient or in acquiring more patients.

tip Preparation of horizontal position To achieve the horizontal positioning of the patient and overstretching of the head for mandibular treatment, it may be necessary to prepare the patient accordingly. Especially older patients or patients suffering from paroxysmal positional vertigo have problems with being lowered rapidly by the motor-driven treatment center. It may be helpful for patient compliance in this regard to move the patient into a sunbed-like “wellness” position before starting therapy. Such a half-lying position prepares the organ of Corti and circulation for being moved to the fully horizontal position later.

In summary In adapting the term of ergonomics to a dental surgery, the dental professional should be enabled to pay attention to himself and to act without pain. Ergonomic aspects simply reinforce medical, economic, and personal success. Ergonomics not only enables the dental professional to relax and focus on the patient, but thereby also generates more confidence and better clinical results—and consequently economic success and personal satisfaction.

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Dental professional and patient

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Successful treatment Ergonomics makes all the difference There are various dimensions of success––always depending, however, on the interaction of the treatment center, dental professional, and readiness to work ergonomically. Furthermore, an ergonomic workflow improves patient compliance. All these key points considered together make success tangible.

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Dental professional and patient

Increased success results from working ergonomically. Only the relaxed dental professional, who is free of pain, can fully attend to his patients with utmost concentration, nurturing full patient satisfaction, and a successful and recommended practice.

Starting with medical success, which is the basis of any further success, the first step is convincing the patient of the best clinical therapy, even if the best often is the most expensive therapeutic option. The dental professional’s personality and the patient’s confidence are crucial in this regard. It is prerequisite that the three ergonomic factors are complied with: one’s own wellbeing, focus on the patient, and patient comfort. Pain impairs a person’s charisma and patients can feel whether their dentist is concentrating on them or his own ailments. Charisma and focus generate confidence, and being more confident, patients decide more often in favor of

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the best possible therapy and thereby the better therapeutic result. Another plus is that superior treatments usually do not only provide for better therapeutic results, but lead to improved patient compliance due to the fact that they are more expensive. In the end, the dental surgery will be recommended. The goals of economic success are: greater yield per treat ment, more treatments per patients, and more patients. However, yield increases are rather seldom achieved by savings, increased prices, or a faster way of working, just as the number of treatments per patient is limited by nature. All

Three ergonomic factors Successful treatment is probably the goal of every dental professional and every dental surgery. Success is strongly influenced by ergonomics, or more precisely by the factors of ergonomics, even though it does not solely depend on them: • Dentist’s wellbeing • Focus on the patient

• Patient comfort

that remains is to generate more pa tients or more of the “right” patients. That means specifically those patients with great dental awareness, who visit the surgery because it was recommen ded to them, who know a lot about the treatment—thus reducing the time need ed for the consultation—and who know the price level of the dental surgery. Re commendations are usually made on the same social level. However, the prerequisite again is confidence, the dental professional’s personality, and good consulting services—and the three ergonomic factors as the indispensable basis. Personal success is measured by the dentist’s satisfaction on the job. Does

tip Positioning of small/female patients he practice the dentistry, he once stud ied for? Does he receive the remuner ation he earns? The three ergonomic factors also have an important impact on personal success. How much recog nition is received from patients, team, colleagues, or the social circle? What is his status level? To what degree is he autonomous to make decisions and how assured is he in looking to the future? All this depends, among other things, on medical and economic suc cess—and not least again on the three ergonomic factors. This means: The combination of WHAT you do and HOW you do it sets a spiral in motion whose direction is guided by the dental professional.

A treatment device may not be optimized for all body heights. It’s sometimes difficult to position rather small patients ergonomically. With treatment centers with hardly or insufficiently adjustable headrests, it is easier to twist oneself than to position the patient correctly. With motor-driven headrests, however, the headrest can be simply rotated by 180° on the magnetic surface, so that the point of head support is repositioned sufficiently into the caudal direction. To adjust the height, the headrest is lowered by about 20° by pressing a button. Thus, even small patients can be treated in all positions in an ergonomic way without losing comfort and without the dentist’s need to twist or bend.

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Survey

You must suffer to succeed … or do you?! “Hang on”, I keep telling myself! The last two patients today are important, too––I don’t want to

An online survey6 conducted in November 2016 among 300 dentists in Germany and the USA, respectively, yielded the most interesting informa tion on the participants’ working conditions.* The study set its sights on three aspects of the daily treatment routine: The importance of comfort and design of a treatment center, how patients feel during treatment, and work related pain of the dental professional. One of the survey results stands out: A number of dentists – that should not be underestimated – suffers from pain while doing their daily work. On a scale from 1 to 6 (1 meaning no workrelated pain and 6 meaning violent workrelated pain), 23 percent of the interviewed den tists in Germany stated that they suffered from moderate pain of grade 3, eight percent from violent grade 5 pain, and still one percent from very violent grade 6 pain. When applying further graduation, incipient perception of pain becomes apparent in 49 percent of the examined dentists in Germany. Similarly clear sta tements were gathered from the US four percent of the interviewed dentists suffer from very violent pain, eight percent from grade 5 pain, and 18 percent from grade 4 pain. In view of such information, we must ask the question: Is pain part of a dentist’s professional life or can he do without by implemen ting the proper knowhow and treatment center?

