<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">OJST</journal-id><journal-title-group><journal-title>Open Journal of Stomatology</journal-title></journal-title-group><issn pub-type="epub">2160-8709</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ojst.2014.42011</article-id><article-id pub-id-type="publisher-id">OJST-43005</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine&amp;Healthcare</subject></subj-group></article-categories><title-group><article-title>
 
 
  Comparative ergonomic evaluation of the hand-pieces of three instrument series for root planning
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>ario</surname><given-names>Migliario</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Andrea</surname><given-names>Melle</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Paola</surname><given-names>Carcieri</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lia</surname><given-names>Rimondini</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib></contrib-group><aff id="aff2"><addr-line>Degree Course in Dental Hygiene, “Amedeo Avogadro” University of Eastern Piedmont, Alessandria-Vercelli-Novara, Italy</addr-line></aff><aff id="aff1"><addr-line>Department of Health Sciences, “Amedeo Avogadro” University of Eastern Piedmont, Alessandria-Vercelli-Novara, Italy</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>mario.migliario@med.unipmn.it(AM)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>06</day><month>02</month><year>2014</year></pub-date><volume>04</volume><issue>02</issue><fpage>61</fpage><lpage>66</lpage><history><date date-type="received"><day>15</day>	<month>December</month>	<year>2013</year></date><date date-type="rev-recd"><day>20</day>	<month>January</month>	<year>2014</year>	</date><date date-type="accepted"><day>28</day>	<month>January</month>	<year>2014</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  Introduction: Musculoskeletal disorders (MSD) are the most frequent cause of disability in the working population, exceeding accidental trauma in frequency. The risk of developing work-related upper limb disorders (WURLDs) is high among dental hygienists and the most frequently affected are elderly subjects and women. Since such disorders can have a negative effect on the working life and on the quality of life, it is of vital importance to put in place preventive measures. Aim: To make a comparative analysis of the hand-pieces of three different manual instruments used for root planning. Materials and Methods: To evaluate the physical characteristics (section, diameter, external surface, weight) of the hand-pieces of three series of instruments for root planning, twenty-nine dental hygienists students were videoed while working clinically. They were also interviewed using a specific questionnaire to determine subjective preferences in terms of perceived efficacy, safety, comfort and general acceptability of the hand-piece used. Results: Lightness, full-cylindrical section with larger-diameter ends, and coating with anti-slip silicone are the most appreciated characteristics of a hand-piece. Conclusions: Ergonomic analyses of manual instruments are not frequent in the dental field, and the literature reports no guidelines to guide selection of the type of hand-piece of manual instruments. The data gathered may help manufacturers in designing new manual instruments, and guiding professionals in their selection.
 
</p></abstract><kwd-group><kwd>Dental Hygienist; Instrumentation; Professional Practice; Periodontal Instruments</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. INTRODUCTION</title><p>Work-related musculoskeletal disorders (MSDs) are the most common occupational disorders around the world. The risk factors for developing MSDs include individual factors, physical requirements at the workplace, organizational and psychosocial factors; their prevalence varies considerably across occupations and working populations. Work-related upper limb disorders (WRULDs) are the musculoskeletal disorders of the neck and upper limbs [<xref ref-type="bibr" rid="scirp.43005-ref1">1</xref>]. Dental hygienists, especially those who are older and female, have a higher risk than other workers of developing upper-limb musculoskeletal disorders (WRULDs), like carpal tunnel syndrome [2-13]. Prevention of MSDs is based on eliminating or reducing risk factors, which may be subdivided into factors linked to the worker, the type of work, the working position, and the instrument used [3,5,12-19]. Correct positioning of hygienist and patient plays a fundamental role in efficient clinical treatment, and should prevent harm to the patient and limit disorders to the hygienist’s musculoskeletal system [5,8,10,12-14,16-19]. Dental