Efeito da magnificação na postura de trabalho em odontologia
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Data
2018-11-26
Autores
Wajngarten, Danielle
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Universidade Estadual Paulista (Unesp)
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Este trabalho teve como objetivo observar o efeito da magnificação na postura de trabalho durante a realização de procedimentos odontológicos. Para isso, propôs-se a realização de sete estudos. Os estudos 1 e 2 tiveram como objetivo revisar a literatura para reunir informações disponíveis em torno da magnificação e ergonomia e da magnificação em endodontia, respectivamente. No estudo 3, foi realizada a observação da acuidade visual de estudantes de odontologia (N=160) em função de cinco diferentes condições visuais (olho nu, visão com lupa simples, visão com lupa do sistema Galilean, visão com lupa do sistema Keplerian e microscópio operatório) e em duas distâncias de trabalho (de 35cm boca/olhos e confortável para o operador). Além disso, os desvios angulares de pescoço foram registrados por meio de tomadas fotográficas. A acuidade visual foi medida através de uma tabela de E-optótipos localizados em cavidades Classe I de molares superiores. O desvio angular foi mensurado por meio do Software de Análise Postural. Realizou-se análise estatística descritiva e Análise de Variância - ANOVA a qual foi conduzida de forma independente para os diferentes anos do curso (2°, 3°, 4° e 5°). O nível de significância adotado para tomada de decisão foi de 5%. Observou-se interação significativa para o sistema de magnificação e distância (p<0,05) em todos os anos, tanto para a acuidade visual quanto para o ângulo de pescoço. Para a distância padronizada e em todos os anos do curso, a maior acuidade visual foi para as lupas Galilean, seguida pela Keplerian e microscópio operatório. Para a distância confortável, as lupas Galilean e Keplerian apresentaram maior acuidade. Para a angulação de pescoço, na distância padronizada, os estudantes do 2° ano apresentaram menores ângulos com o uso do microscópio e lupa Keplerian, para o 3° ano não houve diferença, para estudantes do 4° ano as menores angulações foram proporcionadas pelas lupas Galilean, Keplerian e microscópio operatório e para o 5° ano pelo microscópio operatório. Na distância confortável, as lupas Galilean e Keplerian foram as melhores para os estudantes do 2°, 3° e 5° anos e para os estudantes do 4° ano apenas a Keplerian. Concluiu-se que os sistemas de magnificação Galilean, Keplerian e microscópio operatório promoveram melhoria na acuidade visual e na manutenção de menor angulação do pescoço. No estudo 4, verificou-se o efeito de quatro condições visuais (olho nu, lupa simples, lupa com sistema Galilean e Keplerian) sobre a postura de trabalho e angulação de pescoço, durante a realização de preparos cavitários Classe I por operador com e sem experiência nos conceitos de Dentística e Ergonomia em Odontologia. O registro das posturas de trabalho e ângulo de pescoço foi realizado por meio de filmagem e avaliadas, respectivamente, por meio do Compliance Assessment of Dental Ergonomic Posture Requirements – CADEP adaptado e pelo Software de Avaliação Postural (N=640). Após análise estatística descritiva foi conduzida a ANOVA a dois fatores e o nível de significância adotado foi de 5%. Não se verificou interação significativa entre as variáveis independentes para as variáveis dependentes avaliadas. Ambos operadores obtiveram altos escores de postura de trabalho enquanto trabalhavam com as lupas Galilean e Keplerian (p<0,01), independente do dente tratado assim como menores ângulos de pescoço para ambos operadores (p<0,01). Concluiu-se que a utilização do sistema de magnificação Galilean e Keplerian auxiliaram na manutenção da postura de trabalho adequada. Com relação ao estudo 5, avaliou-se o efeito da magnificação sobre a qualidade dos preparos cavitários Classe I pré-clínicos, confeccionados por indivíduos com e sem experiência operatória. Preparos cavitários Classe I foram realizados em todos os primeiros molares por cada operador (n=320) sob 4 