* Most of the dentists in Germany, who participated in the survey, use treatment centers by a Dentsply Sirona or KaVo. In the US, however, most of the participants in the survey work with ADEC units. Furthermore, the majority of answers were generated by male dentists from the ﬁ eld of general dentistry, who work an average of 36 to 40 hours a week in Germany and 30 to 35 hours a week in the US.

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have to cancel on them …

Work-related pain of dental professionals Intensity of workÂrelated pain 1%

3% 29 %

26 %

16 %

18%

no pain

23 %

17 %

32 %

19 %

severe pain

Importance of comfort Comfort of dentist during treatment 2% 63 %

25 %

3% 5%

4% 3%

28 %

57 %

Patient comfort 2%

3% 3% 72 %

20 %

unimportant

6% 2%

18 %

32 %

42 %

very important

State of relaxation of patient during the treatment How much easier is it to treat a relaxed patient compared to an anxious, stressed patient? 2%

1% 80 %

14 % 1 %

not easier

2% 1%

24 %

much easier

66 %

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Dental professional and patient

Focus on the patient

Personality of dental professional

Surgery ambiance

Comfortable treatment

Without patients, there would be no professi onal basis of the dentist’s work—and of course no medical, economic or personal success. The best motor of success in the end is that patients recommend a practice. However, patients should be satisfied with the dental surgery, the dental professio nal, the team, the offered treatments and the results in order to make recommendations. The patients’ satisfaction comes from special and excellent treatment results.

Treatment experience

The special treatment experience develops from what the dentist offers and how he implements services. Examples of WHAT include prosthetic care in a session or integrated implantology and its remarkable safe ty through simultaneous surgical and prosthetic planning of the implant and the reliable implementation of the plan by means of a highly precise drill template.7 The HOW comes from the dental professional’s personality, the surgery ambiance, treatment comfort, pain management (of the patient, in this case), and to which extent expectations raised in the consultation are met.

Patients appreciate when the dental professional focuses only on them and advises them com prehensively and comprehensibly. Especially at the beginning, the relationship between patient and dental professional requires confidence, which again presupposes a self-secure personality of the dental professional. What he says and the therapeutic results need to be convincing. Even the smallest pain in the neck, back, or shoulder and the resultant mental distraction prejudice that. This is where it depends in particular on the interfaces between treatment center, patient, dental professional, and assistant. If the treatment center is designed so that dental professional and assistant are seated properly, the patient is positioned correctly, and the dental professional has optimal view of the treatment area, a lot is gained. The dental professional should create a technical working environ ment providing all the requirements for above-average success. Thus, he can make use of the environ ment with profound confidence and provide the patient with the best care.

The ambiance of a dental surger y bears a great power of selection. It is impor tant that ambiance and equipment reflect what the den tal professional wants to express with his practice. The more the concept and style match, the more credible the dental practice and treatment. The treatment center as the center of the dental surgery is most significant. It is fur thermore, where the patient puts himself in the care of the dental professional—and not least the ergonomic inter face intended to be of benefit to the dental professional in his daily work.

Good design

A well designed treatment center, i.e. with a syn thesis of aesthetics and function, positively affects the mood and wellbeing of the dental profes sional and patient. A study conducted with 2,000 subjects on behalf of HTC, one of the world’s leading manufacturers and de signers of smartphones and mobile innovations, proved that be autiful and at the same time useful everyday objects have the same positive effect as looking at artworks or physical exerci sing. Good design triggers positive emotions and produces ease and comfort by harmonizing logical thought and feelings. This means that those who are able to look at and use objects that combine aesthetics and function in everyday life, are happier.8

Aesthetics is perceived as appreciation. Similarly is a comfortable place of treatment: A motor-driven headrest that lowers the patient’s head anatomically backwards; comfortable access properly positioning the patient smoothly and carefully by forming the right angle between upper and lower body and adjusting itself to the spine; maintained comfort from beginning to end of treatment; provision of a massage function; and compensation for temperature fluctuations allow for uncompromising focus that the patient will value.

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Patient pain management

Tension and relaxation have great influence over the patient’s pain perception. Nervous patients need more analgesics than patients associating the visit to the dentist with positive feelings. In general, the place of treatment as the central element may greatly influence the patient’s sensations. Comfortable access and a welcoming position of the treatment center, adjusted to the patient, tidy work place with integrated devices and consumables prepared in the background ready to be placed on the tray only after the treatment has started, create a sense of wellbeing and confidence in the patient, counteracting or relieving stress. And not least, the lack of stress will make the treatment more successful for both dentist and patient.

Meet the patient’s expectations

The patient wants to be treated like a spe cial customer, particulary if the highervalue treatment has been chosen. He wants to be courted and expects service at eye level. In addition, professional and com prehensible advice is expected. The patient wants to understand the treatment options in order to make the best possible choice. After all, the patient wants the dental professional to be fully focused and then see the promises held in the form of excellent therapeutic re sults. That is a great deal. The dental professional should avoid medical and equipment compromise from the outset. In the end, the recommendation of the dental surgery is at stake.