scaling is carried out with manual or mechanical instruments (e.g. sonic scaler system); root-planning with manual instruments, e.g. series of Gracey curettes, by pulling the working blade along the surface of dental root with a complex movement involving fingers, wrist and forearm [<xref ref-type="bibr" rid="scirp.43005-ref20">20</xref>]. The manual instruments used by dental hygienists for periodontal scaling and root-planning, their main occupation, comprise a hand-piece, a shank linking the hand-piece to the working tip, and a working tip or blade. The hand-piece is the part gripped during use and it may be of various shapes and sizes [10,20-22]. How and how firmly the hygienist holds the hand-piece when working influence the clinical procedure, but also affect his/her rate of tiring [2-6,14,15]. A correct grip gives the hygienist positive control over the instrument, providing balance and flexibility during movements, decreasing the risk of trauma to the patient’s teeth and periodontal tissues, while improving the hygienist’s tactile sensitivity and preventing tiring of the fingers, wrist and arms [5,14, 15,17,18,20-24]. Pinch force during dental scaling and root-planning is influenced by characteristics of handpieces of instruments: thus these characteristics are important risk factors for developing WRULDs [2-5,14,15, 22]. This study is the continuation of our previous work [<xref ref-type="bibr" rid="scirp.43005-ref25">25</xref>] which assessed the perceived satisfaction in using three different types of hand-piece of manual instruments (Gracey curettes) used for manual root planning. We have first evaluated the physical characteristics of the hand-pieces (section, external surface, diameter and weight) of three Gracey curette and subsequently we have recorded, through a questionnaire, the subjective impressions (perceived efficacy, safety, comfort and overall acceptability) expressed by some students of a Hygienist Dental School during work sessions in which the test instruments were used.</p></sec><sec id="s2"><title>2. MATERIALS AND METHODS</title><sec id="s2_1"><title>2.1. Study Design</title><p>This comparative study was approved by the Local InterHospital Ethics Committee (EC Prot. 57/10). It evaluated three different types of hand-piece of manual instruments used for root planning (Gracey curettes) selected from among those in most widespread use in day-o-day clinical practice.</p></sec><sec id="s2_2"><title>2.2. Materials and Methods</title><p>The hand-pieces were subdivided into three classes, considering shape of section (octagonal, uniformly cylindrical, non-uniformly cylindrical), external surface (knurled, satin-finish, coated with anti-slip material), weight and diameter (<xref ref-type="fig" rid="fig1">Figure 1</xref>). Hand-pieces classified as A are made of steel with octagonal section, diameter 6 mm, external surface knurled, weight 17.68 g; type B are made of steel, cylindrical section, uniform diameter of 10 mm, external surface satin-finish, knurled at either end, weight 21.36 g; type C have non-uniform cylindrical secon with diameter at either end of 11.5 mm and 8.5 mm in the central part, surface covered with anti-slip silicone in the central part and knurled at either end, weight 15.89 g.</p></sec><sec id="s2_3"><title>2.3. Subjects</title><p>Twenty-nine students of our Dental Hygiene School were enrolled in the study and, informed of the goals and study design, all gave their informed consent as per Italian Law no. 675 dated 31/12/1996 and subsequent modifications.</p></sec><sec id="s2_4"><title>2.4. Procedure</title><p>Each student has used, for ten root-planning continually during clinical work, a series of Gracey curettes, one per type of hand-piece to be tested, distinguished with the letters A/B/C.</p><p>At completion of the period of use of the instruments provided, each student filled in a questionnaire (<xref ref-type="table" rid="table1">Table 1</xref>) with questions investigating a series of parameters related to the perceived efficacy, safety and comfort during use. The replies were formulated on a 5-level ordinal scale of evaluation (from 0 = very poor to 4 = high); higher scores indicated a higher value of the parameter investigated.</p><p>The scores assigned to questions 2-5, 7, 9-12, 14-17, 19-24 have contributed to determine the degree of satisfaction for the section, those that refer to questions 3-6</p></sec></sec></body><back><ref-list><title>References</title><ref id="scirp.43005-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Hoe, V.C.W., Urquhart, D.M., Kelsall, H.L. and Sim, M.R. (2012) Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults (Review). 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