A Comparison Between Air Driven and Electric Dental Handpieces

Electric Handpiece Gains Ground in The Clinic
The comparison issue is raised more as the electric handpiece gains ground in clinical use. Coupled with it’s ability to incorporate attachments geared to produce speeds to 200,000+ rpm, the electric handpiece makes a strong bid for its place in the clinical arena. While air driven handpieces typically win the speed race (350,000+ rpm), another variable is introduced – Torque.
Remember, Torque is a measure of how hard something is working, and Watts tell us the rate at which the work is being done.
The average high speed handpiece develops 16 to 17 Watts. To reach this level, it must obtain and hold it’s optimum speed. As the turbine slows, the air driven handpiece loses a portion of it’s ability to cut, as the power output of the handpiece (Watts) decreases as well.
Modern brushless electric motors have the ability to maintain constant torque over practically the entire speed range, so the power output of the handpiece (Watts) is more consistent as well. The Kavo electric handpieceElectroTorque brushless electric motor ranges from 20,000 to 40,000 rpm. Coupled with a speed increasing attachment, it can maintain constant torque between 27 and 200,000 rpm.
So, are we going to go out and buy all new electric setups for each operatory? The cost alone would probably preclude that. Air driven handpieces will likely maintain their place for quite some time. At less than $1000 for a good one, with no other attachments required, the cost is a little easier to swallow.
Weight is another issue. Air driven highspeed handpieces are still a bit lighter and easier to handle. Modern air driven handpieces are beginning to develop much greater torque as well.
electric handpiece
Learning to use an electric handpiece is worth the effort
The electric low speed contra angle handpiece has definitely come a long way, and certainly deserves it’s place in the modern practice. With a little patience, learning to use this newer technology can pay off. There is a learning curve, but not too steep. One large advantage, for the progressive practice, is a quicker patient turnaround, as cutting is a bit faster. Electrics also tend to last a little longer between repairs, which helps to offset the initial cost.

What are important characteristics in choosing portable dental Units?

Important considerations for an effective portable dental delivery system include:

Transportability (how easily it can be moved and utilized):
>weight and size characteristics
>ability to transport the equipment (cubic feet needed — will it fit into your vehicle?)
>carrying case and/or dolly system (is there a built-in handle and/or dolly system? If not, can you utilize generic cart systems effectively to move equipment?)
>capacity to selectively take only the dental equipment you need
>ease of moving the assembled equipment
>capability of transporting equipment into various settings (e.g.,  up/down stairs, through narrow doorways)

Durability (likelihood of malfunction because of constantly moving the units):

>protective carrying cases
>protective padding systems for lights and other delicate equipment
>equipment engineered sufficiently to minimize need for frequent repairs
>avoiding need for repairs

Ergonomic characteristics (creation of an efficient working environment):
>favorable relation of portable dental unit functions to weight and size
>dental chair allows variety of positioning options (e.g., height and reclining angle); movable arm rests to allow wheelchair transfers
>adjustability of operator and assistant stools
>convenient location of handpieces, suction, water and air syringe, and rheostat (foot pedal)
>dental light positioning flexibility for illumination
>dental x-ray unit weight, stability and positioning (stationary tripod bases are less effective than a concave base on wheels that facilitates better x-ray head positioning)
>portable delivery system layout matches available room layouts (equipment should be small enough and flexible enough to be used in a variety of spaces)

Delivery system capabilities (capacity for effective dental treatment provision):
>ability to provide a range of dental services(should also allow for 4-handed delivery of care–dentist/hygienist and dental assistant working together on the same patient)
>portable dental unit  provides adequate sustainable pounds per square inch (psi) for high-speed and low-speed handpieces (35-50 psi is recommended for handpiece operation)
>portable dental unit provides adequate sustainable cubic feet per min (cfm) for high-volume and low-volume suction (2.5-5.0 scfm)
using the handpiece and portable dental suction unit at the same time is possible and does not cause a decline in the functional capabilities of either feature
>supports multiple handpieces