In summary The dental professional serves the patient—and the treatment cen ter serves the dental professional. By sophisticated ergonomics and optimal workflow, relaxation is provided, and thus investment in such critical areas is an investment in the future of the dental surgery. You should compromise only in exceptional cases.

tip Positioning of children For small children, it is not sufficient to turn the motor-driven headrest. The head of a child is positioned where the head of an adult would be, only the child’s bottom will be positioned higher on the horizontal backrest. In addition, the motor-driven headrest is extended even farther, depending on the height of the child, in order to place the child’s bottom in a stable, centered position on the backrest. In this way, all ergonomic positions and gripping paths are properly maintained.

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Interview

Bringing the future into the present It sounds very simple: Easy handling. Innovative comfort. High-quality design. But how can you realize these and more demands on a treatment center from the first idea to the finished product? Which steps are incorporated in the development of an ergonomically optimal treatment center with well-thoughtthrough and practicable workflows? Mechanical engineer Günther Moritz, developer of treatment centers at Dentsply Sirona, delivers insight into his work behind the scenes.

What does the development of a treatment center like, e.g. Teneo look like? Which impulses do you get from real life and research? Designing a treatment center for us is based on a holistic understanding of ergonomics. The healthy posture of all people involved in the treatment and their safety are the primary issues. The use of the functions is organized according to rational aspects, with technology always being secondary to man. The position of the dentist and his assistant in relation to the functional components —patient chair, dentist element, assistant element, light, operating surfaces, display, foot switch, and so on—is most important. In connection with possible patient positioning, treatment workflows unfold according to ergonomic factors almost automatically. In this regard, the position of the patient’s head and thus the headrest take a key position because a headrest that can be adjusted only with difficulty, will not be adjusted at all in the daily routine, as it is easier for the dentist to simply twist and bend. The design is furthermore based on requirements from anthropometric data sheets, standards, and directives.

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The validation accompanying the development process in the form of tests and trials conducted by focus groups helps to develop and finally ensure the fitness for use. Observations of the treatment centers operated in practice, evaluations of customer complaints, and benchmarks are other important indications and impulses incorporated in our development process, supplemented by information from the market, for example the medical development of therapeutic concepts or technological trends and innovations. In your opinion, what characterizes a practicable workflow? The workflow has to be in line with the work routines and habits of the user, be of benefit to him and actually provide for added value in the dental treatment. This includes the intuitive recognition of the work progress and the possibility of intervening at any time in case of necessary deviations therefrom as well as being individually configurable and upgradable. Operating elements/sur faces must be available, the haptic and visual properties of

Günther Moritz works as mechanical engineer at Dentsply Sirona Treatment Centers. He started in 1974 in the production and work preparation department of Sirona and is at present co-responsible for innovations and treatment center concepts, in particular regarding ergonomics.

which are in harmony and can be really operated during the treatment. To create ideal working conditions, all elements of a treatment center need to interact and integrate into the workflow, for example, the foot switch for handsfree control.

in the design of the treatment center, particularly of the inter faces. Designers and developers collaborate closely to create a visual and haptic appearance representing the product characteristics in top quality and consistent value.

How do you design a treatment center that will still comply with the dental and medical requirements even in ten years? Before and during the development of a treatment center, the product management and development department thoroughly examine the demands on functionality for the possibilities of medical development. In addition, they analyze findings and studies conducted by universities, dental surgeries, and others as well as “new” workflow trends and—this is the central look forward— consider their relevance to the future. Linking-up with devices of other Dentsply Sirona divisions plays an important role, too, with regard to holistic dental treatment. Similarly, we evaluate the technologically possible and necessary changes. All findings are incorporated

Keyword head position: What is the clear advantage of the motor-drive? The head positions for the treatment of upper and lower jaws requires different degrees of overstretching. This provides for a good view of the dental surfaces to treat when the mouth is open. The motor drive of the headrest adjusts the support angle and at the same time the point of head support on the longitudinal axis. The kinematics of the headrest simulates the anatomic movement of the head and thus optimally supports the patient’s head and spine. This way, you can adjust ergonomic treatment positions quickly and in a well-targeted manner. The headrest is, like I said before, adjusted so easily that the dentist can do it even during the session, and this a basic requirement for ergonomic treatment.

Interviewer: Marlene Hartinger

tip Hands-free control It is essential for the entire therapy process to leave both hands in the working field, if possible, and to control the therapy by means of the foot switch. Once the dental professional has adapted to this process, work will get done considerably faster and more efficiently. And patients feel immediately, whether the dentist can fully concentrate on them or needs to take care of adjusting the treatment center.

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Six ergonomic treatmen UJ-palatal front This refers to palatine treatment, i.e. with indirect view

10 11

and extra-orally guided photo mirror. The patient’s head is shifted slightly towards the dentist to advance to the 11:30 position. The patient lies mostly horizontally with

far overstretched head, so that the tip of the nose is not lower than the patellae (comfort horizontal), as otherwise patient compliance is overstressed.

