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.
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
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.
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
- Forgetting to flush out saline from surgical or implant
- 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.
- A. Coppa, et al. "Palaeontology: Early Neolithic tradition of dentistry." Nature. 6 April 2006: 755-756