Written by Richard Gennaro, Jr, DMD Thursday, 28 February 2002 19:00
If your office is like most dental offices around the nation, the lab space you have is probably small, cluttered, and not too functional. You could say that most in-office labs were designed as an afterthought—squeezed into any available, albeit small, space. Fact is, many labs double as storage space for supplies!
The basic “necessities” for the in-office lab traditionally have been a counter space with sink and plaster trap, a polishing lathe, vibrator, and perhaps a model trimmer. Some cabinetry and shelves are likely included. The most technical fact received for planning your lab may have been to set the counter height at 34 inches from the floor!
These days, with the buzzword “ergonomics” rolling off the tongues of dental manufacturers and occupying the ever-legislative minds of OSHA officials, we are all but forced to consider ergonomics ourselves. OSHA refers to ergonomics as “the relationship of the human/environmental interface that does not produce injury.” Although OSHA’s aim is to reduce workplace injuries, there is probably a better reason (at least in a dental setting) to have ergonomic design. Of course, making things easier for our staffs and us by decreasing strain and unnecessary movement has the by-product of reducing “WMSDs,” or workplace musculoskeletal disorders.
With many dentists performing added lab procedures, it readily becomes obvious that the current poorly planned labs don’t do the trick anymore. Most labs don’t even include a place to sit! Also, many lab spaces are just too small. Not many dentists would dedicate a space as large as an operatory to building a lab. So, in any remaining “room,” the sink location is determined, a counter and some drawers are built around it, and cabinets are hung. And there it is! Unfortunately, aside from pouring and trimming models, and polishing temporaries or dentures, there aren’t many other functions accomplished.
Much effort and planning has gone solely into the operatory in dental offices, leaving the lab area neglected. Luckily, there are companies who have been making lab equipment for years, and this equipment is now making its way into the dental office. This article looks at why a lab of this type (modular) would be suitable for the dental office and what features to look for in the equipment itself.
BENEFITS OF A CUSTOMIZED LAB WORKSTATION
The initial obvious benefit of a customized workstation (meaning a lab bench specifically designed for dental use) or lab (complete with modular counters, etc) is that it negates the time and cost of planning and building a lab workspace. It can simply be carried into a room and placed wherever needed. And just as simply, it can be carried out, meaning that the room can be used for another purpose later, if so desired (Figure 1).
|Figure 1. Each lab bench is designed for dental use and can be easily moved from one room to another to create the desired workspace. The workstation shown here is the KaVo Select model by KaVo Corporation.||Figure 2. Doctors can build their desired workspace using more than one workstation. The workstation shown here is the KaVo Classic model by KaVo Corporation.|
|Figure 3. This example is the Penta model by Dental-Arte, ergonomically designed to make better use of space.|
The modular construction of the workstation (and its accessories) allows the flexibility and versatility of personalized design and expansion when necessary (Figure 2). It also makes much better use of space. Companies that manufacture these, as well as the dealers who sell them, have planning services to help the doctor determine present needs and future possibilities (the most reputable of the companies include this service at no cost). These units are already ergonomically correct, and in most cases have been well tested in commercial dental laboratories (Figure 3). This feature aids the doctor or the staff in normal use, creating increased efficiency and time savings when performing lab procedures. Of course, they are made to be OSHA compliant, and because they are considered dental equipment, just like a dental chair, they are also tax-deductible.
The materials used in fabrication usually include steel and a variety of work surfaces that are heat, acid, and impact resistant. These materials last for many years, and are far more durable than the fiberboard/laminate used by most cabinetmakers.
Because of the elegant designs, modern materials, and professionally applied finishes, these workstations are very aesthetic and promote a professional appearance. In fact, many of the doctors who own them are proud to show them to their patients. Dr. Thomas Trinker has noted (in personal conversation) that patients like the presentation and the high-tech look of such stations.
