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Industry Leaders on Industry-leading Handpiece Manufacturers by Kyle Patton, Editorial Assistant, Dentaltown Magazine

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by Kyle Patton, Editorial Assistant, Dentaltown Magazine

Drilling in the 6th millennium BC

In 2006 , Nature1, a weekly research journal, reported that dentistry circa 5,500 B .C. was a pain for everybody. In an ancient Pakistani graveyard, researchers digging in the Baluchistan province, uncovered nine rather unique skulls. Each had evidence of drill holes in their teeth. The findings, the journal estimated, meant that dentistry was at least 4,000 years older than believed at the time. Flint drill heads were also found at the site, leading researches to surmise that a small bow, along with the tiny flint drill tip, were used to burrow into patients’ teeth. While signs of fillings were not found, evidence of cavities were, dismissing theories that the drill holes were placed in the teeth decoratively or after death. Handpieces, whether in their brutally primitive original forms or in the modern-day technological wonders that are capable of 380,000rpms (fastest on the planet), have always been the single-most important tool for a dentist. Understanding the history and the advancements of the handpiece helps the practitioner appreciate how far it’s really come.

Roots

Handpieces in the 1950s were monsters. Giant, belt-driven contraptions that had a top speed of 50,000rpms and were loud enough to cause hearing damage over a long career chairside. Things got better, slightly, when Sir John Walsh pioneered one of the earliest air-driven, high-speed handpieces which dramatically reduced preparation time. With higher speeds came increased heat, and water spray features made their way into the handpiece’s growing list of attributes. Using more than two gallons of water a minute, designs like Walsh’s air-driven handpiece began to change how dentistry was performed. By the 1980s, optic fibers debuted and dentists had precision lighting at the cutting area for the first time. More and more handpiece manufactures entered the arena. At this point, handpiece maintenance had always been relatively simple and easy. The instrument required oil every day and the turbine’s lifespan was several years. Then in the 1990s, as the world slowly came to terms with the reality of highly infectious diseases like AIDS, the easy come, easy go cleanup and handling of dental handpieces hit some turbulence. The FDA began issuing the first guidelines that mandated the routine sterilization of handpieces. The problem was that they had not been designed for daily sterilization and so life expectancy of handpieces took a dive. Up until the mandates, the overhead costs and time devoted for basic upkeep was minimal. But as any modern dentist will tell you today, that’s ancient history.

Age of expansion, rise of expenditure

Arguably, the FDA’s mandates led handpiece manufactures into a period of increased competition, each company striving to outdo the other, giving rise to wide varieties of features and designs. Experimentation in materials and concepts continue today. One of the more recent innovations is abandoning stainless steel for titanium, a metal that is 40 percent lighter and able to weather the autoclave with greater integrity. Of course titanium handpieces have a higher price point, but come with the tradeoff of having a longer life. And while the majority of dental practices still rely on air-driven handpieces, the emergence of electric has offered impressive alternatives, though, again, often with an increase in cost. Whether a dentist reaches for air-driven, electric or even the rare air-electric hybrid models, the greatest cost and most complex issue a doctor faces after purchasing his or her drill is maintenance and repair. So what qualities are the deciding factors in making that initial purchase?



What matters most

I asked some of the industry’s experts to weigh in on the top traits to look for in handpieces, how to maintain and repair them, and some of the common misconceptions. As NSK Dental’s director of sales and marketing, Rob Gochoel is dedicated to learning what matters most to a dentist when purchasing a handpiece. “I like to say this category is very much like automobiles are for consumers,” Gochoel says. “There are a lot of choices with features and benefits, and it is always a good idea to give them a test drive before making a purchase.” Gochoel suggests three areas to look at when making a handpiece decision: power, ergonomics and warranty. Coincidently, nearly every expert I spoke to hit on the same key characteristics. We seem to have a consensus.

In terms of power and performance, dentists should consider the total power output, measured in revolutions per minutes. With air-driven, a doctor has to keep in mind that the maximum speed of the handpiece is going to decrease slightly as it comes into contact with tooth structure. Despite losing some speed, air-driven handpieces are still the industry standard and seem to be getting the job done just fine. Electric handpieces maintain their constant speed and lose no power while cutting tooth structure.

Kris Christian, A-dec’s product manager for general restorative clinical products, has a great deal of experience working with doctors and engineers in the research and development phase of handpieces. Doctor and patient comfort and safety is important, Christian said. “Meaning small size, lightweight, good balance, low operating noise and low vibration.”

Variations in size mean variations in power. A small head size in a handpiece will give the user improved visibility and access, while a larger head size often means a higher power output, which could result in less time involved in preparation. Handpiece design beyond the head comes into play too. Handpieces with a wider, flared body shape, rather than the traditional cylindrical shape throughout the handle, are growing in popularity. The new shape reduces the amount of force it takes to grip the instrument, which after an entire day of use means less hand and wrist fatigue for the dentist.

“Just as important is the support behind the purchase,” Rick Gross said. Gross is StarDental’s senior product manager and has launched a handful of air-driven handpieces over the years. For him, a highly-trained customer service support staff and a good, no hassle warranty are right up on the list along with reliability and performance.