10 11 12

UJ, quadrant I (right UJ), molars The molars of the first quadrant are treated between the 10 and 12 o’clock positions, and the patient’s head is slightly tilted to the assistant’s side and rolled a bit to the left. To compensate for this, the torso on the backrest is slightly shifted towards the dentist. The head is only moderately overstretched though. It applies again: The tip of the nose is positioned above the patellae.

UJ, quadrant II (left UJ), molars

10 11

The operator position is between 11 o’clock and 12:30. Below 12 o’clock, the legs are twisted with the assistant’s legs. The assistant’s right leg is positioned to the left of the left dentist’s leg and her left leg between the dentist’s legs. The patient’s torso lies on the left side of the backrest and his head is rolled over to the right in this way, he presents the left maxillary molars to the dentist en face. If possible, the head is maximally overstretched.

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nt positions at a glance LJ front

For this, the operator position is between 11 and 12 o’clock. Usually, the operator puts his left hand around the patient and supports himself on the patient’s chin. Direct view to the

lower jaw front is from above, passing along the nose and upper jaw closely. Very important for sufficient legroom of the operator team: The patient must be positioned absolutely horizontally. The motor-driven headrest is maximally upright. The patient tilts his head forwards and lowers his chin to his chest as far as possible.

10 11 12

LJ, quadrant III (left LJ) The operator sits in the 9 o’clock position. The actually required operator position is 6 o’clock to be able to view the patient’s left lower jaw. This is achieved by turning the head accordingly and shifting the patient to the side. The patient with his head shifted to the side looks directly upwards into the dentist’s face (virtual 6 o'clock position for the dentist). To be able to lie comfortably in this position, the torso is shifted again to the left and slightly rolled to the right on the backrest.

LJ, quadrant IV (right LJ) The operator position again is 9 o’clock, sometimes even 10 o’clock. It is important that the lower part of the dentist’s spine is upright and he does not crouch, e.g. to see the buccal side of 46 or 47. The

10 11 12

patient’s head is slightly turned away from the dentist towards the assistant, slightly tilted, and rolled over in order to present the right lateral side of the mandible to the dentist.

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Xxx Ergonomics meets design

Manufacturer details ZWP EXTRA Behandeln in Balance

Teneo Perfect interaction Teneo made by Dentsply Sirona Treatment Centers represents the uncompromising demand to optimally connect ergonomics, hygiene, and design down to the smallest detail.

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Ergonomics meets design

The Teneo treatment center perfectly combines intelligent ergonomic concepts and efficient workflows. Thus, exactly synchronized work and treatment processes for the daily routine are available to the dental professional automatically and at any time. This translates into easier processes and perfect results, which are most satisfying likewise for the dental professional and the patient. Sophisticated automatic functions of the treatment center guarantee a healthy and convenient way of working: The dental professional does not need to reposition the patient, himself, and the treatment center over and over again, so that he can take the next treatment step in an ergonomic manner and with low physical stress. Teneo takes over this elaborate interaction and creates optimal working conditions likewise for dental professional and assistant. This means in practice that the treatment center not only enables intuitive seating, optimal view, and comfortable patient positioning, but—once properly programmed—performs these tasks automatically in any treatment situation. The operator interfaces are optimized so that it is easier to operate the treatment center than twisting yourself.

Teneo. Perfect interaction

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The design is harmonious and builds confidence, and the integrated workflows are tried and tested—thus Teneo can be regarded as “intelligent”. According to a study conducted by the Institute of Ergonomics & Human Factors of Darmstadt University of Technology, 64 percent of the surveyed dentists suffer from spine conditions and 42 percent complain of postural headaches as a typical result of a tense neck, shoulders, and back. Several surveys in Europe9–15 and in the USA16–18 furthermore prove that the majority of dentists, especially in their younger days, do not sufficiently pay attention to positioning the patient’s mouth so that they can work ergonomically seated free of pain in the long term. And yet, the solution is simple: the headrest. Its per formance is crucial for the posture of dentist and assistant.

The motor-driven headrest not only positions the patient’s head in a relaxed way, but is also programmed for the anatomical movements of the human cervical spine. The patients perceive overstretching as less inconvenient. By means of automatic storage of patient height and dentist work position, the position of the patient’s mouth is treatment-specific in the digital interaction of examination chair and headrest and— and this is the fine art of Teneo—is always correct. The motor-driven headrest can be operated by means of a foot switch, which is beneficial from a hygienic point of view and leaves hands and focus on the patient. In this way, the headrest can be finely adjusted without the dental professional needing to reposition his torso. That is well-thoughtthrough ergonomics.

ErgoMotion The anatomically correct and combined motion of backrest and seating surface prevents the spinal column from being stretched or compressed uncomfortably.