diferentes sistemas de magnificação (olho nu, lupa simples, lupa com sistema Galilean e Keplerian). A qualidade de preparos cavitários Classe I foi avaliada pelo instrumento denominado Class I Cavity Preparation Assessment - COCA, desenvolvido para a realização desta pesquisa. Foi realizada a análise de dados, conduzida de forma independente para os diferentes dentes (16, 26, 36 e 46). Após a estatística descritiva foi realizada ANOVA a dois fatores e o nível de significância adotado foi de 5%. Observou-se que para os dentes superiores não houve diferença significativa entre os sistemas de magnificação e a experiência do operador (p>0,05). Para o elemento dental 36 verificou-se que a qualidade do preparo realizada com a lupa Galilean foi superior ao olho nu (p<0,01). Com relação ao elemento dental 46 observou-se que o operador com experiência obteve maior nota na qualidade do preparo (p= 0,01), independente do sistema de magnificação. Conclui-se que o uso da magnificação não influenciou a qualidade dos preparos cavitários de Classe I para os elementos 16, 26 e 46, a lupa Galilean proporcionou melhor qualidade de preparo para o elemento 36 e o maior grau de experiência do operador influenciou a qualidade do elemento 46. O estudo 6 observou o efeito de diferentes sistemas de magnificação sobre a habilidade motora fina real e percebida de estudantes de odontologia. Participaram desta pesquisa estudantes do 5° ano de graduação da Faculdade de Odontologia de Araraquara (N=51). Foram utilizados 4 diferentes sistemas de magnificação (olho nu, lupa monocular de 3,5x de aumento, lupa Galilean com 3,5x de aumento, lupa Keplerian com 4,0x de aumento). A habilidade motora fina real foi medida pelo teste de Destreza Manual para Dentística Restauradora Pré-clínica, que consistiu na inserção da fresa #3195FF em alvos posicionados sobre uma placa de isopor. Para pontuar a precisão de cada penetração no alvo, utilizou-se o seguinte critéro: escore 3, quando a inserção se encontrava totalmente dentro do alvo, 2 quando 50% estava dentro do alvo, 1 quando 50% estava fora do alvo e 0 para totalmente fora do alvo, totalizando no máximo 246 pontos. A habilidade motora fina percebida foi avaliada por meio da escala VAS a qual variou de zero para nenhuma habilidade e dez para habilidade máxima. Após análise estatística descritiva realizou-se ANOVA a um fator com nível de significância de 5%. Para a habilidade motora final real, não foi observada diferença estatisticamente significativa entre os grupos (p=0,48) ao passo que para a habilidade motora fina percebida houve diferença (p<0,01) com melhores resultados para o olho nu. Concluiu-se que a habilidade motora fina real não foi influenciada pelo sistema de magnificação e que a percebida foi. O estudo 7 propôs-se observar, de forma qualitativa, as percepções de estudantes do 2º ano do curso de graduação em Odontologia da Faculdade de Odontologia da Universidade de Stony Brook – EUA sobre a utilização de lupa Galilean a 2,5x de aumento durante a execução de atividades laboratoriais pré-clínicas. A amostra foi composta por 24 estudantes. Os dados foram coletados por meio de entrevista aberta semiestruturada e individual a qual foi registrada em gravador de voz digital e analisados por meio da análise temática com o software NVIVO® 10. As perguntas foram relativas às experiências do uso da lupa. Observou-se que grande parte dos estudantes (54,2%) se adaptou à utilização da lupa desde o seu início, sem a apresentação de sintomas (50,0%). Os estudantes perceberam que a magnificação auxiliou na manutenção da postura de trabalho (79,2%), impactou positivamente nas habilidades psicomotoras (66,6%) e na qualidade dos trabalhos pré-clínicos realizados (91,7%). Concluiu-se que os estudantes apresentaram percepções positivas relacionadas com o uso da magnificação, destacando-se a melhoria da habilidade motora, qualidade dos procedimentos e postura de trabalho. De acordo com as metodologias utilizadas no presente trabalho pode-se concluir que as lupas Galilean e Keplerian influenciaram positivamente a postura de trabalho durante a realização de procedimentos odontológicos.
