This article is a case report of the implementation of an instrument management
system (IMS) in a private dental practice.
With the establishment of a new practice,
potential instrument processing systems
will be evaluated by the dentists and staff.
In a dental practice, organization and efficiency are paramount. Numerous instruments and materials are necessary to
complete dental procedures and there are
multiple clinical personnel who handle
such supplies routinely during clinical
care. If systems are not in place for effective instrument handling and processing,
confusion, disorder, and potential frustration are likely.
The implementation of an IMS often
requires preplanning and some adjustments within the instrument processing
area. In addition to an initial investment
for the cassettes, a larger ultrasonic may
be required. Space considerations may
include a larger area for wrapping instruments and increased shelving for storage.
As a result, the decision to implement cassettes may be controversial.
Despite the initial costs and preplanning requirements, organization, efficiency, and safety during instrument
processing and handling are enhanced
with cassette usage. Since instruments
are self-contained within the cassettes,
none should be missing during procedures. Midprocedure retrieval is minimal
and operatory preparation is streamlined.
Instrument breakage should be elimi-
nated because they are protected within
the cassette. Instrument processing with
cassettes is safer for members who handle
contaminated instruments during all
phases of instrument processing, includ-
ing transportation, cleaning, packaging,
The dental facility to be discussed was
formed by combining three existing dental practices. Drs. “Dale” and “Thomas”
were two associate dentists practicing
in differing locations who purchased the
office of a retiring dentist. The resulting
staff of five members was a combination
of each of the three practices. When the
new staff was formed, the decision to implement dental cassettes was made. The
observations, attitudes, and comments
of the dentists and personnel were noted
and recorded throughout the decision-making process through the first year of
the dental practice.
Part 1 of this article will review the
introduction and preplanning of the IMS
system to this practice, and part 2 (to be
published next month) will discuss the
implementation process through the first-year follow-up.
OF IMS BY DR. THOMAS
Upon initial discussion, Dr. Thomas was
entirely in favor of cassette usage for instrument processing. As a practicing dentist for 20 years, he had clinical experience
in dental facilities where instruments
were processed utilizing pouches and cassettes.
Dr. Thomas previously practiced in a
high-volume dental facility with nine op-
eratories and two dentists. In this office,
instruments were processed loosely in
pouches and were subsequently arranged
on trays for various operative procedures.
He observed that instruments were often
missing during patient care, requiring as-
sistants to leave the operatory to retrieve
an instrument. During patient care, other
assistants often entered his operatory to
search for missing instruments.
Dr. Thomas noted that isolated incidents of instrument retrieval are sometimes inevitable. An explorer may fall on
the floor midprocedure, and on rare occasions an instrument tip may break. On
these occasions, back-up supplies may be
retrieved from an operatory drawer. He
also noted that repeated recurrences of
retrieval events could lead to awkward interruptions to the smooth flow of dental
treatment. Inefficiency of operative procedures will increase the time to perform
These interruptions may cause distraction and annoyance of the operator
and other dental personnel. The patient
may also note the lack of organizational
systems, which may lead to increased
anxiety during dental procedures.
Dr. Thomas noted that repetitive instrument retrieval incidents may quickly
become frustrating and problematic.
He believed that instrument organization and operatory preparation have the
potential to become particularly challenging in high-volume dental practices
with numerous staff members and multiple operatories. He firmly believed that
continued on pg. 103
BY MARIE T. FLUENT, DDS
Implementation of cassettes
CASE STUDY EXPLORES IMPLEMENTATION OF INSTRUMENT
MANAGEMENT IN A LARGE GROUP PRACTICE