>supports an ultrasonic scaler
>supports fiber optic capability for handpieces to improve visualization of the mouth in settings with less ambient light
>supports air turbine, electric, and/or cable handpieces

dental light should be quartz halogen-based and provide adequate foot-candles for illumination (should provide about 1000 ft candles at working distance of 2 ft)
sufficient suction and water bottle capacity–at least 500 ml (larger size will decrease frequency of emptying the waste or refilling the water bottles)there is an adequate air reservoir to provide continuous sustainable power to the handpiece (1-9 liters with larger capacities preferable to minimize the running of the compressor)

Infection control (meeting OSHA’s requirements for cleanliness and asepsis):
>cleaning and disinfection of the unit
>flushing handpiece and waterlines
>ease of removing suction contaminates from the vacuum to the drain and disinfection

Maintenance (how to avoid “downtime”)
> extent and frequency of preventive maintenance activities (e.g., cleaning, flushing, lubrication
ease of performing needed maintenance and minor repairs (e.g., replacing gaskets, filters, hoses, and/or fuses)
on-site repair capabilities
>repair of more complex problems and need to ship components for servicing or repairs
> loaner unit availability from vendor when extensive repairs are needed

Ease of assembly/disassembly (starting and finishing):
>time and effort needed to set-up unit(s)
>time and effort needed to clean and disassemble unit(s)

Noise level (how loud is it and can it be modified):
Dental compressor and vacuum noise–sound levels may range from 40-70 decibels at 3 to 4 feet (if noisy, check on compressor capability to be placed some distance away from the treatment area; oilless compressors are generally louder than non-oilless ones; check other variables such as air reservoir or continuous flow versus an intermittent flow design)

Why Dentists Use a Dental Suction Unit?

Now that the introductions are over, let’s talk about some of the different reasons why dentists will use a suction.

For Patient Comfort
Keeping the patient comfortable is a high priority.  In response to Jeanny’s question, we suction after giving anesthetic because the anesthetic has a bitter taste, and most patients prefer to rinse out with water and use the saliva ejector.  Also, if the anesthetic sits in the back of your mouth for too long, it may start to slightly numb the back of your mouth and could give the patient a gagging sensation.

We will also use the dental suction unit to make sure that you don’t get too much water in your mouth while we are working.

To Clean Away Any Excess Dental Materials
When a dental hygienist cleans and polishes your teeth, you can get a lot of cleaning paste in your mouth.  We use the suction to help clean all of that away.  Also, when dentists are do amalgam fillings, pieces of the soft amalgam can sometimes fall away from the tooth surface.  We use the suction to help whisk them away.

To Keep The Tooth Dry
During some procedures, such as white fillings, it is important that the tooth stay clean and dry.  The suction helps keep the tooth dry by sucking away any saliva, blood, and water that may have accumulated around the tooth.  If the cavity went below the gum-line, then it’s pretty likely that the gums will bleed during the filling.

To Help the Dentist See
As I mentioned in a previous article about the dental drill, the drill that dentists use to do fillings sprays out a lot of water to keep the tooth cool and clean.  Unfortunately, that water can quickly build up in the mouth and get on the dental mirror.  In order to ensure that the dentist can see the tooth while working on it, it’s necessary to use the high volume suction to suck away all of that debris.

Those are the four main reasons that I came up with as to why dentists use the Portable dental suction unit.  In conclusion, let’s take a look at a question that I asked my dental hygienist as a child.

What Does Dental equipment repair training Courses Include?

Essential Information
Training in biomedical dental equipment technology can typically be found in diploma, certificate and associate’s degree programs. At all levels, the coursework is centered on ensuring biomedical equipment is functioning at national and local standards through preventative maintenance and safety inspections. Clinical lab work is an important aspect of the programs; hands-on training in courses such as electrical circuitry and microcomputer technology, along with biomedical externships, reinforces students’ classroom and textbook studies.