This study aimed to observe the magnification effect on work posture during dental procedures. For this, seven studies were conducted. The studies 1 and 2 aimed to review the literature in order to gather informations regarding to magnification and ergonomics and magnification in endodontics, respectively. Study 3 aimed to determine dental students' visual acuity and neck angulation when using magnification devices and distances from the operating field. Forty students from each of the second through fifth years of the five-year program at the School of Dentistry of Araraquara were selected (N=160). Visual acuity was tested using a miniature Snellen eye chart under five different settings (unaided vision; simple loupe; Galilean loupe; Keplerian loupe and an operating microscope). Photographs were taken during the visual acuity exam in order to evaluate the angulation of the subjects' necks in a neutral posture. The two-factor Analysis of Variance - ANOVA and the Games-Howell post-hoc test were performed for the different years of the course (α=0.05). A significant difference in visual acuity and neck angulation was found between the "magnification device" and "distance" factors in each of the graduating classes analyzed (p<0.05). At a standardized distance, the Keplerian loupe, the Galilean loupe and the operating microscope provided the greatest visual acuity. At a subjectively comfortable distance, the Keplerian and Galilean loupes produced the best visual acuity. Regarding to the neck angulation at a standardized distance, the lowest angles were provided by the microscope and Keplerian loupes for 2nd year students; the Galilean, Keplerian loupes and microscope for 4th year students; and only the microscope for 5th year students. No difference between the magnifications devices was found for 3rd year students. At the comfortable distance, both Galilean and Keplerian loupes were the best for the 2nd, 3rd and 5th year students, and only the Keplerian for 4th year students. It was concluded that the Galilean and Keplerian magnification systems provided the best visual acuity and the lowest angulation of the operator's neck at both standardized and comfortable distances. Study 4 aimed to observe the effect of different magnification systems (unaided visualization, simple loupe, Galilean loupe, and Keplerian loupe) on working posture and neck angulation during procedures involving cavity preparation on artificial teeth by operators with and without experience in restorative dentistry and ergonomics. Working postures were recorded using digital video cameras and evaluated by the Compliance Assessment of Dental Ergonomic Posture Requirements – CADEP (N=640). The neck angulations were evaluated by the Software Para Avaliação Postural. The two-factor analysis of variance (ANOVA) and the Games-Howell post-hoc test were performed (α=0.05). Both operators received the highest posture scores while wearing the Galilean and Keplerian loupes (p<0.01), regardless of the tooth being treated. The Galilean and Keplerian loupes were found to allow lowest neck angulations for both operators (p<0.01). No correlations were found among operator’s experience and working posture score and angulation of the neck (p>0.05). It was concluded that the Galilean and Keplerian magnification lenses helped operators to maintain an ergonomic posture and low neck angulations, regardless the operator's experience. Study 5 aimed to evaluate the effect of magnification on the quality of preclinical class I cavity preparations performed by individuals with and without clinical experience. Class I cavity preparations (N=320) were performed in all first molars (teeth #s 16, 26, 36 and 46) by inexperienced and experienced operators, under four conditions (unaided vision, simple loupe, Galilean loupe and Keplerian loupe). The quality of class I cavity preparations in restorative dentistry procedures were evaluated by the Class I Cavity Preparation Assessment - COCA, developed and validated for this study. The two-factor analysis of variance was performed for all first molars (α=0.05). No interactions between operator’s experience and magnification device were found (p>0.05). Higher quality scores were given to cavity preparations done on tooth #36 with the Galilean loupe than unaided vision (p<0.01). The most experienced operator received higher quality scores for tooth #46 regardless the magnification system used (p=0.01). It was concluded that magnification devices did not influence the quality of class I cavity preparations performed on teeth #s16, 26, and 46. The Galilean loupe improved the quality of the cavity preparation performed on tooth #36, and the operator’s experience influenced the quality of the preparation on tooth #46. Study 6 observed the effect of different magnification