Proper positioning of the patient must meet two criteria: The patient must feel safe and comfortable, and the dental professional needs to be provided with the possibility of ergonomic seating for lower and upper jaw treatments alike. This is achieved by the intelligent interaction of patient chair and headrest. The per fect harmonization of both creates a plus in comfortwhile also developing the confidence of the patient and a consistent ergonomic posture and healthy way of working for the dentist and assistant. A win-win situation par excellence! Part of the basic rules of comfortable positioning is that head and knees should be on one level. This ensures optimal blood circulation. The patient does not feel any tension of the lumbar spine in the lying position with the backrest angle between 8 and 12 degrees, the thighs raised, and the hip positioned slightly lower than the shoulders. The anatomically shaped upholstering of Teneo prevents the patient from slipping, so that a sense of security is acheived at all times. An ergonomic headrest should be adjusted to the

patient’s height only once. Readjusting the extension length when changing the treatment position should not be necessary. Teneo offers two variants of upholstery: a high-tech thermo upholstery and a particularly comfortable lounge upholstery. Both variants have the required compliance and are designed so that the patient feel good even in lengthy treatments. Being a fully digital treatment center, Teneo knows the adjustments specific and preferred for the patient, so that optimal positioning is achieved starting with the very first treatment. In addition, when the position is changed, movement of the backrest and seat is combined in such a way to prevent stretching or compression of the spinal column (ErgoMotion). Other features ensuring great patient comfort include lordosis support, facilitating adjustment of the backrest of the anatomically shaped patient chair individually to the spine, and an integrated massage function, which relaxes the patient, especially during longer treatments.

tip Make use of the head rolling movement (6 o’clock position) For therapies in the 2nd and 3rd quadrant, the spinal column is often strained far in excess of the usual. The danger is that you have to stretch really far across the patient’s torso to get the proper view. It is very important in this regard to have the patient turn his head far to the side to get a 6 o’clock view into the mouth while sitting in a relaxed position. This is usually not uncomfortable for the patient and considerably improves ergonomic access. The assistant has to assist while standing or go further “upwards” to the 12 o’clock position and reach with her right hand around the patient’s head.

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Ergonomics meets design

Being a premium treatment center, Teneo works with a motor-driven sliding track, which moves the dentist element entirely without pulling with the arm into the correct position for the dentist. It is furthermore easierâ&#x20AC;&#x201D;if, for example, you already have shoulder issuesâ&#x20AC;&#x201D;to move the hand downwards instead of grasping a cable-guided instrument at shoulder level. Operating the Teneo-treatment center is simple, clear, and customizable. The hands-free way of working yields a great many of advantages: the seating posi-

tion of the dental professional must be changed, so that hands and focus remain entirely on the patient. Motor movements can be done without force. In addition, more hygiene-conscious work is possible. The EasyTouch user inter face is understood intuitively, can be programmed individually, and allows for the integration of new functions at any time. EasyTouch and the innovative Dentsply Sirona instruments help dental professionals work effortlessly and with the

best results even on longer workdays. Using freely programmable settings and the selectable solo treatment mode, you can easily adapt the EasyTouch menu navigation to the habits of the dental professional. The possibly integrated endodontic and implantology functions make tabletop units and longer retrofit times unnecessary. Because the user inter face is upgradable and the instruments are equipped with standardized inter faces, even future treatment enhancements are possible without any problems.

Integrated implantology and endodontic functions For the integrated implantology function, rotational speed, torque, and flow rate of the sterile coolant can be adjusted individually to the usual work steps of the dental professional. Further the integrated implant data base provides safety and treatment comfort for every setting. The integrated endodontic function, too, makes tabletop units superfluous, and features, besides exact torque control, an optional ApexLocator for the highest clinical safety. The unique file library provides for treatment comfort and safety not only with customary, but also with modern, especially effective, reciprocal file systems.

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tip Repositioning of the spine In order to further improve access, in particular to the molars in the 2nd quadrant, it is ergonomically required—in addition to the head rolling movement —to tilt the patient’s head to the side. However, this causes the head to hang in the air to the right of the headrest. To find a comfortable solution to this problem, have the patient move his torso on to the backrest to the left, allowing the head to actually be positioned to the left of the motor-driven headrest while leaning to the right.

The Teneo design combines dynamics, curvy flowing motions, quality and stability. The design worlds of Teneo provide the opportunity to customize the appliance according to the taste and preferences of the practice owner. There are various variants of upholstery and color available. To facilitate the selection, particularly harmonizing colors are combined in three color patterns. The elegant world is characterized by classic, timeless combinations for an especially high-class look. The natural world, on the other hand, features soft, warm shades for a soothing treatment atmosphere. And the third variant, the vital world inspires with

vivid colors and bright shades for a modern, lively atmosphere. In addition, there are two color ranges available for selection: First, there is the “Neutral” color range, where all painted sur faces are white. The preferred atmosphere is created by means of the colors of the upholstery, creating a clear and focused effect. Second, there is the “Akzent” color range, where the dental professional chooses the color of the upholstery and a color to set an accent that matches the dental surgery by means of a matt-finished metallic paint strip. This metallic paint is applied to the cuspidor, and the dentist and assistant element.

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Ergonomics meets design

tip Indirect working with extra-oral photo mirror In maxillary therapies, most dental surfaces can be seen in an ergonomic way only by use of a mirror. As the intraoral water spray prevents continuous view, the oral mirror or, even better, the photo mirror, should be guided extra-orally and supported by the patientâ&#x20AC;&#x2122;s chin. There is almost no water splash, and the longer beam path is bridged by means of loupe glasses. A trained assistant can also hold the photo mirror.