A comparison of warranties among some of the top handpiece companies turned out only slight variations. Depending on the particular model, dentists can find warranty ranges from six months to the industry-standard two years.

Hands-on help

The single-most effective way to prolong the life of your handpiece is proper maintenance, and it helps to be a bit fanatical about it.

William Irwin, KaVo’s North American product manager, lays out some common mistakes in maintenance that dentists should be careful to avoid. “Always follow the manufacturer’s guidelines,” Irwin says. He also suggests making the investment in an automated handpiece maintenance system. “An automated machine takes out the guess work, saves valuable time for the staff and ultimately saves money for the practice.” An inexpensive tip for those who prefer to handle all of their maintenance the old fashioned way, is to keep a log book. Track your maintenance and repair frequency, along with the costs associated. Look for inconsistencies or increases in costs that could be foreshadowing of an upcoming handpiece failure or staff not following proper procedure.

On top of inconsistencies, one of the most common issues is when a practice doesn’t have the number of handpieces it needs. “Each treatment room should have three high-speeds,” Christian says. “So that one can be in use, one be reprocessed and one be ready for the next patient. When a practice works with fewer handpieces, they don’t have time to properly maintain them.”

Christian has seen his fair share of handpiece horror stories as A-dec is home to the largest handpiece repair center in the world. “We see lots of handpieces with build-up of sludge on internal components,” he says. “This happens because handpieces are not being fully dried before use.”

“I also think that too often a dental practice installs aftermarket turbines because they’re cheaper,” Gross adds. “What they don’t realize is that they come with a shorter warranty for a reason. They are not built to high quality standards that are required by major manufactures and as such, do not last long, requiring replacements more often.”

Other common mistakes in handpiece maintenance:
  • Running the air pressure excessively high to increase cutting power.
  • Forgetting to flush out saline from surgical or implant handpieces.
  • Using disinfecting wipes.
  • Overlooking weekly chuck cleaning.
  • Not using manufacturer-approved tools.
  • Using technicians who lack proper training.
  • Using cheap burs which leads to premature wear on the chuck.
  • Overusing burs to try and save money.
  • Not using enough coolant in new multi-port handpiece designs.
  • Ignoring the maximum lifespan of a handpiece.
  • Lubricating the wrong hole.
  • Not running the handpiece prior to autoclaving.
  • Forgetting to clean the fiber-optic bundles.
  • Leaving the bur in the chuck during autoclaving.


To repair or to replace

Even with the very best maintenance routine, every handpiece is going to need to be repaired sooner or later. Back in the day, before daily sterilization, handpiece replacement came in intervals of years. Cost was minimal. Today … not so much.

The most common method of repair comes in the form of replacing or repairing the turbine. A doctor can easily get lost somewhere between the spindle, chuck, rear bearing, impeller, front bearing, end cap and O-rings, all parts in a standard air-driven handpiece turbine. Electric turbines aren’t any less complicated. So when it comes to repairs, a dentist has a few choices. Either send the handpiece back to the manufacturer, have an independent repair technician take care of it, or handle the repairs in-house. In most repair shops, a technician will attempt to rebuild, rather than replace, a turbine. This usually hinges on whether the spindle and chuck assembly is still in good condition, in which case the technician will replace the O-rings and bearings. In most instances of turbine repair, it’s just the bearings that need replacing. If a dentist decided to send the handpiece back to the manufacturer, he or she will be responsible for purchasing a brand new turbine, as manufacturers do not distribute individual components. This is the most expensive method but also the easiest.

Some handpiece manufactures will often come out to a practice and give a dentist and his or her staff a hand, an option that too few doctors take advantage of. Handpiece experts suggest reaching out to the practice’s handpiece representative and see if they offer any office training or CE opportunities.

“Few manufactures … really spend time at the dental practice teaching the ins and outs of handpiece maintenance and repairs,” Bradley Unamboowe says. Unamboowe is Dentsply Midwest’s brand and product manager and has been responsible for the company’s handpiece line for five years. In one survey, Unamboowe says, only 34 percent of dentists considered their staff’s knowledge of handpiece maintenance as high or very high. The other 66 percent responded that they felt their staff’s knowledge on the matter was average and below. “The key,” Unamboowe says, “is for the practice to reach out to their handpiece representatives to come in and do a lunch and learn on maintenance and repair.”

Now if the dentist wants to get his or her hands dirty and work to repair handpieces in-house, there’s a handful of do-it-yourself kits out there. Quality of parts are the main concern here, along with whether the dentist has the time, skill or attention needed for such detailed work.

Drill baby, drill

Handpieces will continue to be as significant of an investment as they are a vital element in the practice. A little lighter, a little quieter, a little smaller and a whole lot more powerful, these instruments continue to advance. If the industry has shown any sign, it’s that the evolution of the handpiece is still very much active. The most important element of the handpiece however is always going to be the dentist. There’s a great number of resources available to practitioners who want to know, see and do more with handpieces in their offices.




  1. A. Coppa, et al. "Palaeontology: Early Neolithic tradition of dentistry." Nature. 6 April 2006: 755-756
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