systems on real and perceived fine motor skills of dental students. Fifty-one students from the 5th year of graduation from Araraquara School of Dentistry participated in this study. Four different magnification systems were tested (unaided vision, simple loupe, Galilean loupe and Keplerian loupe). The real fine motor skill was measured by the Manual Dexterity Test for Pre-Clinical Restorative Dentistry, which consisted of inserting the bur #3195FF in targets placed on a styrofoam sheet. The precision of each target penetration was scored as: 3 when the penetration was fully within the target, 2 when 50% was within the target, 1 when 50% was off target and 0 for totally out of target. The maximum points obtained were 246. The perceived fine motor skill was assessed using the VAS scale which ranged from zero (no skill) and ten (highest skill). The one-way ANOVA was performed (α=0.05). For the real fine motor skill, no statistically difference was observed between the groups (p=0.48). For the perceived fine motor skill, the best results were obtained with the unaided vision (p <0.01). It was concluded that only the perceived fine motor skill was affected by the magnification systems. Study 7 aimed to observe the perceptions of 2nd year students from Stony Brook Univeristy, USA on the use of Galilean loupes during their pre-clinical activities. The sample was composed of 24 students. The data were collected through a semi-structured and individualized open interview, which was recorded in a digital voice recorder and analyzed through the thematic analysis with NVIVO® 10 software. The questions were related to the experiences of using magnification. It was observed that the majority of the students (54.2%) had a quick adaptation adaptation with magnification and did not present any symptoms (50.0%). The students perceived that the magnification helped them to maintain a good work posture (79.2%), improved their psychomotor skills (66.6%) and increased the quality of their pre-clinical procedures (91.7%). It was concluded that the students presented positive perceptions related to the use of magnification, highlighting the improvement of psychomotor skills, quality of procedures and work posture. It was concluded that the Galilean and Keplerian loupes positively influenced the work posture during dental procedures.
This study aimed to observe the magnification effect on work posture during dental procedures. For this, seven studies were conducted. The studies 1 and 2 aimed to review the literature in order to gather informations regarding to magnification and ergonomics and magnification in endodontics, respectively. Study 3 aimed to determine dental students' visual acuity and neck angulation when using magnification devices and distances from the operating field. Forty students from each of the second through fifth years of the five-year program at the School of Dentistry of Araraquara were selected (N=160). Visual acuity was tested using a miniature Snellen eye chart under five different settings (unaided vision; simple loupe; Galilean loupe; Keplerian loupe and an operating microscope). Photographs were taken during the visual acuity exam in order to evaluate the angulation of the subjects' necks in a neutral posture. The two-factor Analysis of Variance - ANOVA and the Games-Howell post-hoc test were performed for the different years of the course (α=0.05). A significant difference in visual acuity and neck angulation was found between the "magnification device" and "distance" factors in each of the graduating classes analyzed (p<0.05). At a standardized distance, the Keplerian loupe, the Galilean loupe and the operating microscope provided the greatest visual acuity. At a subjectively comfortable distance, the Keplerian and Galilean loupes produced the best visual acuity. Regarding to the neck angulation at a standardized distance, the lowest angles were provided by the microscope and Keplerian loupes for 2nd year students; the Galilean, Keplerian loupes and microscope for 4th year students; and only the microscope for 5th year students. No difference between the magnifications devices was found for 3rd year students. At the comfortable distance, both Galilean and Keplerian loupes were the best for the 2nd, 3rd and 5th year students, and only the Keplerian for 4th year students. It was concluded that the Galilean and Keplerian magnification systems provided the best visual acuity and the lowest angulation of the operator's neck at both standardized and comfortable distances. Study 4 aimed to observe the effect of different magnification systems (unaided visualization, simple loupe, Galilean loupe, and Keplerian loupe) on working posture and neck angulation during procedures involving cavity preparation on artificial teeth by operators with and