The treatment center features integrated workflows in three different forms: devices integrated into the treatment center, unconnected devices integrated into a workflow, and device and workflow control by means of software. The integration of additional devices into the Teneo treatment center is manifold: Instrument control for endodontic or implantological treatment (with associated NaCl pump), the ApexLocator, intra-oral video camera, CEREC Omnicam camera for visual imprintâ&#x20AC;&#x201D; all these devices are controlled with the same foot switch of the treatment center. The treatment center continuously looks professionally and inspires confidence due to its organization. The dental professional always works according to the same operating philosophy and always with the same interface: the foot switch and the touchscreen of the treatment center. The second variant of integrated workflows is the integration of various devices into a treatment process, so that special benefits for dental professional and patient are yielded. In this way, you can effectively save considerable time, e.g. during periodontal management by laser when taking the visual imprint with CEREC during the subgingival preparation,

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during the final CEREC-session for implants set by means of the integrated implantology workflow, through intraoral sensors, providing an immediate control image during the endodontic treatment, and by implementing laser beams for germ management in the root channel. If sensors and lasers are readily available during treatment and easy to handle, the workflow does not stop and the patient experiences the professional flow of the session subconsciously. If treatment processes are combined and the parameters of the accordingly integrated functions are programmed by the software, dental professionals need to take less care of their devices and can focus more on their patients. This generates confidence. If you can adjust the treatment center to the dental professional and patient for every possible treatment with just one click that brings the operating field as well as instruments exactly into the right position, the dental professional automatically sits correctly and suffers no pain. Thus, the treatment center also acts as the permanent expert in ergonomics. The fine art of workflow control is to combine and control several devices by means of software. Like, for example, with the integrated implantology function, where Orthophos SL 3D, CEREC, Sidexis, and the implant planning software Galileos Implant per fectly interact in order to plan the required implants simultaneously in a minimally invasive and patientfriendly manner according to surgical and aesthetical aspects. Another plus is having the derived highly precise drill templates manufactured with CEREC on-site or centrally by SICAT. The simple handling of the software and in particular its application within the scope of patient counseling via the monitor of the treatment center enables ergonomics fit for practiceâ&#x20AC;&#x201D;even though the special benefit is generated from the offered treatments themselves as well as from the WHAT and the HOW.

Teneo complies with the highest hygiene standards. From easy-to-clean, smooth sur faces to easily removable functional components to built-in sanitization adaptersâ&#x20AC;&#x201D;everything is designed for simple handling and maximal germ control in a minimum amount of time. All instrument hoses can be connected to the built-in sanitization adapters for regular cleaning. In addition, the suction hoses can be connected even during treatment and rinsed by means of a water jet with just the press of a button. Optionally, the cleaning function disinfects the suction hoses with automatically added chemicals from the list of Dentsply Sirona care products and disinfectants.

In summary Intuitive user interface: Easy to operate, can be configured and upgraded. Motor-driven headrest: Positioning of patientâ&#x20AC;&#x2122;s head with just one tap of the foot, hands-free and ergonomic for relaxed and upright access at any time. Optimal, flowing treatment comfort due to innovative workflow and automatic functions. Optimal integration of tabletop unit functions for efficient endodontic and implantological treatment. Patient-specific chair positions: Patient-specific saving and opening of chair programs (available for Sidexis 4 and up). Treatment adequate for old age: Slow motion travel, spine-friendly lying (OrthoMotion and ErgoMotion), and patient-specific saving of treatment positions provide for special advantages in the treatment of older people. High-quality materials: Particularly tested, high-quality synthetic materials and the functional design featuring smooth surfaces ensure a long service life and easy cleaning.

tip Split tray without instrumentation The split-system with separate, suspended tray and dentist element facilitates such a convenient positioning of the instruments that the assistant does not need to assist with the instruments. The direct and short gripping paths make faster and less communicative access to the instruments more reasonable for the dentist, and both hands of the assistant can thus be applied in the working environment in a more valuable and ergonomically helpful way.

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Interview

“90 percent of ergonomics is head positioning” Besides his work as a dentist at the group practice of Dr. Nadjmabadi and Senghaas in Hamburg, dentist Thomas Senghaas attends to the research and development of dental equipment, therapeutic systems, and workflow optimization. In 2005, he established the Dental Engineering Senghaas business to provide technical and dental industrial consulting services. In the following interview, the dentist from Hamburg answers questions concerning ergonomics.