Common course subjects will include:
Printed circuit boards
Computer configuration
Repair calibration
Diagnostic procedures
Medical device troubleshooting
List of Courses
Medical Terminology Course
The medical terminology course prepares students to effectively communicate within the healthcare industry. Studying word roots, prefixes and suffixes as they relate to medical vocabulary is the main focus of this class. Students learn how to recognize the basic structure of medical words, the definitions of these words and how to correctly use medical terminology and abbreviations.

Introduction to Biomedical Studies
During this course, students are often presented with an overview of the healthcare industry. The various job roles and duties of a biomedical equipment technician, hospital structure and organization and the interactions between the providers of different medical services are normally discussed. Safety concerns, policies, codes and procedures are typically included in the coursework as well. Students may also be introduced to biomedical instrumentation and control systems.

Biomedical Electrical Circuits Course
This course is centered on basic concepts of electrical circuits as they pertain to biomedical instrumentation. Circuit analysis, measuring and the function of test equipment take up a large portion of the training. Students explore such topics as voltage, circuit simulation, resistance, the effects of electromagnetism, components, test equipment operation and the principles of DC and AC electricity. By the end of the course, students should be competent in using test equipment correctly; designing, constructing, verifying and analyzing DC/AC circuits; and properly understand the schematics for circuits.

A+ Certification Course
Students are introduced to basic computer operating systems and hardware for A+ certification during this course. The Windows operating system, microprocessors, hard drives and system boards are among the topics typically discussed. Through the curriculum, students gain skills in troubleshooting, file management, configuring a microcomputer and performance analysis. Lab exercises are usually included to help develop these skills.

Biomedical Instruments I
This course presents students with concepts in biomedical instrumentation. The curriculum covers the chemical, physical, computational and electronic aspects of how such instrumentation functions. Students examine and work with a variety of devices and instruments to build their skills in troubleshooting techniques, medical applications and circuit analysis. The primary goal of the course is for students to be able to repair, calibrate and verify that instrumentation is up to the manufacturers’ original specification standards.

Biomedical Instruments II
Students further hone their biomedical instrumentation skills and knowledge through theoretical and practical coursework. Studies are typically concentrated on advanced operation, repair and preventative maintenance. Students are introduced to applications of data acquisitions and analysis, control systems and imaging. Computer-based instrumentation as well as microprocessor-based instrumentation are generally part of the curriculum as well.

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What does root canal accomplish?

Root canal therapy is used to treat pathological conditions inside a tooth that have affected its nerve tissue, and often the tissues that surround its root too.

By completing a tooth’s treatment, a dentist can both resolve its internal problems as well as set the stage so your body’s healing process can take place as effectively as possible, thus allowing the tissues surrounding its root to return to and/or maintain a healthy status.

The procedure itself is basically a two-staged process.
A) Cleansing the tooth’s interior. – The first portion of the procedure removes compromised (infected, necrotic, degenerating) tissues, and associated debris and contaminates, from within a tooth’s nerve space.
B) Sealing off the treated area. – The procedure is completed by filling in and sealing off the tooth’s cleansed internal space, so contaminates can’t leak back in, or out.

A) Cleaning the tooth. – What does this step accomplish?
Dentists use root canal treatment to resolve a wide range of nerve-related problems. For example, this same fix is used when a tooth’s nerve tissue is: 1) Acutely inflamed, 2) In the process of dying, or 3) Completely necrotic (dead).

Necrotic pulp tissue removed from a tooth.
This is nerve tissue that’s been pulled out of a tooth’s canal.
View Slideshow
And although each of these conditions is different, what they all have in common is that they involve (or will involve) a situation where the tooth’s nerve space harbors contaminates that will ultimately leak out of the tooth’s root tip and persistently irritate (inflame) the tissues that surround it.

So, the underlying goal of the cleaning portion of the root canal procedure is for the dentist to remove as many of these irritants (or items that will degrade into irritants) as possible.

These types of items include pulp (nerve) tissue (live or dead), the organic debris left over from the breakdown of this tissue, bacteria and the toxins and additional byproducts they have created.