without experience in restorative dentistry and ergonomics. Working postures were recorded using digital video cameras and evaluated by the Compliance Assessment of Dental Ergonomic Posture Requirements – CADEP (N=640). The neck angulations were evaluated by the Software Para Avaliação Postural. The two-factor analysis of variance (ANOVA) and the Games-Howell post-hoc test were performed (α=0.05). Both operators received the highest posture scores while wearing the Galilean and Keplerian loupes (p<0.01), regardless of the tooth being treated. The Galilean and Keplerian loupes were found to allow lowest neck angulations for both operators (p<0.01). No correlations were found among operator’s experience and working posture score and angulation of the neck (p>0.05). It was concluded that the Galilean and Keplerian magnification lenses helped operators to maintain an ergonomic posture and low neck angulations, regardless the operator's experience. Study 5 aimed to evaluate the effect of magnification on the quality of preclinical class I cavity preparations performed by individuals with and without clinical experience. Class I cavity preparations (N=320) were performed in all first molars (teeth #s 16, 26, 36 and 46) by inexperienced and experienced operators, under four conditions (unaided vision, simple loupe, Galilean loupe and Keplerian loupe). The quality of class I cavity preparations in restorative dentistry procedures were evaluated by the Class I Cavity Preparation Assessment - COCA, developed and validated for this study. The two-factor analysis of variance was performed for all first molars (α=0.05). No interactions between operator’s experience and magnification device were found (p>0.05). Higher quality scores were given to cavity preparations done on tooth #36 with the Galilean loupe than unaided vision (p<0.01). The most experienced operator received higher quality scores for tooth #46 regardless the magnification system used (p=0.01). It was concluded that magnification devices did not influence the quality of class I cavity preparations performed on teeth #s16, 26, and 46. The Galilean loupe improved the quality of the cavity preparation performed on tooth #36, and the operator’s experience influenced the quality of the preparation on tooth #46. Study 6 observed the effect of different magnification systems on real and perceived fine motor skills of dental students. Fifty-one students from the 5th year of graduation from Araraquara School of Dentistry participated in this study. Four different magnification systems were tested (unaided vision, simple loupe, Galilean loupe and Keplerian loupe). The real fine motor skill was measured by the Manual Dexterity Test for Pre-Clinical Restorative Dentistry, which consisted of inserting the bur #3195FF in targets placed on a styrofoam sheet. The precision of each target penetration was scored as: 3 when the penetration was fully within the target, 2 when 50% was within the target, 1 when 50% was off target and 0 for totally out of target. The maximum points obtained were 246. The perceived fine motor skill was assessed using the VAS scale which ranged from zero (no skill) and ten (highest skill). The one-way ANOVA was performed (α=0.05). For the real fine motor skill, no statistically difference was observed between the groups (p=0.48). For the perceived fine motor skill, the best results were obtained with the unaided vision (p <0.01). It was concluded that only the perceived fine motor skill was affected by the magnification systems. Study 7 aimed to observe the perceptions of 2nd year students from Stony Brook Univeristy, USA on the use of Galilean loupes during their pre-clinical activities. The sample was composed of 24 students. The data were collected through a semi-structured and individualized open interview, which was recorded in a digital voice recorder and analyzed through the thematic analysis with NVIVO® 10 software. The questions were related to the experiences of using magnification. It was observed that the majority of the students (54.2%) had a quick adaptation adaptation with magnification and did not present any symptoms (50.0%). The students perceived that the magnification helped them to maintain a good work posture (79.2%), improved their psychomotor skills (66.6%) and increased the quality of their pre-clinical procedures (91.7%). It was concluded that the students presented positive perceptions related to the use of magnification, highlighting the improvement of psychomotor skills, quality of procedures and work posture. It was concluded that the Galilean and Keplerian loupes positively influenced the work posture during dental procedures.
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Estudantes de Odontologia, Lentes, Ergonomia, Students dental, Lenses, Ergonomics