How do you live ergonomics in your daily routine? For me, ergonomics and workflow go hand in hand. Living ergonomics every day for our team and our patients means great productivity and definite therapeutic success with little physical stress. When you find work easy and stress-free, especially with regard to challenging therapies like endodontics, then this is not only a benefit for the practice, but it is simply fun! This ease at work should not be underestimated. Ergonomics is the duty of the whole team. How do you assign the specific tasks at your practice? Coordinating the team is the essence of ergonomic interaction, perfecting the workflow. The assistant’s task is to organize the set-up for the therapy. The treatment room is prepared with a wellthought-through tray system and predefined therapeutic scenarios. The patient is guided to the treatment center and positioned correctly. The adjustment to size is called automatically via Sidexis 4 and checked or readjusted by the assistant. Difficult patients are prepared by means of the deep “wellness position” for the later horizontal position. I start to move the treatment center automatically into the decided patient po-

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sition via the carefully programmed positions of Teneo after having welcomed and talked to the patient. Whenever possible in the daily practice routine, I like to meet the patient in the waiting room and accompany him to the treatment center. This shows my personal commitment and empathy to patients despite all the high-tech treatment options. How important is the motor-driven headrest for practical ergonomics? Which examples can you give from your daily practice? All ergonomic parameters of dental ergonomics are derived directly from the ideal head position. Therefore, you can say that 90 percent of our ergonomics is a matter of head, in the literal as well as in the figurative sense. For this purpose, we have to want to get involved with ergonomic rules and sometimes question thoughtless habits. If ergonomics is a matter of head, then the treatment center is in the ergonomic sense only as good as the practical performance of the headrest. But note: The best mechanical 3-D setting options of a headrest do not help us in the daily routine at all, if not adjusted properly! Focusing intensively on the patient in the busy everyday routine makes us less attentive to oursel-

ves. Teneo and the motor-driven headrest provide the perfect answer to this problem. Because of the precise programming of the motor-driven headrest, Teneo moves to the predefined actual head positions for upper and lower jaw treatment. Because different therapies of different dental surfaces always make different demands on the exact head position, the treatment center furthermore provides for direct and hands-free adjustment at any time by means of the foot switch at the bottom of the chair. In this way, it is really easier and actually practicable to adjust the headrest during the therapy for the actually needed view instead of twisting one’s own body. And the best thing for smooth workflows is that hands and instruments remain in the operating position. What does your perfect workflow look like? I like to compare the perfect dental workflow with fine-tuning in top-class sports. There are many parallels, like for example, to radical surfing. Everything may be right—weather, wave, mind, and body —and result in the perfect power jibe or the “washing machine”. The wave has caught you, smashed you and took you apart, because some of the individual components – harness lines, straps, or

rig trim—were not optimally harmonized. Instead of the surge of adrenaline, you feel like totally let down. My strict rule is: Never go to sea without proper material. The same applies to my practice. Every day, we perform minor therapeutic tricks for our patients; if man and “machine” (treatment center) are not congruent in this situation, if we do not succeed in catching the perfect wave of workflow, then it is just like the “washing machine”. You feel smashed by the adverse conditions and the result does not bear any elegance and is rather unsatisfactory. Using the right Teneo program, my operating field is exactly where it is supposed to be—the instruments on the dentist element are exactly at the right distance to grasp them, and the suspended tray is close to the operating field. Control of the motor-driven headrest, chair height, and user interface is hands-free and the workflow to control can be opened directly and individually. Thus, my workflow runs elegantly and calmly upon every wave and every problematic turn during the therapy. Which is the direct relation that results from your conscious pursuit of ergonomics at your practice and your success as a dental professional and practice owner? Like I already said, for me ergonomics and workflow are one unity that makes my work smoother, easier, and more elegant. From my point of view, this dual unity contributes considerably to quality assurance, too. This may be the most important aspect with regard to the success of the practice. My patients can expect dental care on the highest level, and this quality is represented not only in the external presentation including adequate equipment and the general design of the practice, but it also appears during the therapeutic sessions in the ease and confidence of the workflow, which has a calming and relaxing effect on the patient. Patients feel that they are in good hands at all times because they feel that we do not cope with their problems while stressed out and at the breaking point. Instead they experience that the the high-tech dental offerings are in symbiosis with professional skills, lead ing to maximal results at our practice. That is our ergonomics and that is our success.

Interviewer: Marlene Hartinger

“Dental workflow is like fine-tuning in top-class sports.”

Treatment in balance ZWP EXTRA

Treatment in balance

ZWP EXTRA Treatment in balance

Close to perfection Acting instead of reacting

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There is no perfect balance of work and life, effort and relaxation. It is an illusion, and as such as individual as the perception of happiness, freedom, or success. There is, however, the approximation to the ideal.

Treatment in balance ZWP EXTRA

Treatment in balance

Prerequisites for this are the awareness of ergonomic interrelations and the active attempt to implement these interrelations in oneâ&#x20AC;&#x2122;s professional and private everyday life. This involves suitable tools, that have been designed on the basis of these findings and make oneâ&#x20AC;&#x2122;s work and life instantly and sustainably easier, true to the motto: I am, therefore I optimize.