Patients like to know what we do behind the scenes, and it gives satisfaction to the patient (and pride to the doctor) to have the opportunity to view the complete office. Dr. Jonathon Ferencz, a New York prosthodontist, not only offers his patients a tour of his complete lab, but it is also shown on his website (www.nycpros.com) and mentioned in new patient letters. Remember when the sterilization area you had was upgraded/modernized, and how proud you were to show it to your patients? The opposite is also true! For example, if you go to a restaurant that has a dirty restroom, what does that infer to you about the kitchen (even if the dining room is beautiful)? Office cleanliness and organization should be consistent throughout.
The idea of utilizing a customized workstation is also sound in terms of the demands of our work. When something is designed specifically for the task at hand, it functions better. Dr. Damon Wright (personal conversation) states that his own workstation allows him to offer services more quickly and economically. The procedures normally encountered in today’s in-office lab may include some or all of the following: pouring and trimming models, articulation of study and working models, appliances (ie, nightguards, mouthguards, bleaching trays, ortho appliances, etc), denture repairs, fabrication of temporary crowns, diagnostic wax-ups, adjustment and polishing of metals and ceramics, fabrication of composite resin restorations, micro-etching, die trimming, etc. The workstation is the ideal solution to the above procedures.
Aside from model trimming and tasks that can be done standing, the sit-down style workspace is necessary for several reasons. First and foremost, there is a dedicated space for specific tasks where everything needed is available, organized, and easy to reach. The dimensions are ergonomically correct and lend themselves to the comfort and efficiency of the person performing the procedures. This is further enhanced by the addition of a well-designed operator stool, which is an indispensable adjunct in any lab or operatory setting.
ERGONOMIC CONSIDERATIONS/DESIRED FEATURES
Ergonomically speaking, we are interested in protecting three areas of our bodies: our eyes, our skeletal alignment (posture), and our lungs. The workstation chosen should have a well-defined approach to each of these three considerations.
In order to protect the eyes, two basic requirements must be met. The first is illumination. The bulb must provide ample light that is evenly distributed, free of flicker, and eliminates shadows. These attributes help avoid eyestrain and fatigue, especially when working for a long time. The bulb should approach the intensity of natural daylight and should be color corrected for use in shading and matching. Consistent intensity of the light in the field of vision (ie, the entire worksurface) prevents the strain of having to re-accommodate to varying brightness levels when searching for things. Along with illumination is magnification (an option on most units). Magnification will greatly increase comfort and reduce strain on the eyes. The work will show a definite improvement and be done more efficiently. There are several types of magnifying lenses and microscopes available, including models with camera interfaces for video or still pictures. Monitor brackets can also be added to complement the use of web-based communication.
The second basic requirement for eye protection is a shield (safety glass is best) to protect us from flying debris, splinters, and even bur fragments during grinding. This should be mounted in front of the work area where the grinding is done. Also at this location is the suction for collection of particles (more on this later).
With regard to posture, we should not be allowed to slouch or slump into a seemingly comfortable (but damaging) position. This is accomplished first and foremost by the chair or stool we use. It, like our operatory stool, is of primary importance for supporting us in an upright position. Without it, we will feel the consequences, both short-term and long-term. The next consideration is the height of the benchtop itself. Being able to adjust the body of the user in a perfect relation to the bench height is important to the comfort of the operators using it. Along with this is the addition of adjusters that level the work surface so instruments don’t go rolling all over the place. The next thing on the list is the inclusion of arm rests. These prevent arm fatigue, help maintain an erect upper torso and keep the spine in alignment, and provide control for better results. The last thing on the list is a footrest, also adjustable, which helps in maintaining good posture, provides comfort, and promotes circulation.