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What’s the fix for failed root canal treatment?

a) Retreatment
Root canal treatment with root canal treatment equipment cases that have failed can be retreated. In most cases this involves repeating essentially the same procedure that was performed originally, with the exception that time must be committed to removing the previously placed sealing materials. We now discuss this topic here: Root canal retreatment.
Your dentist may offer to perform this work, or they may feel that the expertise of an endodontist is required.

b) Tooth extraction and replacement.
Besides retreatment, the only other option for a tooth with failed root canal is extraction and replacement. This option might be chosen because retreatment is impossible, it only offers a low success probability or its cost-effectiveness is questionable.

c) Timing your treatment.
Whatever type of follow-up treatment is chosen should be performed within the time guidelines recommended by your dentist. After performing an examination, they can gauge how much urgency appears to be involved.

Teeth with failed treatment can be unpredictable due to the fact that they frequently harbor infection, which has the potential to flare up (create pain and/or swelling) without warning. As a precaution, you dentist might write you a prescription for antibiotics, so you have them on hand if conditions with your tooth turn to the worse before treatment can be performed.

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The steps of the root canal procedure

Step 1 – Placing the rubber dam
After numbing you up, your dentist with dental apex locator and dental electric pulp tester will “isolate” your tooth by way of placing a rubber dam.
A “rubber” dam is really a thin sheet of latex (usually about 6 x 6 inches).
Your dentist will punch a tiny hole near its center.
They’ll then stretch the sheet over your tooth so it alone sticks through the punched hole.
A metal clamp is then positioned to hold the dam in place.
As explained in our slideshow, the portion of the tooth that sticks through the dam lies in a region where its environment can be controlled. The tooth can be washed, dried and kept saliva-free.

Why is tooth isolation important?

One of the fundamental goals of root canal therapy is removing contaminates from within the tooth.
Since saliva contains bacteria and other debris, a rubber dam acts as a barrier that helps to keep the tooth isolated (clean, dry, contaminate-free) during its procedure.
Note: Placing a dam is a part of the general “standard of care” that any and every dentist must responsibly provide. If your treatment doesn’t involve using one, you should be asking questions.

Step 2 – Creating the access cavity.

As a starting point for performing your tooth’s treatment, your dentist will need to gain access to its nerve space. This step is called creating an “access cavity.”
An access cavity in the chewing surface of a molar.
The hole through which the dentist performs their work.
View Slideshow
Your dentist will use their dental drill to make a hole that extends through the surface of your tooth to its pulp chamber.
This is the opening through which they will perform their work.
With back teeth, the access cavity is made right through the tooth’s chewing surface (as shown in our picture).
With front ones, it’s made on their backside.
When creating the access cavity, the dentist will also remove all tooth decay, and any loose or fragile portions of the tooth or its filling.

Step 3 – Measuring the length of the tooth.

Your dentist’s goal will be to treat the entire length of your tooth’s nerve space but not beyond.
To be able to work within these confines, your dentist must measure the length of each of your tooth’s root canals. This measurement is typically calculated to the nearest 1/2 millimeter (about 1/50th of an inch).

Step 4 – Cleaning and shaping the tooth’s root canals.

he next step of the root canal process involves “cleaning and shaping” the interior of the tooth (the tooth’s pulp chamber and each of its root canal treatment equipment.

In regard to this step:
Its cleaning aspect removes nerve tissue (live and/or dead), as well as bacteria, toxins and other debris harbored inside the tooth. (Here’s more detailed information about why this is needed.)
Shaping refers to a process where the configuration of a tooth’s canals are enlarged and flared, so they have a shape that’s ideal for the procedure’s filling and sealing step.
The whole process is a balancing act. One where the dentist seeks to accomplish the goals above without removing so much internal tooth structure that the integrity of the tooth is compromised.

Step 5 – Sealing the tooth.

Once the interior of the tooth has been thoroughly cleansed and properly shaped, it’s ready to be sealed (have its hollow interior filled in).

In some cases, the dentist will want to place the filling material immediately after they’ve finished cleaning the tooth.
With other cases, they may feel that it is best to wait about a week before performing this step.