The steps to a stable work-life balance are not a secret: If you create ergonomic working conditions for yourself, facilitating a targeted and stress-free treatment, if you surround yourself with efficient tools and make use of the performance possibilities they yield, then a chain reaction of success will fall into place. The work is done faster and in a more targeted way, because the dental professional acts free from pain and can resort to implemented automatisms. The patient registers the stress-free state of the dental professional and relaxes as well. Tension is released from the treatment, which makes it easier

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and leads to successful final results. All it takes is a little preparatory work to make it as simple as it sounds! The goal is repeatable outcomes that at all times produce the intended results without physical strain. The consequence of such a stress-free, healthy, and successful work situation is that it also encompasses areas beyond the practice and professional operations. You will have more time and more room for personal matters and fulfillment, creating a kind of well-rounded happiness.

tip Control of the motor-driven headrest

Keystones of work-life balance The keystones belonging to a full and successful life are interrelated with each other. Each keystone should be taken care of; they should be interconnected in life and thus kept in balance. Persistent over-evaluation of certain aspects and orientations leads to conflicts and less quality of life in the long term. • Professional level: Career and money • Personal level: Self-fulfillment of the potentials of an ego

• Social level: Family and friends

Assuring the health component on the job, i.e. by consciously taking care of oneself on the basis of ergonomic work processes, allows for the simultaneous development of private/personal options. In shor t: What you get is holistic success, which others—family and friends—benefit from as well. Simply said, success is only greatly enjoyed when shared with others. Ergonomic structures also make up for possible failure—every high achiever knows that past failures flow into the process towards success—by lessening the extent of the impact. If something fails, the causes can be found and, if necessary, remedied quicker, always based on the general conviction of being on the right track to success.

• Physical level: Health

For stress-free, ergonomic access to the operating field, the decided position of the patient’s head is crucial. The exact adjustment of the motor-driven headrest for therapy and during therapy in case of changing working requirements or dental surfaces should be possible hands-free and without interruption of work. This is made possible only by a motor-driven headrest controlled directly by means of the foot switch at any time. For this purpose, the function “Foot switch for motor-driven headrest” of the motor-driven headrest is enabled during setup.

The great profit potential inherent to ergonomic circumstances unfolds and arises, whenever you act, i.e. initiate the necessary steps towards a healthy way of working, before possible health problems occur. When you react only after you suffer from considerable pain, then you need time for fundamental corrections, thus delaying success. In terms of a dental practice and its daily routine, this means establishing ergonomic structures within a highly sophisticated, practicable and automatically running workflow via specifically chosen tools – for example, an ergonomically optimized treatment center. This enables dentist and assistant to work at their best, and clears the way to the already mentioned chain reaction of success.

Treatment in balance ZWP EXTRA

Treatment in balance

tip Level control of instruments To accelerate and facilitate control by foot, it is reasonable to preconfigure the motors according to your own therapeutic applications (rotational speed and cooling), so that you can switch directly between the two levels by means of the cursor during the treatment, e.g. slowly without water for excavation, and fast with water for finishing and polishing.

As described in previous chapters, ergonomic aspects are linked closely to the factors of success of a dental practice. This cybernetic structure of ergonomic effect can be illustrated clearly with the example of proper sitting: If the dental professional sits correctly and free of pain and the treatment center enables the dentist to fully focus on the patient, then a natural ergonomic stor y of success will follow. The balanced personality of the dental professional unfolds effortlessly at work, and the treatment situation is harmonious. The patientâ&#x20AC;&#x2122;s expectations are met and the patient experiences a special treatment event. Thus, confidence has been built between dental professional and patient. This special patient confidence is remarkably important for the next treatment. Patients who are confident usually accept suggested therapies of higher value, the implementation of which again leads to better therapeutic results. Such excellent therapeutic results together with the special confidence and repeated treatment event will

certainly lead to the practice being recommended and thus guarantee economic stability. And there are more things happening: Freedom from pain and excellent therapeutic results increase the dental professionalâ&#x20AC;&#x2122;s satisfaction on the job. Content people have an unchallengeable charisma, which usually infects others and resonates with the practice team and the patients. Looking forward to work in the morning and to the next patient creates new and valuable worth throughout the day. And this value multiplies with the economic upswing of the practice. The particular contentedness of the dental professional at the practice has of course an effect on his personality, too. He gains more authenticity and persuasive power. Only when you are convinced of yourself and the matter, can you convince others, too. The gained confidence motivates, makes work easier, and leads to better results. And there is almost nothing in dentistry that convinces the patient more than excellent results.

In summary The idea that great things arise from small things applies as much to a dental practise as to other areas of lifeâ&#x20AC;&#x201D;every little detail that is part of the daily routine at a dental practice ultimately contributes to the holistic success and should be appreciated and taken seriously. It is vital to face changes and optimization with a positive attitude and to examine in detail the interrelations influencing high and solid labor productivity in order to be healthy, successful, and happy in the long run.

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Intego Pro

Performance you can rely on Intego Pro is the best treatment center of its class. It is based on the innovative power and award-winning design of our existing treatment centers. As a reliable partner for an efficient practice, Intego Pro has all the features that provide optimal support: ergonomic design for better workflows, high quality standards in processing and design, and a great value – this is why Intego Pro is our performance class. Intego Pro is now available with a sophisticated ambidextrous function and our new operating light ”LEDview Plus“.

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Teneo

Innovation in perfect harmony You can only achieve a perfectly harmonious workflow if you and your treatment center interact optimally. For this reason, Teneo responds automatically and individually to all your needs. Comfort features ensure that your patients feel more relaxed throughout the treatment. So you can focus entirely on your work. New: With an extended integrated implantology function.

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