Regarding our lungs, included in features of utmost value are the dust/particle collection systems. A strategically placed powerful vacuum with an effective filtration system accomplishes dust/particle collection (carbon filters are also available that remove odors from grindings). The importance of this cannot be stressed enough. When we grind and adjust chairside, all kinds of particles are sent into the surrounding air, including toxic metals, acrylics, quartz, etc. We do not even realize the amount of unseen particles that can entrap themselves in our lungs without our knowing it. The really small ones (less than 5 µm) can work their way into the alveoli and do great damage over time. With this in mind, it is amazing that most dentists don’t have a collection system. The simple creation of a designated place to do all trimming and grinding (away from the operatory!) with a suction system is more than just a good idea. It is a necessity! Grinding nonprecious metals produces potentially cancer-causing particles. Grindings of quartz and porcelains can create particles that can cut the alveoli and build their own little structures in the lungs, causing silicosis or asbestosis-type lesions. The suction hood needs to be adjustable and should filter particles less than 5 µm at a rate of over 99.9%. Also, it should operate quietly and turn on automatically when starting the micromotor lab handpiece.
The safety glass shield and integrated dust/particle suction systems are invaluable to safety and comfort. If for no other reason than the collection system (a 99+% rate of collection of all particles has been estimated), a lab workstation should be integrated into the dental office. This will increase confidence in the safety of you and your staff.
In addition to the above features, an electric lab handpiece built into a drawer or placed on the benchtop and connected to a knee-, foot-, or unit-operated rheostat is a necessary option, as many procedures depend upon a handpiece. Electric micromotors (ie, lab handpieces) have long been used in labs and are ideal for what we do. If you already own one of these, it can simply be plugged into the built-in receptacle. Also, lines are built in for gas and air, with integrated air nozzles usually included as standard. Computer monitors have also been mounted to facilitate communication via in-house or web-based information. Check each manufacturer’s list of accessories to see if they have what you need.
The work surface itself is also important, as we use flames, chemicals, and sharp instruments for our procedures. The surface should be resistant and durable. Formica-type laminates do not meet this requirement, as they scratch easily, can be easily damaged by heat, and bond with many of our adhesive materials (as does Corian), making them difficult to maintain. Usually the entire lab workstation is made of steel, with a variety of work surfaces available.
The design of the workstation should provide comfort and the ability to reach all drawers and areas easily. The drawers should be the full-extension type, so that the entire drawer is revealed upon opening.
When choosing a company who manufactures these workstations, make sure that you get a guarantee, are able to purchase through a local dealer, and that the company has experience, a service net, skilled technicians, and a good reputation. Verify that the unit can be expanded with shelves, extensions, etc, and that parts are readily available. Also, check to see if the units come in various colors that complement the color scheme of your office (if appropriate).
As your office grows, you may want to increase the capabilities of your lab area. You may even consider hiring a technician. As long as you stick with the same manufacturer (know what they offer before you purchase), you will have no problem integrating the additional components into your workstation. Both wet and dry work area extensions are available. Wet pertains to models and such, while dry refers to areas designed for casting, polishing, etc.
The ability to purchase through your local dealer is important, as they (in addition to the manufacturer) are also available to advise, plan, and upgrade your office lab. In addition to providing a warranty, they also run specials from time to time and can help in the financing of the equipment.
If you have never thought of your in-office lab as vital to your office, think again! Think again every time a piece of acrylic gets in your eye, when you have to squint to see an area for adjustment on a crown, or when you are in your lab looking for something you can’t find. Think once again when you lose time and money, sending things out that could be done better right in your office. You may even be surprised to learn that staff members may actually enjoy doing procedures that vary from the normal routine and do not directly involve the patient. The dental lab in your office is as important as your operatory and will serve you well if given the proper planning and attention.
The purchase of a well-designed and manufactured lab workstation is a valuable addition to any dental office. The companies who have made these for years have already considered the experiences of technicians who use such products day after day, with their modifications and improvements. Dentists need a place to carry out even small lab procedures, and these workstations afford a designated place to do these procedures with less stress and strain and more efficiency. With safety in the workplace as a concern for us (as doctors and employers), and with legal obligations on the horizon, it is nice to know that a solution exists.
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